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


Carcinoma in situ, non-infiltrating intraductal carcinoma, or

Paget's disease of the nipple with no demonstrable tumour


No evidence of primary tumour


Tumour <2 cm


Tumour >2 cm but <5 cm


Tumour >5 cm


Any size with extension to chest wall or skin


Fixation to chest wall only


Oedema, infiltration, or ulceration of skin

Ipsilateral satellite nodules


Both a and b present


Regional nodes cannot be assessed


No regional node metastases


Mobile ipsilateral axillary node metastases


Fixed ipsilateral axillary node metastases


Ipsilateral internal mammary node metastases

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