XB40-501-250

---19-11

---2Paget

---3

---4 XX30 9-11301.0cm

---5

---6 SPECTXXCT MRICT CTB PET

---1 Paget

---2 Paget

--- ER,PR Her2/New CEA, P53, PCNA, K-ras

---Ca-153, CEA, Ca-125

---AJCC1Primary tumor (T)TX: Primary tumor cannot be assessed T0: No evidence of primary tumor Tis: Intraductal carcinoma, lobular carcinoma in situ, or Pagets disease of the nipple with no associated invasion of normal breast tissue Tis (DCIS): Ductal carcinoma in situ Tis (LCIS): Lobular carcinoma in situ Tis (Paget's): Paget's disease of the nipple with no tumor. [Note: Paget's disease associated with a tumor is classified according to the size of the tumor.]

---AJCC2T1: Tumor 2.0 cm in greatest dimension T1mic: Microinvasion 0.1 cm in greatest dimension T1a: Tumor >0.1 cm but 0.5 cm in greatest dimension T1b: Tumor >0.5 cm but 1.0 cm in greatest dimension T1c: Tumor >1.0 cm but 2.0 cm in greatest dimension T2: Tumor >2.0 cm but 5.0 cm in greatest dimension T3: Tumor >5.0 cm in greatest dimension

---AJCC3T4: Tumor of any size with direct extension to (a) chest wall or (b) skin, only as described below T4a: Extension to chest wall, not including pectoralis muscleT4b: Edema (including peau dorange) or ulceration of the skin of the breast, or satellite skin nodules confined to the same breast T4c: Both T4a and T4bT4d: Inflammatory carcinoma

---AJCC4Pathologic classification (pN)* pNX: Regional lymph nodes cannot be assessed pN0: No regional lymph node metastasis histologically, no additional examination for isolated tumor cells (ITC)pN0(I-): No regional lymph node metastasis histologically, negative IHCpN0(I+): No regional lymph node metastasis histologically, positive IHC, no IHC cluster >0.2 mmpN0(mol-): No regional lymph node metastasis histologically, negative molecular findings (RT-PCR)**pN0(mol+): No regionally lymph node metastasis histologically, positive molecular findings (RT-PCR)**

---AJCC4pN1: Metastasis in 1 to 3 axillary lymph nodes, and/or in internal mammary nodes with microscopic disease detected by sentinel lymph node dissection but not clinically apparent** pN1mi: Micrometastasis (>0.2 mm but 2.0 mm)pN1a: Metastasis in 1 to 3 axillary lymph nodespN1b: Metastasis in internal mammary nodes with microscopic disease detected by sentinel lymph node dissection but not clinically apparent** pN1c: Metastasis in 1 to 3 axillary lymph nodes and in internal mammary lymph nodes with microscopic disease detected by sentinel lymph node dissection but not clinically apparent.** (If associated with >3 positive axillary lymph nodes, the internal mammary nodes are classified as pN3b to reflect increased tumor burden)

---AJCC5)pN2: Metastasis in 4 to 9 axillary lymph nodes, or in clinically apparent ** internal mammary lymph nodes in the absence of axillary lymph node metastasis to ipsilateral axillary lymph node(s) fixed to each other or to other structures pN2a: Metastasis in 4 to 9 axillary lymph nodes (at least 1 tumor deposit >2.0 mm)pN2b: Metastasis in clinically apparent* internal mammary lymph nodes in the absence of axillary lymph node metastasis

---AJCC6)pN3:pN3a: Metastasis in 10 or more axillary lymph nodes (at least one tumor deposit >2.0 mm), or metastasis to the infraclavicular lymph nodespN3b: Metastasis in clinically apparent* ipsilateral internal mammary lymph nodes in the presence of 1 or more positive axillary lymph node(s); or in more than 3 axillary lymph nodes and in internal mammary lymph nodes with microscopic disease detected by sentinel lymph node dissection but not clinically apparent**pN3c: Metastasis in ipsilateral supraclavicular lymph nodes

---AJCC7)Distant metastasis (M) MX: Presence of distant metastasis cannot be assessed M0: No distant metastasis M1: Distant metastasis

---8TNM/AJCC/

0TisN0M0T1N0M0AT0-1N1M0,,T2N0M0BT2N1M0,T3N0M0AT0-2N2M0, T3N1-2M0 BT4N3,M0 M1

--- (S1) 2cm1/43-4cm (S2) Patey Dyson Auchincloss 0

--- S3T3,N1 S4

---S5 (S6) 96-98%

--- (R1) 4 T3-44 60Gy50Gy

---R2 ,80Gy

--- R350Gy/5-5.5 15-20Gy50-60Gy

---R4R560Gy,10-15Gy50-60Gy

---C1T2-4, N2 C2

---C3C4

---NCI Combination regimens include: CA: cyclophosphamide and doxorubicin.[54] Docetaxel and doxorubicin.[55] CAF: cyclophosphamide, doxorubicin, 5-fluorouracil.[56] CMF: cyclophosphamide, methotrexate, 5-fluorouracil.[57] Doxorubicin and paclitaxel.[58,59] Docetaxel and capecitabine.[60]

--- E1

---(E2) ER,PR TAMTOR AG MPAMA LH-RH

---CTM BHER2/New(++,+++)(Herceptin)

0,,A,B 0,,A,BT3-4cm 5cmT3-4cm T5cm S1 S2 S3

0,,A,B0,,A,B 0,,A,B 10% 90% 80-90% 70-80% 1cm 1-2cm 2cmERPR G1 G1-2 G2-3 0.6cmT1cm 35 35Her2/New - + +++++

0,,A,B0,,A,B

ER/PR(+) E1,E2, C2, E1,E2, C2, E1,E2, C2, E1,E2, ER/PR(-) CTM CTM C2 CTM C2 CTM ER/PR(+) NE1,E2, C2, E1,E2, C2, E1,E2, E1,E2 C2 ER/PR(-) CTM CTM C2 CTM C2 CTM E1,35ER/PR(+) Her2/New+++++N2

0,,A,B0,,A,B S1S23R3N2CTM S23R1R1

A,B1 A,B T3,4a-c, N0-3 T4d, N0-3 S3 C1 C1 T3,N1 C2 CR SDPD PR CR/PR PR/SD/PD () R3 R3 S3 S1 S3 R3 C2 C2 R1 S3 R1 C2

A,B2

ER/PR ER/PR E1,2,CTM CTMHer2/New+++++

/ ER/PR ER/PR ER/PR ER/PR N1,2, CTM C4, C4 N1,2, C4 CTM CTM CTMHer2/New+++++

5-10 2

T3-44C12, N1N2S5

6-11