Breast cancer
Download
1 / 25

BREAST CANCER - PowerPoint PPT Presentation


  • 450 Views
  • Updated On :

BREAST CANCER Curtis Tucker M.D. Epidemiology 32% of all female cancers 15% of cancer deaths 217,000 new cases per year 40,500 deaths per year Risk Factors FEMALE Increasing age – very uncommon below the age of 40, but risk increases to 1 in 8 for women living into their 80’s

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'BREAST CANCER' - Sophia


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
Breast cancer l.jpg

BREAST CANCER

Curtis Tucker M.D.


Epidemiology l.jpg
Epidemiology

  • 32% of all female cancers

  • 15% of cancer deaths

  • 217,000 new cases per year

  • 40,500 deaths per year


Risk factors l.jpg
Risk Factors

  • FEMALE

  • Increasing age – very uncommon below the age of 40, but risk increases to 1 in 8 for women living into their 80’s

  • Family history – relative risk is 1.7 if women have a first degree relative with breast cancer

  • Proliferative breast disease- ductal hyperplasia, sclerosing adenosis, lobular hyperplasia, LCIS

  • Personal history of breast cancer (also colon, ovarian, endometrial)

  • Reproductive factors

  • Radiation exposure, especially at early age

  • ?? HRT

  • Alcohol, high fat diet, obesity


Genetic risk factors l.jpg
Genetic Risk Factors

  • Hereditary forms of breast cancer account for only 5% of breast cancer cases

  • BRCA1 mutation – inherited AD fashion with a lifetime risk of breast cancer of ~55% - 85% and ovarian cancer risk of ~15 – 45%

  • BRCA2 mutation – 6% lifetime risk of breast cancer


Screening l.jpg
Screening

  • Breast self-exams – beginning in their 20’s

  • Clinical breast exam – beginning at age 20 q 3 yrs and annually after age 40 (15% of breast cancers detected only clinically)

  • Mammography – annually beginning at age 40 or 5-10 yrs prior to any first degree relatives dx age (85% of tumors mammographically detectable) 50% of lesions dtected by mammo only

  • Screening US for dense breasts

  • ?? Breast MRI


Signs and symptoms l.jpg
Signs and Symptoms

  • Mammo findings – microcalcifications, asymmetry, mass, architectural distortion most DCIS found on mammo only

  • Breast lump – 65% of cases

  • Eczematoid changes in the nipple (Paget’s dz)

  • Nipple retraction/discharge

  • Skin changes/ulceration


Pathology l.jpg
Pathology

  • Ductal Carcinoma In Situ (DCIS) - 25% of cases

  • Infiltrating Ductal Carcinoma – 65% of cases

  • Infiltrating Lobular Carcinoma – 5-10% of cases

  • Rare types – medullary, tubular, lymphoma, sarcoma


Tnm staging l.jpg
TNM Staging

  • Tx – tumor cannot be assessed

  • T0 – no evidence of primary tumor

  • Tis – DCIS

  • T1 - tumor less than/equal to 2 cm

  • T2 - tumor > 2 cm but not > 5 cm

  • T3 – tumor > 5 cm

  • T4 – involvement of skin or chest wall or inflammatory carcinoma


Tnm staging9 l.jpg
TNM Staging

  • Nx – lymph nodes (LN) cannot be assessed

  • N0 – No regional LN

  • N1 – movable axillary LN

  • N2 – fixed/matted axillary LN or internal mammary LN only

  • N3 – both axillary and internal mammary LN, or infraclavicular LN or supraclavicular LN


Tnm staging10 l.jpg
TNM Staging

  • Mx – metastasis cannot be assessed

  • M0 – no distant mets

  • M1 – distant mets


Tnm staging11 l.jpg
TNM Staging

  • Stage 0 – DCIS

  • Stage I – T1 N0 M0

  • Stage II – T1 N1 M0 T2 N0-1 M0 T3 N0 M0

  • Stage III – T3 N1 M0 any N2-3 M0 any T4 M0

  • Stage IV – any M1


Prognostic factors l.jpg
Prognostic Factors

  • TNM staging

  • Lymph node status – prognosis directly correlates with number of positive LN

  • Node negative - 20% recurrence at 5 yr

  • LN+ > 10 nodes – 75% recurrence rate at 5 years

  • Hormone receptor status – ER/PR positive is more favorable

  • Her2/neu positive is more unfavorable


Breast cancer survival rates at 8 years l.jpg
Breast Cancer Survival Ratesat 8 years

  • Stage 0 – 98%

  • Stage I – 90%

  • Stage II – 70%

  • Stage III – 40%

  • Stage IV – 10%


Treatment lcis l.jpg
TreatmentLCIS

  • Not breast cancer

  • Marker for increased risk of breast cancer

  • Lifetime risk of developing breast cancer 25 to 30%

  • Do not need excisional bx or clear margins

  • Treatment options – close observation, tamoxifen, bilateral prophylactic mastectomies


Treatment dcis l.jpg
Treatment DCIS

  • Pre-invasive cancer

  • Risk of LN involvement/distant mets is 1%

  • Do not need met w/u or LN dissection

  • Options for tx – breast conserving therapy vs simple mastectomy

  • Need clear margins for breast conservation


Bct for dcis l.jpg
BCT for DCIS

  • DFS rate at 5 years – 99%

  • Review of NSABP-06 showed no difference in survival for BCT vs mastectomy

  • NSABP-17 prospective randomized trial lumpectomy vs lumpectomy and radiation at 8 yrs local recurrence reduced from 27% to 12% with radiation, no difference in survival (no boost)

  • European trial prospective trial same results

  • All subgroups showed decrease in local recurrence rate

  • Addition of tamoxifen further reduced risk (6 year FU 13% recurrence vs 8%)both ipsilateral and contralateral

  • Do patients need radiation? Yes.


Invasive breast cancer early stage l.jpg
Invasive Breast CancerEarly Stage

  • Treatment options include BCT vs. modified radical mastectomy


Bct vs mastectomy l.jpg
BCT vs Mastectomy

  • Multiple US and international prospective randomized trials all show equivalency of BCT with radiation to mastectomy (over 4000 patients total)

  • Largest US trial NSABP-06, 1800 women randomized, 20 year follow up no difference in either local/regional recurrences – 15% mastectomy vs 9% BCT, or in disease-free survival 36% mastectomy vs 35% BCT


Bct vs mastectomy19 l.jpg
BCT vs Mastectomy

  • This study included an arm with lumpectomy alone and although DFS was not significantly effected (P 0.07) local recurrence rate was 40%

  • Ability to have is BCT is not affected by LN status and in fact in women with positive LN after mastectomy appear to have a survival benefit with the addition of radiation to the chest wall

  • Current radiation techniques yield a failure rate in the breast of ~ 4% at 5 years


Breast conserving treatment criteria l.jpg
Breast Conserving TreatmentCriteria

  • Typically less than 5 cm lesion

  • No multicentric dz/calcifications

  • Must have negative margins (>1mm) this includes DCIS

  • No Scleraderma/autoimmune dz

  • Breast/tumor proportion – cosmetic outcome


Early stage breast cancer adjuvant treatment l.jpg
Early Stage Breast CancerAdjuvant Treatment

  • Chemotherapy

  • Hormonal therapy – tamoxifen, arimidex, femara, aromasin, raloxifene

  • Herceptin monoclonal antibody to her2/neu receptor


Advanced stage work up l.jpg
Advanced Stage Work Up

  • CBC, CMP

  • CT chest and upper Abd

  • Bone scan

  • Consider PET scan


Advanced stage treatment l.jpg
Advanced StageTreatment

  • Typically includes surgery, chemotherapy, radiation, and if possible hormonal therapy


Inflammatory breast carcinoma l.jpg
Inflammatory Breast Carcinoma

  • Can present with a cellulitis type picture and usually arises very quickly

  • Does not typically have a dominant mass

  • Poor prognosis and must be treated very aggressively

  • Treated with chemotherapy followed by mastectomy then radiation and more chemotherapy


ad