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Breast Cancer Pathology for Precision Oncology

Background Breast carcinoma is the most common type of malignancy affecting women, aside from skin malignancy. It is the second most common cause of cancer deaths among women. Invasive breast carcinomas are a complex and heterogenous group of tumors, largely adenocarcinomas, with the majority falling into the category of invasive ductal carcinoma, not otherwise specified (NOS) . These tumors account for approximately 75% of all breast…

Systemic Therapy for Breast Cancer

Introduction As the reader will see in this chapter, systemic treatment for all stages of breast cancer is complex and rapidly changing. There are many “approved” therapies that can be submitted to insurance companies for approval in determining treatment for a given patient. One of the reasons why our group has made the decision to follow pathways in the selection of treatments for cancer patients is…

Radiation Therapy

Radiation therapy is frequently employed in treating breast cancer and is thus available in virtually all radiation centers. Given the commonality of breast cancer across the world, management of this disease occupies a large volume of patient care in a radiation oncology clinic. As science advances and innovative approaches are validated in the literature, breast cancer management in the modern era has become more complex and…

Contemporary Surgical Approaches to Breast Cancer

Biopsy Techniques Key Points Biopsy of suspicious breast lesions is necessary prior to considering operation. Historical Context Historically, biopsy of suspicious breast lesions required surgical excision. Lesions were sampled and sent for frozen section prior to performing a radical or modified radical mastectomy. It was not until the 1970s that percutaneous biopsy was introduced as an alternative. Image-guided biopsy was first described by Roberts et al.…

Outcomes and Quality Indicators

Introduction Given the complexity of the care of patients with breast cancer, outcomes assessment and improvement in the quality of care delivered have become essential. Quality of cancer care may be difficult to define and assess precisely; however, given the variability of morbidity and mortality of patients with breast cancer based on different characteristics, quality metrics become a way to help achieve a standard of care.…

Breast Cancer Screening

Early Use of Mammography for Cancer Detection and Benefits of Screening Mammography Screening mammography is the practice of using radiologic imaging to evaluate breast tissue in otherwise asymptomatic patients in an effort to find clinically occult cancers. With regular screening exams, cancers may be detected at an earlier stage. This reduces the risk of advanced regional and metastatic disease while increasing the overall survival and cure…

Oncology Nurse Navigation in the Care of Breast Cancer

Introduction A breast cancer diagnosis can be highly stressful and traumatic, not only for the patient but also for their family and support systems. The experience of moving through the breast cancer continuum from diagnosis to treatment and beyond is a complex process that can be alleviated by the guidance and support of an Oncology Nurse Navigator (ONN). An ONN is defined by the Oncology Nursing…

Multidisciplinary Team Approach to the Management of Breast Cancer

Implementation of a Multidisciplinary Care Program When setting up a multidisciplinary treatment program ( Fig. 2.1 ), several areas must be evaluated, which include selecting the needed personnel, their proximity to the primary treatment site(s), and their ability to attend meetings in-person or virtually. The types of meetings that can be arranged include multidisciplinary tumor boards (case presentations) and multidisciplinary clinic conferences (patient seen and examined…

Brain Metastases from Breast Cancer: Focus on Risk Factors, Treatment, and Clinical Outcome

Introduction Among the worldwide female population, breast cancer accounts for 29% of the total new cancer cases diagnosed and 15% of the cancer deaths. To date, breast cancer is the most frequently diagnosed tumor and the second leading cause of cancer death among women ( ). The American Cancer Society assessed that 160,000 women in the United States are living with metastatic breast cancer with an…

Management of Melanoma Therapy-Associated Toxicities

Introduction There has been a dramatic shift in the treatment of advanced cutaneous melanoma within the last 5 years. Until 2011, the only FDA-approved therapies for metastatic melanoma were dacarbazine chemotherapy or high-dose interleukin-2 (IL-2) immunotherapy, which each have limited efficacy and can carry significant toxicity. While response rates may range as high as 20%, dacarbazine generally fails to prolong overall survival (OS) ( ) and…

Prognostic Factors for Survival in Melanoma Patients with Brain Metastases

Introduction Melanoma is the most aggressive form of the common skin cancers and is the cause of over 75% of the deaths attributed to skin cancer each year. Worldwide, its incidence is rising, particularly in younger individuals. An estimated 70,000 new cases of melanoma will be diagnosed in the United States alone in 2014 ( 2014). Melanoma generally metastasizes regionally first to lymph nodes. While…

Treatment of Brain Metastases from Ovarian and Endometrial Carcinomas Using Stereotactic Radiosurgery

Introduction Ovarian and endometrial carcinomas together create a substantial cancer burden, combining for nearly 10% of all cancers in women in the United States ( ). Despite this figure, the incidence of brain metastases from these primary cancers is quite small: 0.3–2.2% for ovarian cancer and 0.4–1.2% for endometrial cancer ( ). However, as is the case with many primary malignancies, the incidence of brain metastases…

Brain Metastases from Cutaneous Melanoma: Biology and its Implications for More Rational Therapeutic Approaches

Introduction Cutaneous melanoma is the fifth and seventh most frequently diagnosed cancer in the United States in men and women, respectively, for 2014 ( ). In other countries, such as Australia, cutaneous melanoma has reached epidemic proportions. Although it is rare among men and women less than 30 years old, it is the fourth and second most frequently diagnosed cancer in this age group, respectively. Surgery…

Brain Metastases from Breast Cancer in Patients Receiving Trastuzumab

Introduction HER2 Receptor The HER2/neu proto-oncogene is located in chromosome 17q11-q21 ( ). In physiological conditions, this gene encodes a glycoprotein with molecular mass of 185 kDa (p185), named HER2 receptor or HER2 protein. HER2 and three structurally related tyrosine kinase receptors—HER1 (epidermal growth factor receptor (EGFR)), HER3 (ErbB3) and HER4 (ErbB4)—constitute the ErbB family. HER2/neu gene amplification and/or overexpression, which occur in 15–20% of invasive…

Gastrointestinal Stromal Tumors with Intracranial Metastasis: Treatment Strategy and Review of the Literature

Introduction Gastrointestinal stromal tumors (GISTs) are rare mesenchymal neoplasms that arise from precursors of the gastrointestinal tract connective tissue. Approximately 70% of GISTs are located in the stomach, 20% in the small bowel, and 5% in the rectum ( ). Stromal tumors belong to the leiomyosarcoma or leiomyoma group. GISTs arise from precursors of the intestinal cells of Cajal ( ). Clinically, GISTs are usually diagnosed…

The Risks and Advantages of Whole Brain Radiation Therapy in Patients with Brain Metastases

Brain Metastasis Overview Clinical Presentation Brain metastasis occurs in approximately 25% of all cancer patients. The most common primary cancers include lung and breast cancers ( Table 14.1 ) ( ). Brain metastasis incidence has been rising and this may be attributed to systemic therapy advancements as well as accessibility to imaging tests such as magnetic resonance imaging (MRI). Headaches, mental problems, focal weaknesses are just…

Patients with Brain Metastases from Melanoma: Treatment with Surgery and Radiotherapy

Introduction Chemotherapy has been the mainstay of systemic treatment of malignancy but due to matters largely concerning the blood–brain-barrier and heterogeneity of the tumors it has been largely ineffective in the management of brain metastasis. Instead, surgery and radiation therapy has been the accepted first line treatment in the management of brain metastasis. Up until recently, melanoma was no exception but with the advent of targeted…

Optimal Selection of Targeted Therapies for Melanoma Patients: Role of the Mitogen-Activated Protein Kinase Pathway

Introduction Metastatic melanoma is a chemotherapy refractory disease and historical treatment options have been limited. Dacarbazine was once considered the standard systemic treatment despite a response rate of only 5–15% and having never demonstrated an improvement in survival ( ). Alternative agents such as temozolomide, fotemustine, platinum-based regimens, and combinations with interferon alpha-2b or interleukin 2 had consistently failed to make meaningful improvements ( ). As…