1 / 104

Breast Cancer and Chemotherapy.

Breast Cancer and Chemotherapy. Dr.Kensarah. TNM Classification Staging Management of Breast Cancer Neoadjuvant Chemotherapy Adjuvant Chemotherapy. TNM classification. Primary tumor (T) : TX: Primary tumor cannot be assessed. T0: No evidence of primary tumor

fairly
Download Presentation

Breast Cancer and Chemotherapy.

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. Breast Cancer and Chemotherapy. Dr.Kensarah

  2. TNM Classification • Staging • Management of Breast Cancer • Neoadjuvant Chemotherapy • Adjuvant Chemotherapy

  3. TNM classification • Primary tumor (T) : • TX: Primary tumor cannot be assessed. • T0: No evidence of primary tumor • Tis : DCIS, LCIS, Paget’s disease of the nipple with no tumor .

  4. TNM classification • T1: Tumor ≤2.0 cm in greatest dimension • T1mic: Microinvasion ≤0.1 cm in greatest dimension • T1a: Tumor >0.1 cm but ≤0.5 cm in greatest dimension • T1b: Tumor >0.5 cm but ≤1.0 cm in greatest dimension • T1c: Tumor >1.0 cm but ≤2.0 cm in greatest dimension

  5. TNM classification • T2: Tumor >2.0 cm but ≤5.0 cm in greatest dimension • T3: Tumor >5.0 cm in greatest dimension • T4: Tumor of any size with direct extension to (a) chest wall or (b) skin.

  6. TNM classification • T4a: Extension to chest wall, not including pectoralis muscle. • T4b: Edema (including peau d’orange) or ulceration of the skin of the breast. • T4c: Both T4a and T4b • T4d: Inflammatory carcinoma

  7. TNM classification • Regional lymph nodes (N) : • NX: Regional lymph nodes cannot be assessed (e.g., previously removed) • N0: No regional lymph node metastasis • N1: Metastasis to movable ipsilateral axillary lymph node(s)

  8. TNM classification • N2: Metastasis to ipsilateral axillary lymph node(s) fixed or matted, or in clinically apparent* ipsilateral internal mammary nodes in the absence of clinically evident lymph node metastasis

  9. TNM classification • N3:- • N3a: Metastasis in ipsilateral infraclavicular lymph node(s) • N3b: Metastasis in ipsilateral internal mammary lymph node(s) and axillary lymph node(s) • N3c: Metastasis in ipsilateral supraclavicular lymph node(s)

  10. Staging of Breast Cancer

  11. Management of Breast Cancer A) In situ Breast Cancer: I ) LCIS : • Observation with or w/o Tamoxifen • The goal of treatment is to prevent or detect cancer in early stages, which might develop in 25-35%

  12. Management of Breast Cancer • There is no benefit to excising LCIS, as the disease diffusely involves both breasts and the risk of invasive cancer is equal for both breasts

  13. Management of Breast Cancer II) DCIS : • For women with widespread disease ( 2 or more quadrants ) → Mastectomy • For women with limited disease → Lumpectomy and Radiation

  14. Management of Breast Cancer B) Early Invasive Breast Cancer : • Includes stage I,IIa , or IIb • Mastectomy or Lumpectomy and radiation therapy • Axillary Lymph node dissection .

  15. Management of Breast Cancer • Relative Contraindication to breast conservation therapy : • Prior radiation therapy to the breast or chest wall. • Positive surgical margins. • Multicentric disease • Scleroderma

  16. Management of Breast Cancer B) Early Invasive Breast Cancer : • Adjuvant Chemotherapy is considered for all node positive patients, tumor > 1 cm. • Tamoxifen is considered for hormone receptor positive patients with cancer > 1 cm

  17. Management of Breast Cancer C) Advanced Regional Breast Cancer : • Operable stage III A : • MRM followed by adjuvant chemotherapy, followed by adjuvant radiotherapy.

  18. Management of Breast Cancer 2.inoperable stage III a and stage III b : • Neoadjuvant chemotherapy • MRM , followed by adjuvant chemotherapy, followed by adjuvant radiotherapy.

  19. Management of Breast Cancer D) Distant metastases: • Treatment for stage IV breast cancer is not curative • Goal: prolong survival and enhance a women’s quality of life. • Hormonal therapy preferred versus chemotherapy.

  20. Neoadjuvant Chemotherapy • 7 prospective , randomized trials have evaluated the efficacy of chemotherapy administered in the neoadjuvant setting prior to breast surgery versus administered in the adjuvant setting after surgery

  21. Neoadjuvant Chemotherapy • Although two of these trials reported improvement in disease free survival with the use of neoadjuvant chemotherapy, none have demonstrated improvement in overall survival.

  22. Neoadjuvant Chemotherapy • Consistently, patients treated with neoadjuvant chemotherapy were more likely to be treated with breast conservation.

  23. Neoadjuvant Chemotherapy • From a practical perspective, prior to initiating chemotherapy in the neoadjuvant setting, under image guidance, a metalic clip is placed into the tumor.

  24. Neoadjuvant Chemotherapy • IF a complete clinical and radiological tumor response occur, preoperative stereotactic wire placement alongside the clip will facilitate excision of the tumor site.

  25. Neoadjuvant Chemotherapy • If histology demonstrates a localized tumor with negative margins, radiation can commence and the breast preserved.

  26. Neoadjuvant Chemotherapy • For a diffuse tumor with satellite lesions, consideration of excision prior to radiation should be given even if the margins are technically cleared.

  27. Neoadjuvant Chemotherapy • For a diffuse tumor with many satellite foci and positive margins, mastectomy maybe required.

  28. Neoadjuvant Chemotherapy for Operable Breast Cancer • Neoadjuvant therapy can achieve high response rates and may permit conservative surgery in more advanced breast cancer.

  29. Neoadjuvant Chemotherapy for Operable Breast Cancer • There are reasons to apply to apply this treatment to earlier stages of Cancer 1st : for the lower tumor burdens, the probability of drug resistance cells is theoretically less. Definition: Refers to the number of cancercells, the size of a tumor, or the amount of cancer in the body; Tumor load

  30. Neoadjuvant Chemotherapy for Operable Breast Cancer 2nd : the absolute number of tumor cells left after treating a small tumor burden may be below a threshold, above which re-growth will occur.ie, no recurrence .

  31. Neoadjuvant Chemotherapy for Operable Breast Cancer • For these and other concerns, investigators have treated earlier stage patients with preoperative chemotherapy.

  32. Neoadjuvant Chemotherapy • “Success of neoadjuvant chemotherapy in conversion of mastectomy to breast conservation surgery.” • Harbor-UCLA Medical Center, Torrance, California, USA , Am Surg. 2006 Oct;72(10):935-8

  33. Neoadjuvant Chemotherapy • Objective: to determine the success of Neoadjuvant Chemotherapy in achieving Breast conservation in women who initially were not candidates for BC. • Harbor-UCLA Medical Center, Torrance, California, USA , Am Surg. 2006 Oct;72(10):935-8

  34. Neoadjuvant Chemotherapy • Tumors were predominantly infiltrating ductal carcinoma (83.3% ) • high grade (62.2% ) • Chemo: Cyclophosphamide, Doxorubicin and 5 FU. • Harbor-UCLA Medical Center, Torrance, California, USA , Am Surg. 2006 Oct;72(10):935-8

  35. Neoadjuvant Chemotherapy • Mean tumor size was 51 mm. • 62 % were larger than 4 cm. • Harbor-UCLA Medical Center, Torrance, California, USA , Am Surg. 2006 Oct;72(10):935-8

  36. Neoadjuvant Chemotherapy • Results: • Complete clinical response was seen in 32.4 % • Complete pathological response was seen in 10.8 % • Harbor-UCLA Medical Center, Torrance, California, USA , Am Surg. 2006 Oct;72(10):935-8

  37. Neoadjuvant Chemotherapy • BC was achieved in 56.7 per cent of cases. • Only initial tumor size predicted tumor regression and success of BC . Neither Histology nor biological marker. • Harbor-UCLA Medical Center, Torrance, California, USA , Am Surg. 2006 Oct;72(10):935-8

  38. Neoadjuvant Chemotherapy • “Axillary lymph node count is lower after neoadjuvant chemotherapy” PMID: 16720159 [PubMed - indexed for MEDLINE]. Am J Surg. 2006 Jun;191(6):830-1.

  39. Neoadjuvant Chemotherapy Results: A total of 143 patients recived NC first. 170 patients received surgery first PMID: 16720159 [PubMed - indexed for MEDLINE]. Am J Surg. 2006 Jun;191(6):830-1.

  40. Neoadjuvant Chemotherapy Patients treated with neoadjuvant chemotherapy had fewer than 10 L.N retrieved at ALND than patients who had the surgery first. PMID: 16720159 [PubMed - indexed for MEDLINE]. Am J Surg. 2006 Jun;191(6):830-1.

  41. Neoadjuvant Chemotherapy • CONCLUSION: A low lymph node count is more common in patients after treatment with neoadjuvant chemotherapy.

  42. Pathological Response after neoadjuvant chemo • “Prognostic significance of pathological response of primary tumor and metastatic axillary lymph nodes after neoadjuvant chemotherapy for locally advanced breast carcinoma.” Cancer J Sci Am. 1998 Mar-Apr;4(2):125-31.

  43. Pathological Response after neoadjuvant chemo • PATIENTS AND METHODS: • Between January 1989 and April 1995, 148 consecutive patients with locally advanced breast carcinoma participated in the study. Cancer J Sci Am. 1998 Mar-Apr;4(2):125-31.

  44. Pathological Response after neoadjuvant chemo • Of these, 140 patients were treated with three courses of 5-fluorouracil, doxorubicin, and cyclophosphamide (FAC), followed by modified radical mastectomy or definitive radiation therapy. Cancer J Sci Am. 1998 Mar-Apr;4(2):125-31.

  45. Pathological Response after neoadjuvant chemo • RESULTS: • Complete response occurred in 11 patients (8%) • Partial response occurred in 88 patients (63%). • No change was recorded in 37 patients (26%) • and progressive disease occurred in 4 patients (3%) Cancer J Sci Am. 1998 Mar-Apr;4(2):125-31.

  46. Pathological Response after neoadjuvant chemo • Maximal pathological response of the primary tumor (in situ carcinoma or minimal microscopic residual tumor) was observed in 24 (18%) Cancer J Sci Am. 1998 Mar-Apr;4(2):125-31.

  47. Pathological Response after neoadjuvant chemo • 112 patients (82%) presented minimal pathological response of the primary tumor. Cancer J Sci Am. 1998 Mar-Apr;4(2):125-31.

  48. Pathological Response after neoadjuvant chemo • A significant correlation was noted between pathological response of primary tumor and the number of metastatic axillary lymph nodes Cancer J Sci Am. 1998 Mar-Apr;4(2):125-31.

  49. Pathological Response after neoadjuvant chemo • CONCLUSION: • After neoadjuvant chemotherapy, pathological responses of both primary tumor and metastatic axillary lymph nodes had a marked prognostic significance and influenced outcome for patients with locally advanced breast carcinoma. Cancer J Sci Am. 1998 Mar-Apr;4(2):125-31.

  50. Pathological Response after neoadjuvant chemo • The results suggest that maximal tumor shrinkage of potentially involved axillary nodes may represent a major goal of neoadjuvant chemotherapy Cancer J Sci Am. 1998 Mar-Apr;4(2):125-31.

More Related