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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%)

slide5
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

slide8
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
slide10
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

slide17
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
slide19
In advanced breast carcinoma its less of surgery more of palliation therapy(hormonal/chemotherapy/radiotherapy)
slide20
Australian couple who underwent

fertility tretment following detection

of massive cancer running in family.

complementary medicine
Complementary medicine
  • Meditation
  • Acupuncture
  • Nutrition
  • Vitamin tablets
slide22
"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
ad