1 / 15

The Management of a Lump in the Breast

step by step. The Management of a Lump in the Breast. Answers to Commonly Asked Questions on:. Dr. Ian D’Souza Surgical Oncologist. Contents. This CD contains answers to commonly asked question on the treatment of a malignant lump in the breast.

ghita
Download Presentation

The Management of a Lump in the Breast

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. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. step by step The Management of a Lump in the Breast Answers to Commonly Asked Questions on: Dr. Ian D’Souza Surgical Oncologist

  2. Contents This CD contains answers to commonly asked question on the treatment of a malignant lump in the breast. The chapters are arranged in the same logical sequence that is followed when managing such patients. Each chapter lists a number of commonly faced questions pertaining to that aspect of treatment. Key to the actions performed by clicking on various buttons is given below: 1 Breast lump Clinical Examination Mammography 2 Activates the respective chapter / answer 3 Biopsy foreward or backward one slide 4 Clinical staging Return to previously viewed slide 5 Surgical options Returns to this content / help page 6 Adjuvant Therapy activates commentary (when present) Dr. Ian D’Souza Surgical Oncologist

  3. What are the clinical features to suspect malignancy? I have a cyst / multiple cysts in the breast. Should I be worried? What is a fibroadenoma? Can it lead to cancer? 1 What is benign breast disease (BBD)? Breast lump What is the relationship between BBD and cancer? How does a positive family history of breast ca affect me? I do not have a lump in the breast, can I still have cancer? Dr. Ian D’Souza Surgical Oncologist

  4. What does the doctor check for in his examination of the breast? Can a negative examination absolutely rule out cancer? What is mammography? Is mammography painful? 2 When is a mammography indicated? • Clinical Examination • Mammography Are mammographic finding conclusive? Is the radiation risk of yearly mammograms significant? Why is it necessary to perform mammography of both breasts ? Why is it necessary to preserve mammograms even if normal? Why do a mammogram in an already diagnosed case of breast cancer? Dr. Ian D’Souza Surgical Oncologist

  5. What is meant by ‘biopsy’? Is a biopsy mandatory in all breast lumps? 3 What are the types of biopsies for breast lumps? • Biopsy • FNAC • Core needle biopsy • Excision biopsy • Guided biopsy FNAC was negative, does that mean I do not have cancer? What is a guided biopsy? Why are blood tests done prior to an excision biopsy ? What are the possible problems following an excision biopsy? Dr. Ian D’Souza Surgical Oncologist

  6. Are all breast cancers the same? What are the routine tests to stage breast cancer? Is a bone scan done in all cases? 4 Do the above tests conclusively rule out metastasis? • Clinical staging: • Size of lump • No of involved nodes • Presence of metastasis • Tumour markers What are tumor markers? Which are the tumour markers pertaining to breast cancer What is the natural history of breast cancer? What is early breast cancer? What is meant by locally advanced breast cancer? What is advanced breast cancer? Dr. Ian D’Souza Surgical Oncologist

  7. Can simple lumpectomy be enough to cure me? Stage 1and11 (Early breast cancer) What is the rational behind surgery? What are the differences between conservative surgery and modified radical mastectomy? 5 What are the side effects of modified radical mastectomy? • Surgical options: • Breast Conservative Surgery (BCS) +Radiotherapy • Modified Radical Mastectomy If I remove the breast what are the methods to restore my appearance? Am I fit to under go general anesthesia and surgery? Further tests done after surgery Will I need further treatment? Dr. Ian D’Souza Surgical Oncologist

  8. What is meant by adjuvant therapy? Why the need to take other treatment besides surgery ? What is chemotherapy? 6 • Adjuvant Therapy • Radiotherapy • Chemotherapy • Hormonal Manipulation What is the basis behind hormonal therapy? What is radiotherapy? What is the difference between radiotherapy and chemotherapy? What are the tests I will need to do and how often will I require to perform them after my treatment is over? Dr. Ian D’Souza Surgical Oncologist

  9. What is meant by ‘biopsy’? • Biopsy is the examination of tissue (a collection of body cells) removed from the living body to discover the presence, cause, or extent of disease • In the case of a lump in the breast, either a part or the entire lump is removed and examined under the microscope. • It is the only method that can definitely confirm or rule out the presence of cancer in the sampled tissue. Dr. Ian D’Souza Surgical Oncologist

  10. Why the need for further treatment? • Simply performing surgery will result in an unacceptably high recurrence rate in the majority of cases. Recurrences are of two types: • local: where the tumour recurs locally ie in the breast/chest wall and/or axilla • systemic: blood borne metastasis which can be virtually anywhere in the body (common sites being liver lungs, bone, brain etc.) • The probability of recurrence depend on the stage of the tumour and the type of surgery. • Most cancers will need some form of additional (adjuvant) treatment (chemotherapy +/- hormonal manipulation). • If the cancer is locally advanced (large size, involvement of a large number of nodes, involvement of skin and/or chest wall) radiotherapy is added to reduce the possibility of local recurrence. • Patients opting for breast conservative surgery will need to take radiotherapy to reduce the chances of local recurrence. Dr. Ian D’Souza Surgical Oncologist

  11. Chemotherapy • Chemotherapy involves administration of cytotoxic (drugs that destroy cells) drugs. • These are usually given intravenously. • For optimal effect, drugs are given in combination, (eg 5-flurouracil, Adriamycin, Cyclophosphomide) • Typically they are given in ‘cycles’ ie one cycle every 3 weeks. • Each cycle usually lasts a day and is accompanied with drugs to reduced side effects • Chemotherapy acts by destroying rapidly dividing cells. Unfortunately, even normal rapidly dividing cells are destroyed like hair cells, bone marrow cells etc. • Side effects include • vomiting • hair loss • aneamia, leucopenia (reduced Hemoglobin and white blood cells) Dr. Ian D’Souza Surgical Oncologist

  12. What is hormonal therapy? • It is a proven fact that the progression of breast cancer is dependant on female hormones oestrogen and progesterone. • Manupulation of these hormones in selected cases result in significant improvement in survival. • Tumour markers help to identify patients who will benefit from hormonal manipulation. • Hormonal manipulation may be done in various ways: • Drugs: • Tamoxifen, Anastrozole, Letrozole • Goserelin • Surgery • Oophorectomy (removal of the ovaries) • Radiotherapy • radiotherapy of the ovaries • Chemotherapy • It is now known that the cessation of menses as a result of chemotherapy contributes significantly to it efficacy. Dr. Ian D’Souza Surgical Oncologist

  13. What is radiotherapy? • Radiotherapy involve giving ionizing radiation to the involved site. It may be given in two ways: External or Internal (brachytherapy) • External radiotherapy is usually given in the form of very strong xrays (as in linear accelerator) or gamma rays (as in a cobalt60 based machine). • The radiotherapy is typically given in divided doses called fractions • Each fraction is given daily (typically a couple of rest days are given after every 5 days) • over a period of 4-6 weeks. • Each dose or ‘fraction’ lasts about 15-20 minutes. • Brachytherapy (also known as internal radiotherapy) is occasionally indicated in selected patients. This involves inserting fine tubes in the tumour bed and filling them with radioactive material for a few hours. The patients need to be isolated during the period of radiotherapy to protect others from getting contaminated. Dr. Ian D’Souza Surgical Oncologist

  14. What is the difference between radiotherapy and chemotherapy? • Click the respective buttons to see details on the individual forms of treatment. • Treatment will often combine all three modalities of treatment for optimal results. • Radiotherapy basically helps to control the tumor in a particular area. • In the case of breast cancer it is often given post operatively as an adjuvant to surgery to reduce the chances of local recurrence. • It may also be given palliatively to reduce pain in cases with metastasis to the bones such as the vetebrae (bones of the spine) etc. • Chemotherapy attemts to achieve systemic control of cancer cells. • At some time during the natural progression of breast cancer, cancer cells will enter the blood and from there can go to virtually any organ of the body. • Chemotherapy drugs attempt to reach, and destroy, cancer cell at distant parts of the body Dr. Ian D’Souza Surgical Oncologist

  15. What are the tests I will need to do and how often will I require to perform them after my treatment is over? • The number of tests done vary from patient to patient • Typically a mammogram is performed about 6 months after treatment and yearly thereafter. • If the tumour marker test CA15/3 was done pre operatively and was raised it may be done on a yearly basis • Depending on clinically suspicion the following test may also be advised: Ultrasonography of the abdomen and pelvis, chest x-ray, bone scan, etc. These are however not done in all patients. • Your doctor will call you for a physical check up once every 3-6 months for 3-5 years after treatment. The interval between checkups may be increased to a yearly basis after a couple of years. Dr. Ian D’Souza Surgical Oncologist

More Related