new advances in treating breast cancer
TRANSCRIPT
PowerPoint Presentation
DR.S.G.BALAMURUGAN M.CH.,
SURGICAL ONCOLOGIST GURU CANCER HOSPITAL . MADURAI
BREAST CANCER - CURRENT CONCEPT
GURU CANCER HOSPITAL
World: Commonest in female,
30% of Total body cancer in female
India: upto 2010
2nd most commonest in women, 2011 - Commonest
BREAST CANCER
TODAYS AGENDA
To discuss about BREAST CANCER
How to approach pt with Oncological norms
Recent updates in cancer management
Mismanagement QUALITY
BREAST CANCER AWARENESS
APPROACH
PALPABLE BREAST MASSES
fibrocystic changes (40%)
no disease (30%)
benign NOS (13%)
fibroadenoma (7%)
CANCER (10%)
DIAGNOSIS
Triple assessment
Clinical examination + imaging +FNAC/Corebiopsy
MALIGNANT LESION
Lump in breast usually painless
Bloody nipple discharge
Recent inversion of nipple
Destruction of nipple
Thickening of skin orange peel like
Node in the Axilla
Peaudeorange
Axillary vein thrombosis
Mammographic appearance of Cancer
A mass
Associated calcification
Architectural distortion
Irregular border
Skin or nipple change
WHAT TO DO?
SUSPECTED MALIGNANT LESION
FNAC - if inconclusive
Trucut biopsy - if inconclusive Small lesion excision biopsy Large lesion incision biopsy
CONFIRMATION OF DIAGNOSIS
trucut biopsy open biopsy
IDEAL - BIOPSY
BIOPSY INCISIONS
Incision must be transverse or curvilinear
Scars should be included in the future definitive incision
. NO VERTICAL INCISION Adversely affects the plan of treatment both in definitive surgery & RT planning
NO VERTICAL INCISION
ORDER OF INVESTIGATION INBREAST
CONFIRMATION OF DIAGNOSIS
fnac trucut biopsy incision biopsy
METASTATIC WORKUP
X-ray chest
US abdomen
Bone scan
THE NEED OF THIS ERA
Multidisciplinary Tumor Board
Finalize Tumor stagingFormulates treatment plan
MANAGEMENT
MULTIMODAL
Pt to be treated by all three weapons (surgery,RT,chemotherapy) by appropriate sequence that results in high success rate
and less complications
MANAGEMENT
CLASSIFICATION
EARLY CANCER (INTENT CURE)
SURGERY
LOCALLY ADVANCED CANCER (INTENT CURE) NEOADJUVANT CHEMO
METASTATIC CANCER (INTENT PALLIATION)
PALLIATIVE
MANAGEMENT
CLASSIFICATION
EARLY CANCER
Size < 5cm
Mobile axillary node
NO skin involment
LOCALLY ADVANCED CANCER
Size > 5 cm
Fixed Axillary node / SCLN involvement
Skin involvement
METASTATIC CANCER
CHANGING TRENDS
CHANGING TRENDS
M.R,M = W.L.E + RADIOTHERAPY
EARLY CASES - OPTIONS OF SURGERY
Modified radical mastectomy
OR
Breast Conservative surgery
FOR PRIMARY
FOR AXILLA
EARLY CASES - OPTIONS OF SURGERY
Whether Modified radical Mastectomy or Breast conservative surgery
Axillary dissection is mandatory
20TH CENTURY
21 CENTURY
BREAST CONSERVATIVE SURGERY
Brachytherapy
Alternative
BCT is not possible
Solution ?
Breast
Reconstruction
ONCO SURGEONS VISION SHOULD BE
BEYOND CURE
Breast reconstruction
BREAST RECONSTRUCTION
TRAM FLAP
BREAST RECONSTRUCTION
LD FLAP
LOCALY ADVANCED BREAST CANCER
WHAT TO DO LABC?
3 cycles of Neo adjuvant Chemo
Review
Responds well
No Response
Surgery
RT & Review for Surgery
MRI-before treatment
After treatment
Early Nipple retraction
Orange peel like skin
Ulcer
LABC- POOR SURGICAL SELECTION
Dont's
HOW TO MANAGE METASTATIC DISEASE?
Palliative treatment
Chemotherapy
Commonest metastasic site BONE
MASTECTOMY
NO ROLE IN METASTATIC DISEASE WITH OUT BLEEDING , FUNGATION
Toilet mastectomy indicated only for bleeding and fungating tumor
MICRO METASTASIS
IMAGE OCCULT MATASTASIS
risk of recurrence and death from breast cancer with local therapy alone
30% with node-negative disease
75% with node-positive disease
Principles of Adjuvant Therapy
FOR WHOM ADJUVANT CHEMOTHERAPY TO BE GIVEN?
For all cases except1. Node negative status2. Tumor size