[...]... Surgical guidelines for breast cancer Figure 9 Ductal carcinoma in situ (DCIS) 33 34 Guidelines for management of breast cancer Figure 10 Ductal carcinoma in situ (DCIS) (concluded) Chapter 5 Management of special problems in breast cancer This chapter gives guidelines on management of special problems in breast cancer (Figures 11–16) Figure 11 Phyllodes tumour of the breast 36 Guidelines for management of. .. methotrexate for leptomeningeal carcinomatosis Guidelines The guidelines for selection of systemic hormonal therapy or chemotherapy are summarized in Figures 5, 6 and 7 Management of metastatic disease Figure 5 Management of metastatic disease 27 28 Guidelines for management of breast cancer Figure 6 Selection of hormonal therapy sequence Management of metastatic disease Figure 7 Selection of chemotherapy... treated with chemotherapy Guidelines A multidisciplinary treatment planning approach should be adopted for the management of breast cancer The guidelines outlined in this publication are applicable in most cases Figures 1, 2 and 3 give treatment guidelines for early stage invasive breast cancer, node-negative breast cancer and node-positive breast cancer, respectively Role of primary chemotherapy (neoadjuvant... surgery (see Chapter 7) Figure 2 Adjuvant therapy for node-negative breast cancer Treatment policy 21 Figure 3 Adjuvant therapy for node-positive breast cancer 22 Guidelines for management of breast cancer Definitions for response evaluation of primary systemic therapy Clinical definition • Complete: no palpable mass detectable (cCR) • Partial: reduction of tumour area to < 50% (cPR) Imaging definition... recommended for asymptomatic patients Because of the risk of tamoxifen-assisted endometrial cancer, a yearly pelvic examination coupled with evaluation of vaginal spotting is essential The performance of endometrial biopsy or ultrasound is not recommended Treatment policy Figure 4 Treatment of locally advanced invasive breast cancer 23 Chapter 3 Management of metastatic disease Staging of metastatic... use of trastuzumab plus AC is associated with significant cardiac toxicity 26 Guidelines for management of breast cancer Failure to achieve a tumour response to two sequential chemotherapy regimens or an Eastern Cooperative Oncology Group performance status of 3 or greater was felt to be an indication for supportive therapy only Patients with metastatic breast cancer frequently develop a number of. .. tumour residuals in the removed breast tissue • Only in situ tumour residuals in the removed breast tissue (pCR inv) • No invasive or in situ tumour cells (pCR) • No malignant tumour cells in breast and lymph nodes (pCR breast and nodes) Guidelines Figure 4 gives the treatment guideline for locally advanced invasive breast cancer The best treatment option for this type of cancer is participation in a... Diagnosis of breast cancer Clinical examination History This should include the following elements: 1 2 3 4 5 Presenting symptoms: • breast mass • breast pain • nipple discharge • nipple or skin retraction • axillary mass or pain • arm swelling • symptoms of possible metastatic spread • suspicious findings on routine mammography Past medical history of breast disease in detail Family history of breast. .. Physical examination Careful physical examination should cover the following: 1 Performance status 12 Guidelines for management of breast cancer 2 3 4 Weight, height and surface area General examination of other systems Local examination: • breast mass – size – location (specified by clock position and distance from the edge of the areola) – shape – consistency – fixation to skin, pectoral muscle and chest... disease Staging of metastatic or recurrent breast cancer The staging evaluation of women presenting with metastatic or recurrent breast cancer includes the performance of a CBC, platelet count, liver function tests, chest X-ray, bone scan, X-rays of symptomatic bones or bones that appear abnormal on bone scan, CT or MRI of symptomatic areas, and biopsy documentation of first recurrence, if possible (see . Publications Series 31 Guidelines for management of breast cancer WHO Library Cataloguing in Publication Data Guidelines for management of breast cancer/ by WHO Regional Office for the Eastern Mediterranean . members of the task force developed the 8 Guidelines for management of breast cancer guidelines with the consensus of all contributors. The task force took into consideration the cost of treatment. phyllodes tumour of the breast. Chapter 6 presents guidelines for the pathological handling of breast cancer excision specimens and Chapter 7 outlines radiotherapy guidelines for breast cancer. Acknowledgements The