Breast Cancer Treatment and Management Plan

Patient Information

Name: _________________________ Date: __________________________ Treating Oncologist: ____________

Diagnosis Details

• Type of Breast Cancer: _________________
• Stage: ______
• Grade: ______
• Hormone Receptor Status:
  • Estrogen (ER): □ Positive □ Negative
  • Progesterone (PR): □ Positive □ Negative
• HER2 Status: □ Positive □ Negative

Treatment Plan

Surgery

□ Lumpectomy □ Mastectomy □ Sentinel lymph node biopsy □ Axillary lymph node dissection

Planned Date: ________________

Radiation Therapy

□ Whole breast □ Partial breast □ Not indicated

Duration: _____ weeks Frequency: _____ sessions/week

Systemic Therapy

Chemotherapy

□ Neoadjuvant (before surgery) □ Adjuvant (after surgery) □ Not indicated

Regimen: ________________ Duration: _____ cycles

Hormone Therapy

□ Tamoxifen □ Aromatase inhibitor □ Not indicated

Duration: _____ years

Targeted Therapy

□ Trastuzumab (Herceptin) □ Other: ________________ □ Not indicated

Follow-up Schedule

• First year: Every ____ months
• Second year: Every ____ months
• Years 3-5: Every ____ months
• After 5 years: ________________

Support Services

□ Genetic counseling □ Nutritional support □ Physical therapy □ Psychosocial support □ Support groups

Emergency Contact Information

Clinic Hours: ________________ After Hours: ________________

Notes

Physician Signature: ________________ Date: ________________