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Breast Cancer
- Tips, pearls, and rules-of-thumb "cheat
sheet"
- Overview: overview types of specimens obtained
for diagnosis, and a brief note about Lexington Medical
Center's "5-day Detection to Diagnosis" program...one
of the most personalized breast programs in the USA [check
it out]; for pathologists: how we handle the anatomical pathology
for our above program.
- About standardizing breast pathology
exams and reports.
- Nomogram (computerized decision programs) sites:
- breast: treatment factors and how to discussion
of how to decide among choices of early stage breast cancer
treatments [@ Mayo
Clinic; click on "programs and tools"...then
scroll down to Health Decision Guides" and click on "early
stage breast cancer".
- breast: how much advantage will adjuvant (a "pre-emptive
strike" against possible cells still in your body)
chemotherapy give...Mayo
Clinic nomogram calculator (you must put your
age, number of positive lymph nodes, and maximum tumor
size in the formula) by clicking on "programs and
tools"...then scroll down to Health Decision Guides" and
click on "adjuvant therapy for breast cancer".
- breast: how much advantage will adjuvant (a "pre-emptive
strike" against possible cells still in your body)
chemotherapy give...Adjuvant!online...free
registration and online use.
- breast: decision tool at MSKCC to predict pre-surgical likelihood
cancer has spread to axillary lymph nodes.
- Note file on "immuno" (IHC)
tissue molecular stains in breast cancer.
- Note file on serum & tissue markers: [CA27.29/CA15.3].....[HER-2/neu].
- Note file on FNA cytopatholgy.
- Note file on benign breast tumors or masses.
- Grading non-cancer, "premalignant" breast epithelial proliferations: ductal (DIN) and lobular (LIN) neoplasia and microglandular adenosis (MGA) ; and cancer-associated ADH & CCH. And, see below.
- Note file on non-invasive breast cancer.
- Note file on invasive breast cancer types.
- Risk calculations for chances of getting breast cancer:
- Factoring in your other health problems: your doctors
must consider diabetes, heart conditions, tendency to form blood
clots, etc., as they decide the risks of treatments. There are
electronic calculators (such as the Charlson comorbidity index...CCI)
to help in this [online
calculator].
- Grading CIS and/or Invasive Breast CANCER (how
bad is it?):
- Elston-Ellis modification of Scarff-Bloom-Richardson
(S-B-R) grading system (Nottingham combined histological
grade) for invasive ductal adenocarcinoma
(IDC) [check
it out].
- LeDoussal's modified S-B-R system (MSBR) for invasive ductal
adenocarcinoma (IDC) [check
it out].
- grading invasive lobular cancer (ILC) [check
it out].
- Bloom-Richardson nuclear grading system
for non-invasive ductal-CIS (d-CIS) [check
it out].
- Lagios nuclear grading system non-invasive ductal-CIS
(d-CIS) [check
it out].
- Van Nuys grouping system for non-invasive ductal-CIS
(d-CIS) [check
it out].
- Armed Forces Institute of Pathology (AFIP) system for non-invasive ductal-CIS
(d-CIS).
- IHC/ISH markers:
- estrogen receptor (ER): one can use an instrument to "count" the result or grade the findings with words (weak to moderate staining of 80% of nuclei) or interpret an Alred score (0 to 8). As to concordance, one expects ER positivity in tubular & grade I-II IDC, ILC; ER negativity in pleomorphic IDC, medullary ca., invasive micropapillary ca. , and basal-like "triple negative" ca. (which should have very high Ki67).
- progesterone receptor (PR): about same as ER.
- Ki67 proliferation: expect tubular ca. & classical nuclear grade 1 ILC to be 10% or less; expect "triple negative" to be 50-90% (if not, may not be "basal-like") & expect grade III IDC to be over 25%.
- HER-2 membrane product: check concordance by seeing what your IHC does with normal internal control duct epithelium (not to "normalize" but to help evaluate whether for "overstaining" by the IHC process); expect negativity in tubular and positivity in invasive micropapillary.
- Staging Breast Cancer [ How far has it gone already?]:
- Finding the lymph nodes:
- TNM
Staging: staging criteria 5th & 6th editions...for all invasive malignancies (AJC/TNM) [check
it out].
- For ductal-CIS (Van Nuys Prognostic Index...VNPI) [check
it out]; The USC/VNPI is a new modification (scores
4-12) which takes age into consideration.
- Calculate your VNPI for
noninvasive (CIS) cancer [go
do it].
- KATS risk grouping predictive
for lymph node metastasis...is node sampling needed [check
it]?
- imaging studies: nuclear medicine bone
scans, CT's ("cat" scans), MRI, FEG, or PET scans to detect
bone, node, liver, lung, brain metastases.
- blood tests: for cancer antigen (Ag)
levels...either CA15-3 or CA27.29 (they
are nearly the same...two different instrument companies
and two different detection reagents) and LDH (pretreatment
LDH elevations may mean proliferating cancer with necrosis).
- sentinel lymph node (SLN) biopsy
issues & Is completion (your SLN was positive) node
dissection needed?...decision
tool at MSKCC to predict
likelihood cancer has spread to other axillary lymph
nodes beyond
the sentinel node (therefore, go for more).
- special blood tests: peripheral blood CTCs (circulating
tumor cells).
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(posted Jan.
2001; latest update 28 January
2008) |
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© Copyright
1999 - 2006, all rights reserved, Pathology Associates Of Lexington,
P.A. |
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