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Management of Breast Cancer

Management of Breast Cancer. Dr.Unmesh Takalkar. M.S. (Gen.Surg.)M.E.D.S.,F.U.I.C.C. (Switzerland) FAIS, MSSAT (USA) , Fellow,Johns Hopkins (USA) Cancer,General & Endoscopic Surgeon. Management of Breast Cancer. Early Locally advanced Advanced. ETIOLOGY. Age – increases with age

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Management of Breast Cancer

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  1. Management of Breast Cancer Dr.Unmesh Takalkar M.S. (Gen.Surg.)M.E.D.S.,F.U.I.C.C. (Switzerland) FAIS, MSSAT (USA) , Fellow,Johns Hopkins (USA) Cancer,General & Endoscopic Surgeon

  2. Management of Breast Cancer Early Locally advanced Advanced

  3. ETIOLOGY • Age – increases with age • Geographical variation – more in the west • Early age at menache • Late age at menopause • Late Pregnancy and nulliparity • Family history • Benign breast disease and lifestyles

  4. Classification of Breast Cancer In – situ ductal and lobular carcinoma Invasive ductal and lobular carcinoma Tubular,eribiform,medullary,muscid, Papillary and elessiclobular Tumor grade Lympho-vascular invasion

  5. Locally Advanced Breast Cancer • Skin involvement- anytime • Fixed nodes • Lymphoedema • Supraclavicular nodes • Sattelite nodules

  6. Essential Investigations • Physical examination Care should be taken to asses size of tumor nodal involvement, specially supraclavicular lymphadenopathy • Tissue diagnosis FNAC is most commonly used open biopsy (wedge) is condemned exicision biopsy is oncologically sound • Radiology In small tumors, mammography is recommended – to consider breast conservation

  7. Early breast cancer • Breast conservation • Modified radical Mastectomy Locally advanced breast cancer • Chemotherapy followed by radiotherapy • Chemotherapy followed by surgery + adjuvant treatment • Local radiotherapy • Tollet mastectomy

  8. Radiotherapy in breast cancer • Radiotherapy should not be used routinely after mastectomy • If disease is extensive, infiltrating pectoralls muscle • For chest wall recurrances • Nodal recurrances, specially supraclavicular and internal mammary • For bony metastasic, to relieve symptoms

  9. Breast cancer Prognostic indicaters Pathological factors • Size of tumor (<1 cm Vs >1cm) • Grade of tumor(I Vs II Vs III) • Nodal status (no Vs n+) • Lymphovascular invasion • Estrogen receptor status (ER –ve Vs ER +ve )

  10. Breast cancer Prognostic indicators Biological factors • DNA Pioldy (ansuploid Vs diploid) • S-phase fraction • P53 expression • Erb b-2 expression • Catherin D/Cathopain/etc

  11. Adjuvant therapy in breast cancer • Post menopausal • TAMOXIFEN only (R.Peto,et al. overview of adjuvant therapy breast cancer Lancet.May 1992) • Pre-menopausal • Chemotherapy in selected cases • TAMOXIFEN • Safe Bet – Chemotherapy + TAMOXIFEN

  12. Role of receptor assay • Role of ER/PR in planning adjuvant therapy Estrogen and progestorene receptors are indicators of tumor behaviour. Receptor assays have no role in planning primary adjuvant therapy which is based on pathalogical prognostic indicators Receptor assays are useful guides in predicting outcomes and management of recurrent/metastatic disease

  13. Role of receptor assay • Avoid vaccinations – BP injection • Gloves, minute works • antiseptic’ • Avoid constricting clothing • Avoid lifting heavy weight • No spray

  14. Cancer cervixFactors for treatment • Age of patient • Wish to preserve ovarian fn • Tumor size • Size and location of primary • Histology • Infrastructure and expertise

  15. Breast cancer modes of presentation Breast • Lump breast • Retraction of nipple • Nipple discharge • Vnnbvmhvmbmn Lymph nodes • Axillary nodes • Supraclavicular nodes

  16. Evaluation • Symptoms • Cutaneous territory • Oral/ nasal examination • Hopkins: Triple endoscopy • CxR/waters • CT-nonnecroctic lymphoma -necrotic – metastatic • Anatomical location

  17. THANK YOU !

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