Chapter 1 - Diagnosis and Staging of Breast Cancer and Multidisciplinary Team Working
All BC patients should have their case discussed at a multidisciplinary team meeting, pre- and post-surgery. Metastatic 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 with experience in BC patient care are essential team members.
Plastic surgeons, nuclear medicine specialists, geneticists, physiotherapists and social workers may also contribute substantially to treatment planning.
The pathology report is a key document at the team meeting and should include the dimensions of the tumour(s) and the width of the surgical margins in millimetres, regardless of the type of breast surgery. Cancer histological type and grade and presence of lymphovascular invasion are also reported.
The number of examined regional lymph nodes, lymph nodes 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 immunostaining for the oestrogen receptor, the progesterone receptor, HER2 and Ki-67 to estimate cell proliferation rate. An in situ hybridisation assay to demonstrate HER2 amplification complements immunostaining for HER2. Multiple gene expression arrays may provide further prognostic information.
The sequence and timing of staging examinations, neoadjuvant and adjuvant systemic therapies, selection of the type of surgery, breast reconstruction and radiation therapy are optimised at the team meeting.
The fluent flow to and the exact documentation of information from all parties are essential for successful multidisciplinary team work.
Revision Questions
- What are the goals of a multidisciplinary team meeting?
- Which health care professionals should be included in the core team?
- What information should be available in the pathology laboratory report?
