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TOPIC: NEWER TREATMENT IN BREAST CANCER. BY Chaitra.t.m 9 th term Bangalore medical college. TOPIC: NEWER TREATMENT IN BREAST CANCER. BY Chaitra.t.m 9th term Bangalore medical college. Chance of developing This at some Point of womens Life is 13% whereas in man is <2%.

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TOPIC: NEWER TREATMENT IN BREAST CANCER

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Topic newer treatment in breast cancer

TOPIC: NEWER TREATMENT IN BREAST CANCER

BY

Chaitra.t.m

9th term

Bangalore medical college


Topic newer treatment in breast cancer1

TOPIC: NEWER TREATMENT IN BREAST CANCER

BY

Chaitra.t.m

9th term

Bangalore medical 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

Breast cancer


Types

TYPES

Lobular(15%)

Ductular(85%)


Topic newer treatment in breast cancer

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

MYTHS ABOUT BREAST CANCER

  • Antiperspirents

  • Induced abortion

  • Breast implants

  • Environmental pollution

  • Night shift working

Thought to be carcinogens


Clinical staging

CLINICAL STAGING

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

NODES

METASTASIS

One more type of classification = manchesters


Topic newer treatment in breast cancer

  • PATIENT INVOLVEMENT

  • Health education

Whats new in

Breast cancer

treatment

  • POST OP

  • Better arm function

  • Cosmesis

  • Quality of life

  • TECHNOLOGY

  • Diagnostic

  • Treatment


Screening investigations

SCREENING INVESTIGATIONS

  • Mammography – all patients with family history -Sensitive for even 2-3cm tumour


Topic newer treatment in breast cancer

2. Clinical breast examination

3. Breast self examination


Diagnostic investigations

DIAGNOSTIC INVESTIGATIONS

  • Diagnostic mammography

  • Ultrasonography

  • Biopsy

    - F N A C

    - 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

CXRLFTLIVER USG

Isotope bone scan


Surgery

SURGERY

Halsteds –radical mastectomy

Patey’s –modified radical mastectomy

BREAST CONSERVATIVE SURGERY=

(wide local excision-margin +/-) /QUART

{quadrantectomy+axillary dissection+

Radiotherapy}

No lymphedema/no limb dysfunction

new


Breast reconstruction surgery

Breast reconstruction surgery

After huge tumours resection

  • TRANS RECTUS ABDOMINUS flap

  • LATTISIMUS DORSI flap

Breast prosthesis


Adjuvant therapy

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

Chemotherapy- (given in 6 cycles at an interval of 28 days with heamatological monitoring)

  • conventional CMF regime

  • Newer less toxic drugs

    1.anthracyclines-adriamycin/cyciophosphamide

    2.taxanes-paclitaxel/docetaxel

  • Indications-

  • Lymph node positive tumour

  • Poor prognostic lymph node negative

  • As palliative therapy

  • As neoadjuvant therapy


Hormonotherapy

Hormonotherapy

  • Conventional oophorectomy

  • antioestrogens

    -SERMS-tamoxifen(gold standard)

    -aromatase inhibitor-anastrazole(postmenopausal women)ATAC trials show more beneficial in preventing reccurence

  • Estrogen receptor down regulator

    -fluvanstrant(once a month dose)

ER

ER


Topic newer treatment in breast cancer

  • 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

Immunotherapy

  • Make tumour cells to be recognised as foreign

  • Boost up host immunity to destroy them


Topic newer treatment in breast cancer

In advanced breast carcinoma its less of surgery more of palliation therapy(hormonal/chemotherapy/radiotherapy)


Topic newer treatment in breast cancer

Australian couple who underwent

fertility tretment following detection

of massive cancer running in family.


Complementary medicine

Complementary medicine

  • Meditation

  • Acupuncture

  • Nutrition

  • Vitamin tablets


Topic newer treatment in breast cancer

"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

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


Topic newer treatment in breast cancer

THANK YOU


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