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MANAGEMENT OF CARCINOMA BREAST ANEEKA ZIA

MANAGEMENT OF CARCINOMA BREAST ANEEKA ZIA. Early Breast carcinoma. Non invasive Breast Carcinoma. Invasive breast carcinoma. Surgery. BCS. local regional. Mastect- omy. LCIS. DCIS. Observation Bilateral mastectomy with reconstruction Tamoxifen(optional). Mastectomy

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MANAGEMENT OF CARCINOMA BREAST ANEEKA ZIA

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  1. MANAGEMENT OF CARCINOMA BREASTANEEKA ZIA

  2. Early Breast carcinoma Non invasive Breast Carcinoma Invasive breast carcinoma Surgery BCS • local • regional Mastect- omy LCIS DCIS • Observation • Bilateral mastectomy • with reconstruction • Tamoxifen(optional) • Mastectomy • Wide Excision+Radio • Tamoxifen(optional) Radiotherapy Adjuvant chemoth- erapy Hormonal therapy

  3. Advanced carcinoma • Stage IV • chemotherapy • radiotherapy • pleurodesis • gamma knife- • surgery • bisphosphona- • nates • Stage III • initial hormonal ,chemo(down- • staging) • MRM • Followed by radio • Inflamatory carcinoma • chemo • radio • Fungating • toilet mastectomy

  4. Breast Conservation Surgery • Wide local excision : Tumor plus1 cm of normal breast tissue rim • Lumpectomy : benign lump plus large amount of normal breast tissue is not resected • Quadrentectomy : a simple quadrant of breast removed Indication • Facility of radiotherapy • Lumps not in centre • Breast sizable • Patient wish • Premenopausal women

  5. Follow up by MRI (6 weeks)

  6. Mastectomy History • Super duper mastectomy : whole breast ,lymph nodes(axillary,supra clavicular,internal mammary)both arms • Super mastectomy : bilateral extended radical • Extended radical : supraclavicular plus internal mammary

  7. Simple Mastectomy • Tissue removed 1. breast tissue 2.skin 3.nipple • Sentinal node biopsy 1.early invasive car- cinoma 2. Ductal carcinoma in situ

  8. Skin sparing mastectomy cont. . . . • Tissue removed 1.breast tissue 2.skin of nipple and areola only • Circular incision • Keyhole incision

  9. cont. • Total skin sparing : • Nipple sparing: 1.Breast tissue involved 2.leaves areola intact Indication: 1.Tumor less than 2 cm 2. Tumor 2 cm away from nipple • Best in prophylactic mastectomy

  10. Radical Mastectomy • Entire breast • Nipple and areola • Pec major • Pec minor • Lymph nodes

  11. Modified Radical Mastectomy • Entire breast • Nipple and areola • Lymph nodes • Pec major and minor reserved

  12. Post Operative Care • Dressing • Suction drainage • Analgesics • Early ambulation • Physiotherpy • Antibiotics Suction drainage

  13. Axillary Surgery • Sentinal node biopsy • Axillary sampling • Partial clearance/ dissection • Complete cleara- nce • Endoscopic axillary clearance • Levels of clearance Sentinal node biopsy

  14. Role of radiotherapy: 1.Positive sampling 2.Lymph node status unknown 3.Salvage if axillary relapse • Complications

  15. Complications of Surgery • Wound infection • Necrosis of margins • Lymph oedema(elastic sleeve,physiotherapy) • Restriction of movement • Nerve injury • Phantom breast

  16. Breast Reconstruction

  17. True cut biopsy

  18. Radiotherapy • Indications 1.ductal carcinoma insitu following excision 2.Invasive disease following BCS in : Pt upto 55yr of age positive axillary nodes Extensive intraductal com- ponent 3.Following mastectomy in : positive lymph nodes extracapsular extension positive margins inadequate axillary dissection

  19. Adjuvant Therapy • Premenopausal ER PR negative CMF • Premenopausal ER PR positive CMF + Tamoxifen/LHRH Analogs • Postmenopausal ER PR positive Aromatase inhibitor(Anistrazole) or Tamoxifen • Postmenopausal ER PR negative Chemotherapy • Within 6 weeks of surgery • Every 2-4 weeks • Base lines maintained

  20. Newer agents: 1.Taxanes 2.Herceptin 3.Anthracyclines • Ovarian ablation: 1.LHRH analogs 2.Surgical Ophorectomy 3.Radiation ablation

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