breast cancer l.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
BREAST CANCER PowerPoint Presentation
Download Presentation
BREAST CANCER

Loading in 2 Seconds...

play fullscreen
1 / 25

BREAST CANCER - PowerPoint PPT Presentation


  • 494 Views
  • Uploaded 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

BREAST CANCER

Curtis Tucker M.D.

epidemiology
Epidemiology
  • 32% of all female cancers
  • 15% of cancer deaths
  • 217,000 new cases per year
  • 40,500 deaths per year
risk factors
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
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
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
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
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
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
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
TNM Staging
  • Mx – metastasis cannot be assessed
  • M0 – no distant mets
  • M1 – distant mets
tnm staging11
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
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
Breast Cancer Survival Ratesat 8 years
  • Stage 0 – 98%
  • Stage I – 90%
  • Stage II – 70%
  • Stage III – 40%
  • Stage IV – 10%
treatment lcis
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
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
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
Invasive Breast CancerEarly Stage
  • Treatment options include BCT vs. modified radical mastectomy
bct vs mastectomy
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
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
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
Early Stage Breast CancerAdjuvant Treatment
  • Chemotherapy
  • Hormonal therapy – tamoxifen, arimidex, femara, aromasin, raloxifene
  • Herceptin monoclonal antibody to her2/neu receptor
advanced stage work up
Advanced Stage Work Up
  • CBC, CMP
  • CT chest and upper Abd
  • Bone scan
  • Consider PET scan
advanced stage treatment
Advanced StageTreatment
  • Typically includes surgery, chemotherapy, radiation, and if possible hormonal therapy
inflammatory breast carcinoma
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