 Determining the Nature of a Breast Abnormality  It is a procedure that may be used to determine whether a lump is a cyst (sac containing fluid) or a solid mass.  Ultrasound can also be used to precisely locate the position of a known tumor in order to guide the physician during a biopsy or aspiration procedure.  Supplemental Breast Cancer Screening

Today, ultrasound is being investigated for use as a screening tool for women who:  are at high risk for breast cancer and unable to tolerate an MRI examinations.  are at intermediate risk for breast cancer based on family history, personal history of breast cancer, or prior biopsy showing an abnormal result.  have dense breasts.  have silicone breast implants and very little tissue can be included on the mammogram.  are pregnant or should not to be exposed to x-rays (which is necessary for a mammogram).  are at high risk for breast cancer based on family history, personal history of breast cancer, or prior atypical biopsy result.

 To assess whether or not the cancer has moved into the chest wall. This helps determine whether or not the cancer can be removed with mastectomy.  To examine other parts of the body where breast cancer can spread, such as the lymph nodes, lungs, liver, brain, and/or spine.  If advanced breast cancer is found, CT scan may be helpful to assess whether or not it is responsive to treatment.  After treatment, CT scans may be used if there is reason to think the breast cancer has spread or recurred outside the breast.

 An imaging test used to determine whether breast cancer has traveled to the bones.  at initial diagnosis, to make sure your bones are healthy, as well as to create a set of “baseline images” that could be compared to any future bone scans that are done  during and after treatment, if you experience persistent bone and joint pain, or if a blood test suggests the possibility that the breast cancer has traveled to the bones

 Microscopic findings  Invasive breast cancer — Invasive breast cancers usually require surgical treatment (mastectomy or breast conserving therapy) as well as treatment after surgery (called adjuvant treatment).  Noninvasive (in situ) breast cancer — Noninvasive or in situ breast cancer is divided into two types: lobular carcinoma in situ (LCIS) and ductal carcinoma in situ (DCIS).  Size of the breast tumor  Spread to the lymph nodes

 Factors to consider :  Tumor size  Tumor margins  Need for future surgery  Individual needs and expectations  Reasons to avoid BCT — Certain factors clearly favor mastectomy over BCT. These include:  Having two or more separate tumors in different areas of the breast  Having tumor spread throughout the breast tissue  Previous radiation of the breast or chest, which makes future radiation inadvisable  Pregnancy in the first or second trimester, which makes radiation inadvisable  Factors that do not affect your decision — Several factors do not play a role in the choice between BCT and mastectomy:  The spread of cancer cells to lymph nodes in the armpit  The specific location of the tumor within the breast; however, certain tumor locations may negatively affect the cosmetic results of BCT  A family history of breast cancer  A high likelihood that cancer will metastasize (recur elsewhere in the body)

 Another important question is the use of induction chemotherapy in the management of resectable breast cancer.  Although available randomized studies have shown that disease-free and overall survival rates after chemotheraphy are at least equivalent to those observed after classic postoperative systemic treatment, only large well designed trials with newer effective regimen will demonstrate the worthiness of this approach.

 Advantages  Neoadjuvant chemotherapy is most often done to reduce the size of the cancerous tumor.  Neoadjuvant chemotherapy can also tell you whether your cancer is sensitive to the particular combination of drugs that is being tried. If the tumor shrinks, you know it is responding to the drugs.  Disadvantages  One is purely psychological. Neoadjuvant chemotherapy means that you live with the tumor for a few months before surgery. Some of the cancer cells are still dividing and growing while the chemotherapy is killing others.

 Indications:  women who have already had radiation therapy to the affected breast  women with 2 or more areas of cancer in the same breast that are too far apart to be removed through 1 surgical incision, while keeping the appearance of the breast satisfactory  women whose initial lumpectomy along with (one or more) re-excisions has not completely removed the cancer  women with certain serious connective tissue diseases such as scleroderma, which make them especially sensitive to the side effects of radiation therapy  pregnant women who would require radiation while still pregnant (risking harm to the fetus)  women with a tumor larger than 5 cm (2 inches) that doesn't shrink very much with neoadjuvant chemotherapy  women with a cancer that is large relative to her breast size  Women who have tested positive for a deleterious mutation on the BRCA1 or BRCA2 gene and opt for prophylactic removal of the breasts  male breast cancer patients.

 Major Benefits  Neoadjuvant chemotherapy is most often done to reduce the size of the cancerous tumor.  Neoadjuvant chemotherapy can also tell you whether your cancer is sensitive to the particular combination of drugs that is being tried. If the tumor shrinks, you know it is responding to the drugs.

 Breast conserving therapy refers to surgical removal of the tumor and a small portion of normal surrounding breast tissue, followed by radiation therapy to the remaining breast tissue  Radiation is generally recommended for all women who have had breast conserving surgery for invasive breast cancer, even if the tumor is very small. The goal of this treatment is to kill any remaining cancer cells in areas of the breast that were not removed during surgery. Studies confirm that RT plays a critical role in preventing a recurrence of breast cancer in the same breast and in improving survival