Breast cancerpresentation and staging

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The diagnosis of breast cancer is made by 'triple assessment':

♦ Clinical examination

♦ Bilateral mammography

♦ FNA cytology or core biopsy

This combined approach to assessment has >90% sensitivity and specificity. The axilla is staged surgically. In the absence of locally advanced breast cancer or symptoms of metastatic disease or biochemical abnormality, routine radiological staging with CXR, CT scan, and isotope bone scan has not been found useful. The TNM staging system is commonly used.

Table 17.4 TNM staging system

Tis

Carcinoma in situ, non-infiltrating intraductal carcinoma, or

Paget's disease of the nipple with no demonstrable tumour

TO

No evidence of primary tumour

T1

Tumour <2 cm

T2

Tumour >2 cm but <5 cm

T3

Tumour >5 cm

T4

Any size with extension to chest wall or skin

T4a

Fixation to chest wall only

T4b

Oedema, infiltration, or ulceration of skin

Ipsilateral satellite nodules

T4c

Both a and b present

NX

Regional nodes cannot be assessed

NO

No regional node metastases

N1

Mobile ipsilateral axillary node metastases

N2

Fixed ipsilateral axillary node metastases

N3

Ipsilateral internal mammary node metastases

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