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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
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%)


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


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


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



Immunotherapy
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/radiotherapy)


Australian couple who underwent

fertility tretment following detection

of massive cancer running in family.


Complementary medicine
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
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



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