What is the correct positioning for Rad. therapy?
Arms above head in immobilization divice. Breast board may be used if needed for large breasts.
Supine and straight on the table(including feet).
Head turned to contralateral side.
What are the radiation doses?
Breast treated with photons, chestwall with photons or abutting electrons. 4500-5000 cGy; boost 6000-6600cGy
SCV(supraclavicular) 4500-5000 cGy
PAB(posterior axillary boost) boost midline 4500-5000cGy
Internal Mammory Nodes 4500-5000 cGy
What are the field borders for tangents in rad. therapy?
superior- 1st intercostal space
inferior- 2cm below inframammary fold
lateral- mid axillary line
(include 1-2cm of lung)
Beam should be coplanar
What are the surgical treatment methods for breast cancer?
Radical Mastectomy, Modified radical mastectomy, Lumpectomy, Axillary Dissection(dissection of multi nodes leads to lymphedema), Sentinel node biopsy and Breast reconstruction.
What are the chemotherapy treadments used for breast cancer?
CAF- cytoxan,adriamycin, 5FU
What drugs are used for endocrine therapy?
List the 5 methods of detection for breast cancer.
SBE(self breast exam), Clinical breast exam, Mammogram(can miss 10-15% of lesions), Sonography, Diagnosis(biopsy)
How often should SBE be done?
note: 90% of lesions found by SBE
How often should Mammograms be done?
Baseline at 35
every other year at 40 (gray box p.874 says yearly)
yearly at 50
What are doctors looking for when they order a sonogram of a breast lesion?
cystic(fluid filled) lesion
What type of biopsies are done for diagnosis?
fine needle, core needle, incisional(partial removal of lesion), excisional(whole removal of lesion)
excisional biopsy has become the method of choice
What are the 5 clinical presentations of breast cancer?
painless lump(>0.5cm is palpable), nipple discharge or retraction or pain, skin changes and alteration, lymphadenopathy, abnormal mammogram
What is lymphadenopathy?
enlargement(desease) of lymph nodes, usually axillary nodes in breast cancer
What are some of the skin changes and alterations associated with breast cancer?
skin dimpling, warmth, irration, ulceration, peau d' orange
What are the assessments of a breast mass that must be addressed?
size, shape, consistency, mobility, pain or tenderness, location, relationship to skin and chestwall