Chapter 1: Screening, diagnosis & staging of breast cancer and multidisciplinary team working
Multidisciplinary work
Figure 1.13: A multidisciplinary team meeting.
Credit: Dr Mazen Sudah, Department of Radiology, Kuopio University Hospital, Dr Katja Hukkinen, Department of Radiology, Helsinki University Hospital and Dr Päivi Heikkilä, Department of Pathology, Helsinki University Hospital.
All BC patients should have their case discussed at a multidisciplinary team meeting, pre- and post-surgery. Advanced BC should be discussed when a treatment decision is necessary.
The team should include a breast surgeon, a medical oncologist, a radiation oncologist, a radiologist and a pathologist. In addition, nurses experienced in the care of patients with BC are essential team members.
Plastic surgeons, nuclear medicine specialists, geneticists, physiotherapists and social workers may also contribute substantially to treatment planning.
Figure 1.14: Example of pathology report.
Abbreviations: DCIS, ductal carcinoma in situ.
Credit: Dr Mazen Sudah, Department of Radiology, Kuopio University Hospital, Dr Katja Hukkinen, Department of Radiology, Helsinki University Hospital and Dr Päivi Heikkilä, Department of Pathology, Helsinki University Hospital.
The pathology report should include the dimensions of the tumour(s) and the width of the surgical margins in millimetres. Cancer histological type and grade and presence of lymphovascular invasion are also reported.
The number of examined regional LNs, LNs containing cancer, the size of the largest nodal metastatic deposit and any presence of cancer growth beyond the node capsule should be reported.
At the minimum, tumour biological profiling includes testing for oestrogen receptor (ER), progesterone receptor (PgR), HER2 and Ki-67. Gene expression arrays and other genetic tests may assist in decision-making for adjuvant therapy.
Figure 1.15: Personalised sequence of treatments.
Credit: courtesy of M. Leidenius.
The sequence and timing of staging examinations, neoadjuvant and adjuvant systemic therapies, selection of the type of surgery, breast reconstruction and RT are optimised at the team meeting.
The fluent flow and the exact documentation of information from all parties are essential for successful multidisciplinary teamwork.
Revision questions
- What are the goals of a multidisciplinary team meeting?
- Which healthcare professionals should be included in the core team?
- What information should be available in the pathology laboratory report?
