This Presentation was created by me, Dr Faisal Abdullah, when I was a student of 5th year in Faridpur Medical College. It was presented in an 'Integrated Teaching' porgramme.

1. TREATMENT OF
CARCINOMA
BREAST
A MULTI-DISCIPLINARY APPROACH
Faisal Abdullah
5th year, Batch F23

2. TREATMENT OPTIONS
SURGERY
Hormone
Therapy
Radio-
therapy
Biological
Therapy
Chemo-
therapy

3. SURGICAL OPTIONS
SURGERY IS THE MAINSTAY OF TREATMENT
Surgeries can be
done in which the
entire diseased
breast is removed
Surgeries can be
done in which only
the diseased
portion or quadrant
of the breast is
removed
Surgeries can be
done in which
breast is
reconstructed after
being removed
entirely
Breast Conserving
Surgery
Mastectomy
Reconstructive
Surgery

4. 4
BREAST CONSERVING SURGERY
LUMPECTOMY QUADRANTACTOMY
Only the tumour and some
surrounding tissue is removed
The diseased quadrant of the
breast is removed

5. 5
MASTECTOMY
Simple
Mastectomy
Modified Radical
Mastectomy
Radical
Mastectomy

6. 6
SIMPLE MASTECTOMY
A Simple Mastectomy
removes the entire breast-
breast tissue, nipple, areola
and skin; but not all the
lymph nodes.

7. 7
MODIFIED RADICAL MASTECTOMY
A Modified Radical
Mastectomy removes the
entire breast — the breast
tissue, skin, areola and
nipple ; and most of the
axillary lymph nodes.

8. 8
RADICAL MASTECTOMY
A Radical Mastectomy
removes the breast,
underlying chest muscle
(Pectoralis major &
Pectoralis Minor), and
lymph nodes of the axillary
lymph nodes.

9. 9
RECONSTRUCTIVE SURGERY
Implant
Reconstruction
Latissimus Dorsi
Flap
Transverse Rectus
Abdominis Flap

10. IMPLANT RECONSTRUCTION

11. LATISSIMUS DORSI FLAP RECONSTRUCTION

12. TRANSVERSE RECTUS ABDOMINIS
MYOCUTANEOUS FLAP- TRAM FLAP

13. RADIOTHERAPY
In the form of external beam radiotherapy to the chest wall
and axilla

14. Radiotherapy is
indicated for:
 Large tumor >5 cm
 After breast conserving
surgery
 Lymph node involvement
 Age <35 years

15. HORMONAL THERAPY
2 out of 3 breast cancers are hormone receptor-positive. Their
cells have receptors that attach to the hormones- estrogen
(ER-positive cancers) and/or progesterone (PR-positive
cancers) which help them grow. we use hormone therapy to
block this attachment.

16. 16
Check for Hormone Receptor Status
Breast Tissue
If Positive, give
hormone
therapy
If Negative, hormone
therapy not needed
Each malignant breast
tissue obtained either
through biopsy or
surgery should be
evaluated for the
expression of:
• Estrogen receptor-ER
• Progesterone
receptor-PR
If any of the above is
positive, hormonal
therapy is given.

17. DRUGS USED IN HORMONE
THERAPY
 Tamoxifen
 LHRH agonists-
Goserelin, Leuprolide
 Tamoxifen
 Oral aromatase
inhibitors-
Exemestane, Anastrozole
Pre Menopausal
Women
Post Menopausal
Women

18. 18
Chemotherapy is treatment with cancer-
killing drugs.
CHEMOTHERAPY
Chemo can be
used to kill
cancer cells
that have been
left behind
Chemo can be
used to shrink the
tumor so it can be
removed with less
extensive surgery.
Chemo can be
used to treat
metastatic breast
tumor

19. 19
WHEN IS CHEMOTHERAPY USED?
Adjuvant
Chemotherapy
After Surgery
Neoadjuvant
Chemotherapy
Before
Surgery
Palliative
Chemotherapy
For advanced
stage

20. 20
ADJUVANT CHEMOTHERAPY
Used to try to kill any
cancer cells that
might have been left
behind or have
spread but can't be
seen.

21. 21
NEOADJUVANT CHEMOTHERAPY
used to try to
shrink the tumor
so that it can be
removed with
less extensive
surgery

22. 22
PALLIATIVE CHEMOTHERAPY
Used as the
main treatment
for women
whose cancer
has spread
outside the
breast and
underarm area.

23. Drugs used in Chemotherapy
1st gen Regimen Modern regimen
36 monthly cycle
combined therapy with:
 Cyclophosphamide
 MTX
 5- Flurouracil
 Ananthracycline
(Doxorubucin or
Epirubicin)

24. BIOLOGICAL THERAPY
Treatment against specific genes/proteins that
promote the growth of cancer cell by using
monoclonal antibody. Used in HER2 positive cancer
cells.

25. 25
DRUGS USED IN BIOLOGICAL THERAPY
 Trastuzumab
(Herceptin)
 Lapatinib
 Pertuzumab (Perzeta)

26. 26
How do we know which treatment
is appropriate for my patient?
Treatment is given according
to Staging of the tumor

27. Staging of
Breast Cancer
Manchester
StagingTNM Staging

28. TNM STAGING
T
Primary
Tumour
T0
No evidence
of primary
tumour
T1
Tumor 2cm or
less in
greatest
diameter
T2
Tumor size 2-
5 cm
T3
Tumor size >5
cm
T4
Tumor of any
size with
direct
extension to
cest wall or
skin
N
Lymph
Node
N0
No palpable
axillary
nodes
N1
Mobile
palpable
axillary
nodes
N2
Fixed
axillary
nodes
N3
Fixed
supraclavicul
ar nodes
M
Metastasis
M0
No evidence
of distant
metastasis
M1
Distant
metastasis

29. MANCHESTER STAGING
STAGE 1 TUMOUR SIZE <2 CM
NO NODAL INVOLVEMENT
NO DISTANT METASTSSIS
STAGE 2 TUMOUR SIZE 2-5 CM
IPSILATERAL MOBILE NODAL METASTASIS
NO DISTANT METASTASIS
STAGE 3A TUMOR SIZE >5 CM
IPSILATERAL FIXED NODAL METASTASIS
NO DISTANT METASTASIS
STAGE 3B TUMOR OF ANY SIZE INVADING SKIN OR CHEST
WALL
SUPRACLAVICULAR NODAL METASTASIS
NO DISTANT METASTASIS
STAGE 4 TUMOUR OF ANY SIZE
NODAL METASTASIS
DISTANT METASTASIS

30. Early Breast Cancer-
Stage 1 and 2
Localy advanced breast
cancer Stage 3
Metastatic breast cancer-
Stage 4

31. STAGE 1 & 2
Surgery
Chemotherapy
Radiotherapy
Hormone Therapy
Biological Therapy

32. STAGE 3
Neo adjuvant chemotherapy
Surgery
Adjuvant chemotherapy
Hormone therapy
Biological therapy

33. STAGE 4
Palliative
chemotherapy
Radiotherapy
Hormone
therapy
Biological
therapy

34. BREAST CANCER TREATMENT
IN BANGLADESH

35. in 2017, Bangladesh Cancer Society (BCS) organised the
International Cancer Congress and Health Fair 2017 in
co-operation with International Union for Cancer Control
and Global Cancer Institute
There are only about 180
oncologists for 165 million.
People.
we have only six institutions,
including government and
private medical centres,
which have advanced
equipment.
We need at least
20 centres in
Dhaka alone,
whereas we have
only about six all
around the country

36. Our Government is taking initiatives to
procure new equipment, recruit trained
personnel and to create awareness among
people at root level.