/ NCCN. ACS ( NCC ( NCCN NCCN ACS ACS-2345
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1 /2002 9
2
3 / (NCCN) (ACS) NCCN ACS ( NCC ( NCCN NCCN ACS ACS-2345
4 NCCN ACS NCCN NCCN ACS NCCN 2002 (NCCN) (ACS) NCCN ACS
5
6 Arthur G. James Richard J. Solove (City of Hope Cancer Center) Dana-Farber Duke Fox Chase Fred Hutchinson H. Lee Moffitt Huntsman Memorial Sloan-Kettering Robert H. Lurie Roswell Park St. Jude UCSF Sidney Kimmel M. D. Anderson UNMC/Eppley
7 (ACS) ACS-2345 NCCN NCCN (ACS) (NCCN) 1995 NCCN NCCN 19 NCCN NCCN NCCN 85 NCCN ACS 5
8 6
9 (ILC) 10% 15% (LCIS) 5% LCIS (DCIS) (IDC) 2% 80% 7
10 1% IIIB IV 8
11 (MRI) 9
12 FNA FNA (FNA) NCCN NCCN 10
13 CBC (CT) CT CT CT CT H E R - 2 / (MRI) MRI MRI (ER) 11
14 (PR) HER-2/ HER-2/ Trastuzumab (Herceptin ) Trastuzumab ER PR HER-2/ Trastuzumab ER PR ER PR ER PR 2/ (anthracycline) HER-2/ HER- 12
15 (DCIS) TNM TNM (AJCC) LCIS (LCIS) LCIS TNM 0 I IV T N T T M T1: 2cm 3/4 T2: 2cm 5cm T3: 5cm T4: T0: Tis: N N 1 cm 2 cm 3 cm 5 cm 2.5 (cm) = 1 1 cm = 10 mm 13
16 T N M 0 Tis N0 M0 I T1 N0 M0 IIA T0 N1 M0 T1 N1 M0 T2 N0 M0 IIB T2 N1 M0 T3 N0 M0 IIIA T0 N2 M0 T1 N2 M0 T2 N2 M0 T3 N1 M0 T3 N2 M0 IIIB T4 N M0 T N3 M0 IV T N M1 N0: N1: 0 I II III IV N2: N3: M M M0: M1: 14 M T N
17 6 7 5cm
18 lymph node biopsy) 20 5cm 6cm (sentinel 16
19 5 cm 2 17
20 CMF CAF AC 19 18
21 CAF CEF AC (paclitaxel) A-CMF CMF (Anthracycline) (Taxane) CMF Docetaxel (Doxorubicin) Paclitaxel (Tamoxifen) Toremifen Trastuzumab Taxotere (Adriamycin) Ellence (Taxol) Nolvadex Fareston Herceptin (anthracycline) CMF (taxane) (taxane) (anthracycline) CMF capecitabine gemcitabine vinorelbine CMF: CAF: (doxorubicin) AC: (doxorubicin) AC + Paclitaxel: (doxorubicin) Paclitaxel A CMF: (doxorubicin) CMF CEF: HER-2/ (anthracyline)
22 HER-2 (Tamoxifen) toremifene NCCN (Fever and Neutropenia Treatment Guidelines for Patients with Cancer) Trastuzumab HER-2/ (aromatase inhibitors) H E R - 2 / Trastuzumab (anthracyline) Trastuzumab 20
23 ACS (LHRH) 21
24 22
25 ACS FDA 23
26 CANCER NCI (cancer.gov) NCCN ACS 24
27 Work-Up (Evaluation) and Treatment Guidelines NCCN ACS ( NCCN ( NCCN NCCN ACS ACS
28 0 (LCIS) 0 (LCIS) LCIS NCCN LCIS LCIS LCIS 26
29 0 (LCIS) (NCCN) (ACS) NCCN ACS LCIS LCIS 5 27
30 0 (DCIS) DCIS 0 LCIS DCIS DCIS DCIS NCCN 28
31 0 (DCIS) * * 1/5 inch 0.5 cm * 2002 (NCCN) (ACS) NCCN ACS DCIS DCIS DCIS DCIS 29
32 5 5 DCID 1/5 DCIS DCIS DCIS 30
33 0 (DCIS) (NCCN) (ACS) NCCN ACS DCIS DCIS
34 I II 5 cm IIIA / HER-2/ * HER-2/ II III CT MRI 42 2 cm I II IIIA T3 N1 M0 I II 5 cm(2 ) III 32
35 I II IIIA IIIA I II 5 cm 5 cm * CMF (NCCN) (ACS) NCCN ACS / HER-2/ II I 33
36 5cm 2 5cm 34
37 I II IIIA 3 I II 5cm 35
38 I II 5cm 2 * * 36
39 I II 2002 (NCCN) (ACS) NCCN ACS 5cm 37
40 0.5 cm 1cm I II 5cm 2 IIIA I II 1 cm 3cm 3 cm 1cm cm 1 1 cm 5 I II IIIA cm 2/5 1 38
41 I II IIIA I II IIIA 5 * HER-2/ 2002 (NCCN) (ACS) NCCN ACS cm 3 cm cm 1 NCCN 1 cm 1 cm NCCN 39
42 5 Anastrozole Anastrozole 48 5 Anastrozole 40
43 I II IIIA CMF FAC, CAF, CEF FAC, CAF AC Paclitaxel AC A CMF CMF EC 19 41
44 3 4 2cm II II IIIA 42 / HER-2/
45 II 2002 (NCCN) (ACS) NCCN ACS IIIA II II IIIA CT II Paclitaxel Taxane Docetaxel 43
46 III 5cm / HER-2/ * CT MRI * IV III IV III 44
47 III IV 5 /IV (NCCN) (ACS) NCCN ACS HER-2/ IIIA 5 cm CT 45
48 IV IV III IV 46
49 III IV IIIA 5 IIIB 47
50 IV I II III CT HER- 2/ I II III
51 I II III IV (NCCN) (ACS) NCCN ACS 49
52 CT HER-2/ 50
53 I II III NCCN IV 51
54 IV HER-2/ HER-2/ IV IV IV IV III 44 52
55 IV 2 Anastrozole Letrozole LHRH Trastuzumab 2002 (NCCN) (ACS) NCCN ACS 48 / Toremifene LHRH 53
56 Anastrozole NCCN Letrozole Trastuzumab Pamidronate Zoledronate HER-2/ 54
57 IV (Anthracycline) (Taxane) CMF (anthracycline) CMF (taxane) (taxane) (anthracycline) CMF capecitabine vinorelbine gemcitabine 55
58 Anastrozole Exemestane Letrozole Pamidronate Zoledronate 56
59 HER-2/ HER-2/ Trastuzumab 57
60 45 50 LHRH LHRH LHRH 58
61 (Tamoxifen) 59
62 Toremifene ACS 60
63 61
64 62
65 63
66 64 ACS-NCCN
67 NCCN Terri Ades, MS, APRN-BC, AOCN American Cancer Society Health Content Products Robert W. Carlson, MD Stanford Hospital and Clinics Stephen B. Edge, MD Roswell Park Cancer Institute Herman Kattlove, MD American Cancer Society Health Content Products Joan McClure, MS National Comprehensive Cancer Network Eric P. Winer, MD Dana Farber Cancer Institute Mary-Lou Smith NCCN Breast Cancer Clinical Practice Guidelines NCCN Y-ME National Breast Cancer Organization Dia Taylor Patient Information Specialist National Comprehensive Cancer Network Rodger Winn, MD University of Texas M.D. Anderson Cancer Center NCCN Benjamin O. Anderson, MD University of Washington Medical Center William Bensinger, MD Fred Hutchinson Cancer Research Center Robert W. Carlson, MD Stanford Hospital and Clinics Charles Cox, MD H. Lee Moffitt Cancer Center and Research Institute at the University of South Florida Stephen B. Edge, MD Roswell Park Cancer Institute William B. Farrar, MD Arthur G. James Cancer Hospital & Richard J. Solove Research Institute at Ohio State University Lori J. Goldstein, MD Fox Chase Cancer Center William Gradishar, MD Robert H. Lurie Comprehensive Cancer Center of Northwestern University Beryl McCormick, MD Memorial Sloan-Kettering Cancer Center Lisle M. Nabell, MD University of Alabama at Birmingham Comprehensive Cancer Center Lori J. Pierce, MD University of Michigan Comprehensive Cancer Center Elizabeth Reed, MD UNMC Eppley Cancer Center at the University of Nebraska Medical Center Samuel M. Silver, MD University of Michigan Comprehensive Cancer Center Mary Lou Smith Y-ME National Breast Cancer Organization George Somlo, MD City of Hope National Medical Center Richard Theriault, DO, MBA University of Texas M.D. Anderson Cancer Center John Ward, MD Huntsman Cancer Institute at the University of Utah Eric Winer, MD Dana-Farber Cancer Institute Rodger Winn, MD NCCN Guidelines Steering Committee Antonioi C. Wolff, MD The Sidney Kimmel Comprehensive Cancer Center of Johns Hopkins
68 2003, American Cancer Society, Eastern Division, Inc. All rights reserved. Breast Cancer Treatment Guidelines for Patients-Chinese Healthcare Association of New York State's Breast Cancer Demonstration Project American Cancer Society Centers for Disease Control and Prevention Healthcare Association of New York State's Breast Cancer Demonstration Project Grant/Cooperative Agreement U57/CCU Centers for Disease Control and Prevention The translation of this publication is courtesy of a cooperative effort between the Healthcare Association of New York State's Breast Cancer Demonstration Project and the American Cancer Society. The translation of this publication was supported by Grant/Cooperative Agreement Number U57/CCU awarded to the Healthcare Association of New York State's Breast Cancer Demonstration Project from the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention ACS Hope.Progress.Answers NCCN
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