Transcript Breast cancer

TOPIC: NEWER TREATMENT IN
BREAST CANCER
BY
Chaitra.t.m
9th term
Bangalore medical college
TOPIC: NEWER TREATMENT
IN BREAST CANCER
BY
Chaitra.t.m
9th term
Bangalore medica
college
Breast cancer
Chance of
developing
This at some
Point of womens
Life is 13%
whereas in man
is <2%.
2nd leading cause
of death
TYPES
Ductular(85%)
Lobular(15
%)
RISK FACTORS
• AGE - MORE THAN 40yrs
• GENDER- FEMALE
• GEOGRAPHY- WESTERN COUNTRIES
• ENDOCRINE- NULLIPAROUS
• NO CHILD UPTO 30yrs
• HARMONE REPLACEMENT THERAPY
• NO BREAST FEEDING
• HIGH FAT DIET
• OCPs
• OBESITY
• GENETIC
MYTHS ABOUT BREAST CANCER
• Antiperspirents
• Induced abortion
• Breast implants
• Environmental pollution
• Night shift working
Thought to be carcinogens
CLINICAL STAGING
NODES
METASTASIS
TUMOUR SIZE
Stage 0- DCIS
Stage 1- tumour confined
To breast & <2 cm
Stage 2- 2-5cm , may involve
Same side body lymph nodes
Stage 3- >5cm, any lymph node
No mets
Stage 4- metastatic breast cancer
One more type of classification = manchesters
PATIENT INVOLVEMENT
•Health education
Whats new in
Breast cancer
treatment
TECHNOLOGY
•Diagnostic
•Treatment
POST OP
•Better arm function
•Cosmesis
•Quality of life
SCREENING INVESTIGATIONS
1. Mammography –
all patients with family history -Sensitive for even 23cm tumour
2. Clinical breast examination
3. Breast self examination
DIAGNOSTIC INVESTIGATIONS
1. Diagnostic mammography
2. Ultrasonography
3. Biopsy
-FNAC
- core biopsy
surgical biopsy-lumpectomy/ stereotactic localisation
(nonpalpable tumours)
4. Scintimammography (99mm Tc- Sestamibi)
5. MRI (localisation )
6. CT
7. PET(mets work up & effective chemotherapy)
METS WORK UP
CXR
LFT
LIVER USG
Isotope bone scan
SURGERY
Halsteds –radical mastectomy
Patey’s –modified radical mastectomy
BREAST CONSERVATIVE SURGERY=
(wide local excision-margin +/-) /QUART
{quadrantectomy+axillary dissection+
Radiotherapy}
new No lymphedema/no limb dysfunction
Breast reconstruction surgery
After huge tumours resection
1. TRANS RECTUS ABDOMINUS flap
2. LATTISIMUS DORSI flap
Breast prosthesis
ADJUVANT THERAPY=
(Chemotherapy/harmonotherapy/
radiotherapy/immunotherapy)
.RADIOTHERAPY- 1. to tumour bed only
2. peroperative
3. palliative
Chemotherapy-
(given in 6 cycles at an
interval of 28 days with heamatological monitoring)
• conventional CMF regime
• Newer less toxic drugs
1.anthracyclinesadriamycin/cyciophosphamide
2.taxanes-paclitaxel/docetaxel
Indications-
•Lymph node positive tumour
•Poor prognostic lymph node negative
•As palliative therapy
•As neoadjuvant therapy
Hormonotherapy
• Conventional oophorectomy
• antioestrogens
-SERMS-tamoxifen(gold standard)
ER
ER
-aromatase inhibitor-anastrazole(postmenopausal
women)ATAC trials show more beneficial in preventing
reccurence
• Estrogen receptor down regulator
-fluvanstrant(once a month dose)
• HER2 receptor positive cancer (25%)do
respond to herceptin
(herceptin trial shows 50% relapse
prevention)
• FDA approved avastin is a trial drug which
acts on VEGF preventing tumour
progression
Immunotherapy
• Make tumour cells to be recognised as
foreign
• Boost up host immunity to destroy them
In advanced breast carcinoma its
less of surgery more of palliation
therapy(hormonal/chemotherapy/ra
diotherapy)
Australian couple who underwent
fertility tretment following detection
of massive cancer running in family.
Complementary medicine
• Meditation
• Acupuncture
• Nutrition
• Vitamin tablets
"The smaller the tumor, the
greater your options. So if you feel
something you're concerned about,
you need to get in and get it taken care of
. That's a key thing. Because a lot
of people have this fear that they're
going to lose their breast, and it's
just not true anymore."
Take home MESSAGE
• Patient education regarding BSE
(breast self examination) is the key point
in our country.
• With numerous options in treatment of
carcinoma breast is now a realistic
challenge to we doctors and we got to
individualise the treatment
THANK YOU