New Advances in Treating Breast Cancer

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http://cancer-treatment-madurai.com Breast cancer is a type of cancer that starts in the tissues of the breast. Dr.S.G.Balamurugan is one of the best cancer doctor in India, offers low cost breast cancer diagnosis, breast cancer treatments and breast cancer care at Guru Cancer Hospital, Madurai.

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New Advances in Treating Breast Cancer

  1. 1. DR.S.G.BALAMURUGAN M.CH.,SURGICAL ONCOLOGISTGURU CANCER HOSPITAL. MADURAIBREAST CANCER- CURRENTCONCEPT
  2. 2. GURU CANCER HOSPITAL
  3. 3.  World: Commonest in female,30% of Total body cancer in female India: upto 20102ndmost commonest in women,2011 - CommonestBREAST CANCER
  4. 4. TODAYS AGENDA To discuss about BREAST CANCER How to approach pt with Oncological norms Recent updates in cancer management Mismanagement –QUALITY BREAST CANCER AWARENESS
  5. 5. APPROACH
  6. 6. PALPABLE BREAST MASSESfibrocystic changes (40%)fibrocystic changes (40%)no disease (30%)no disease (30%)benign NOS (13%)benign NOS (13%)fibroadenoma (7%)fibroadenoma (7%)CANCER (10%)CANCER (10%)
  7. 7. DIAGNOSISTriple assessmentClinical examination + imaging+FNAC/Corebiopsy
  8. 8. MALIGNANT LESIONo Lump in breast – usually painlesso Bloody nipple dischargeo Recent inversion of nippleo Destruction of nippleo Thickening of skin – orange peel likeo Node in the Axilla
  9. 9. Peaude’orangeAxillary vein thrombosis
  10. 10. Mammographic appearance of Ca A mass Associated calcification Architectural distortion Irregular border Skin or nipple change
  11. 11. WHAT TO DO?SUSPECTED MALIGNANT LESIONFNAC - if inconclusiveTrucut biopsy - if inconclusiveSmall lesion – excision biopsyLarge lesion – incision biopsy
  12. 12.  CONFIRMATION OF DIAGNOSIS trucut biopsy open biopsyIDEAL - BIOPSY
  13. 13. BIOPSY INCISIONS Incision must be transverse or curvilinear Scars should be included in the future definitive incision . NO VERTICAL INCISION Adversely affects the plan oftreatment both in definitive surgery & RT planning
  14. 14. ORDER OF INVESTIGATION INBREAST CONFIRMATION OF DIAGNOSIS fnac trucut biopsy incision biopsy METASTATIC WORKUP X-ray chest US abdomen Bone scan
  15. 15. THE NEED OF THIS ERAMultidisciplinary Tumor BoardFinalize Tumor stagingFormulates treatment plan
  16. 16. MANAGEMENT
  17. 17. MULTIMODAL Pt to be treated by all three weapons(surgery,RT,chemotherapy) by appropriatesequence that results in high success rateand less complications
  18. 18. MANAGEMENTCLASSIFICATION EARLY CANCER (INTENT – CURE)SURGERY LOCALLY ADVANCED CANCER (INTENT –CURE) NEOADJUVANT CHEMO METASTATIC CANCER (INTENT –PALLIATION)PALLIATIVE
  19. 19. MANAGEMENTCLASSIFICATION 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
  20. 20. CHANGING TRENDS
  21. 21. CHANGING TRENDS
  22. 22. EARLY CASES - OPTIONS OF SURGERYModified radical mastectomyORBreast Conservative surgery
  23. 23. EARLY CASES - OPTIONS OFSURGERY Whether Modified radical Mastectomyor Breast conservative surgeryAxillary dissection is mandatory
  24. 24. 20TH CENTURY 21 CENTURY
  25. 25. BREAST CONSERVATIVE SURGERY
  26. 26. Brachytherapy
  27. 27.
  28. 28. Alternative…………BCT is not possible
  29. 29. BreastReconstruction
  30. 30. Breast reconstruction
  31. 31. BREAST RECONSTRUCTIONTRAM FLAP
  32. 32. BREAST RECONSTRUCTIONLD FLAP
  33. 33. LOCALY ADVANCED BREAST CANCER
  34. 34. WHAT TO DO LABC?3 cycles of Neo adjuvant ChemoReviewResponds well No ResponseSurgery RT & Review for Surgery
  35. 35. MRI-before treatment After treatment
  36. 36. Early Nipple retractionOrange peel like skinUlcerLABC- POOR SURGICAL SELECTION
  37. 37. HOW TO MANAGE METASTATICDISEASE? Palliative treatment Chemotherapy Commonest metastasic site – BONE
  38. 38. MASTECTOMY NO ROLE IN METASTATICDISEASE WITH OUTBLEEDING , FUNGATION Toilet mastectomy indicated onlyfor bleeding and fungating tumor
  39. 39. MICRO METASTASIS IMAGE OCCULT MATASTASIS risk of recurrence and death from breastcancer with local therapy alone 30% with node-negative disease 75% with node-positive diseasePrinciples of Adjuvant Therapy
  40. 40. FOR WHOM ADJUVANT CHEMOTHERAPYTO BE GIVEN?For all cases except1. Node negative status2. Tumor size <1cm3. Grade 1 – Well differentiated cancer Preferable regimen FAC
  41. 41. FOR WHOM ADJUVANTRADIOTHERAPY TO BE GIVEN?Node positive statusIncomplete axillary dissectionTumor size more than 5cm
  42. 42. FOR WHOM ADJUVANT HORMONALTHERAPY TO BE GIVEN?ER and / or PR positive tumorsPREMENOPAUSAL – TAMOXIFENPOSTMENOPAUSAL – A.I(LETROZOLE)5 years
  43. 43. QUALITY GUIDELINE
  44. 44. HOW TO ASSESS WHETHER THESURGERY IS COMPLETE?Specimen should contains atleast 10axillary node
  45. 45. MISMANAGEMENT Incomplete Mastectomy Inadequate or no axillary dissection Direct surgery in locally advancedcancers Lumpectomy without FNAC or Trucut Improperly placed incision Incomplete data while referring
  46. 46. Residual Breast mass
  47. 47. Residual Breast with recurrence
  48. 48. Residual Breast with Tumor - Pre operative RT
  49. 49. LOCAL RECURRENCE DUE TO INADEQUATESURGERY
  50. 50. IS OPERATING SURGEON REALLY APROGNOSTIC FACTOR?Fact, always known but scientificallyand statistically accepted only
  51. 51. BREAST CANCERTreatment by surgical oncologistsresulted in a 33% reduction in the riskof death at 5 years.An analysis of 43,411 cases, cancersurveillance program data base- Los AngelesAnnals of surgical oncology 10:606-615(2012)Annals of surgical oncology
  52. 52. POSITIVE ATTITUDE
  53. 53. Prognosis: Lymph Nodes010203040506070800 1 2 3 4 5 6-10 11-15 16-20 >20Number of Involved Lymph NodesNumber of Involved Lymph Nodes%Five-YearSurvival%Five-YearSurvival(adapted from Harris et al. Cancer: Principles and Practice of Oncology. 5thed.)
  54. 54. Future treatment20th centuryCytotoxic therapyRadiotherapyHormonal therapySurgery21st centuryOncogene-based diagnosisTargeted therapyPatient-specific therapyToday
  55. 55. Paclitaxel & Docetaxel19711986OHEuropean Yew: Taxus baccataPacific Yew: Taxus brevifolia
  56. 56. GENETIC
  57. 57. PROGNOSISdisease state 5 year survivalnoninvasive 97%invasive, local 78%invasive, metastatic 22%
  58. 58. TODAY 50% of cancer is curable 25% it is possible to achieve long termsurvival
  59. 59. Breast Cancer Awareness
  60. 60. Breast cancer screening inwomen: the problemN= 10004 malignantCancerNormalN= 98016 Benignlesions
  61. 61. 9 Million Cancer Survivors“Progress with a Purpose: Eliminating theDeath and Suffering from Cancer by 2015”
  62. 62. Breast Cancer Awareness:
  63. 63. THE CANCERTO CURE OR NOT TO CUREIS IN YOUR HANDS
  64. 64. Cancer is a word not a sentenceCancer is a word not a sentence
  65. 65. THANK YOUDR.S.G.BALAMURUGAN M.Ch

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