美国癌症联合会(AJCC)乳腺癌病例（二）.pptVIP

AJCC Staging Moments AJCC TNM Staging 7th Edition Breast Case #2 Breast Case # 2 Presentation of New Case Newly diagnosed breast cancer patient Presentation at Cancer Conference for treatment recommendations and clinical staging Breast Case # 2 History Physical 62 yr old woman noticed a non-tender mass in the upper outer quadrant (UOQ) of the left breast Family hx-breast ca in maternal aunt at age 70 Physical examination reveals a firm, mobile, 4 cm mass in the UOQ with no overlying skin changes and no palpable adenopathy Breast Case # 2 Imaging Results Mammogram- 3.9cm density UOQleft breast, right breast negative Ultrasound breast- 3.8cmhypoechoic area UOQ left breast, left axillary nodesnegative, right breastnegative Breast Case # 2 Diagnostic Procedure Procedure Ultrasound-guided core needle biopsy UOQ left breast Pathology Report Infiltrating duct carcinoma Bloom-Scarff-Richardson (BSR) Grade 3 Estrogen receptor positive Progesterone receptor positive HER2 negative by IHC Breast Case # 2 Clinical Staging Clinical staging Uses information from the physical exam, imaging, and diagnostic biopsy Purpose Select appropriate treatment Estimate prognosis Breast Case # 2 Clinical Staging Synopsis- patient with 3.9cm mass, infiltrating duct ca, axilla is negative on exam and imaging What is the clinical stage? T____ N____ M____ Stage Group______ Breast Case # 2 Clinical Staging Clinical Stage correct answer T2 N0 M0 Stage Group IIA Based on stage, treatment is selected Review NCCN treatment guidelines for this stage Breast Case # 2 Clinical Staging Rationale for staging choices T2 for 3.9cm primary tumor N0 because nodes were clinically negative on physical exam and imaging M0 because there was nothing to suggest distant metastases; if there was, appropriate tests would be performed before developing a treatment plan Prognostic Factors Clinically Significant Applicable to this case Paget’s disease: no BSR: Grade 3 Estrogen receptor: positiv