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Breast Cancer, A Common Problem in Sri Lanka

Breast Cancer, A Common Problem in Sri Lanka. Dr Dehan Gunasekera Consultant Oncologist National Cancer Institute of Sri Lanka. Leading Cancer sites-2010 Male Lip ,oral cavity and pharynx 14.1 % Bronchus and Lung 7.7 %

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Breast Cancer, A Common Problem in Sri Lanka

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  1. Breast Cancer,A Common Problem in Sri Lanka Dr Dehan Gunasekera Consultant Oncologist National Cancer Institute of Sri Lanka

  2. Leading Cancer sites-2010 Male • Lip ,oral cavity and pharynx 14.1 % • Bronchus and Lung 7.7 % • Oesophagus 5.8 % • Colon rectum 4.4 % Female • Breast 18.4 % • Cervix 8.9 % • Ovary 5.9 % • Thyroid 5.6 %

  3. 5012 new Cancer patients • 6063 new Cancer patients • 7300 new Cancer patients • 10925 new Cancer patients • 12632 new Cancer patients • 13372 new Cancer Patients

  4. Breast Cancer • Epidemic! Asian-young,ER-,PR-,High grade Europian->50 years,ER+,PR+ Awareness of Breast CA at all ages Presentation Mammographic detection Blood stained nipple discharge Self detected lump Clinical breast examination detected Locally advanced-ulcer,Peud’orange Metastatic-Pleural effusion,Back ache

  5. 6 5

  6. Diagnosis Triple assesment Clinical Examination-site,size for staging Mammogram/US scan in < 40-45 years FNAC/Core(trucut) biopsy Metastatic Survey General and systemic examination Xray chest US scan Abdomen and Pelvis LFT FBC,SC Bone Scan,CT scan–depending on the symptom

  7. Histology • Preinvasive CA Duct Carcinoma in Situ (DCIS) Lobuler Carcinoma in Situ (LCIS) Invasive CA Duct CA Mucinous Ca Medullary CA Papillary CA Lobuler CA

  8. Receptor status is mandatory • General Concept • ER-,PR- Poor prognosis • Her2- Good prognosis • Change in Concepts due to • Complicated cross talk between Receptors • Concept of Triple negative Disease • ER (-) • PR (-) • Her-2/neu (-)

  9. Treatment • Early Stage –Surgery Breast Conserving Surgery+RT to the breast Wide local Excission Qadrantectomy Lumpectomy Mastectomy+immediate or delayed reconstruction Axilla- US scan axilla (-) LN –Sentinal Lymph node biopsy US scan axilla (+) LN- Axillary clearance

  10. Place for Radiotherapy Mandatory in Breast conservation Lymph nodes in Axilla+ Large tumours (>5 cm) Poorly Differentiated CA To relieve pain locally-spine • Place of Chemotherapy Post operative(Adjuvant) Lymph nodes in Axilla+ Poorly Differentiated CA Large tumours (>5 cm) ER-,PR-,Her2 + Metastatic Disease

  11. Preoperative(Neoajuvant) Locally advanced disease(T3,T4) Inoperable Chemothrapy-Anthracyclin based Paclitaxel based Place of hormonal Therapy ER+,PR+ Premenapausal-Tamoxifen ER+,PR+ Postmenapausal- Aromatase inhibitors Anastrazole Letrazole Exemestane

  12. The occurrence of relapse and survival (Prognosis) are influenced by • 1.Stage at presentation (Size,Pathology,Grade,Metastasis) • 2.Lymph node status • 3.Hormone receptor status • 4.Measures of proliferation of the cancer cell • 5.Genetics of the cancer and the host • 6.Age at diagnosis

  13. St Galens Recommendations Low risk T1 N0 G1 ER+ and /or PR+ Her2 – >35 years No lymphovasculer invasion

  14. Intermediate risk ER and/or PR + Her2 – N0 No lymphovasculer invasion pT>1 or G2-3 or <35 years or (1-3) LN

  15. High risk ER- and PR- LN >3 Her2+ or LN 1-3 with lymphovasculer invasion

  16. Stage 5 year survival • Stage I T1 NO M0 85% • Stage II T0-1 N1 M0 T2 N0-1 M0 65% T3 N0 M0 • Stage III T0-2 N2 M0 T3 N1-2 M0 T4 any N M0 45% Any T N3 M0 • Stage IV Any T any N M1 10%

  17. Prevention • All females should do self breast examination monthly • Women over 40 years old should have Clinical breast examination every 3 years • Bilateral Mammogram at perimenapausal age of 45-50 years • If Clinical Breast examination detects a suspicious lesion under the age of 45 years-US scan breasts and ideally MRI of Breast

  18. Thank you

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