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Prof.Arshad Cheema

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Prof.Arshad Cheema

  1. 1. Early Detection of Cancer Breast <br />Prof. Muhammad Arshad Cheema FRCS<br />Chairman Department of Surgery<br />King Edward Medical University<br />Chief Division of Surgery Mayo Hospital Lahore<br />Consultant Cancer Surgery<br />
  2. 2. 5 common causes of deaths in Pakistan<br />Injuries<br />Cancer<br />Cardiovascular Diseases<br />TB, Hepatitis and other Communicable Diseases<br />Diarrhea & Malnutrition<br />
  3. 3. Cancer has become the no 1 killer of people worldwide WHO 2010<br />
  4. 4. Major Surgical Disease Burden in Pakistan<br />Trauma<br />Tumors<br />Infections like TB, Typhoid, Peritonitis <br />
  5. 5. What is World Cancer declaration?<br />
  6. 6. What is World Cancer declaration?<br />
  7. 7.
  8. 8. Surgical Oncology Society Pakistan<br />(SOS-PK)<br />Association for advancement of cancer surgery in Pakistan<br />www.cancersurgerypk.org<br />
  9. 9. Four components of cancer control<br />Prevention, <br />Early detection<br />A third of cancers could be cured if detected early and treated adequately <br />Diagnosis & treatment <br />Palliative care <br />All patients in need of pain relief could be helped if current knowledge about pain control and palliative care were applied. <br />
  10. 10. Can we Prevent Cancer?<br />
  11. 11.
  12. 12. Cancer Prevention<br />Avoid exposure to known carcinogens <br />Modify risk factors<br />
  13. 13. Cancer Prevention<br />40% of cancer could be prevented, mainly by <br />not using tobacco, <br />having a healthy diet, <br />being physically active <br />and preventing infections that may cause cancer. <br />
  14. 14. Tobacco use is the single largest preventable cause of cancer in the world <br />
  15. 15. Carcinogen Vendor<br />
  16. 16. Oral Cancer from Tobacco use<br />
  17. 17. Is there any advantage in early detection?<br />
  18. 18. One fifth of all cancers worldwide are caused by a chronic infection, for example human papillomavirus (HPV) causes cervical cancer and hepatitis B virus (HBV) causes liver cancer <br />
  19. 19. Chances of survival are increased if diagnosis is made at an early stage and prompt therapy is instituted<br />
  20. 20. How can we detect cancer early<br />
  21. 21. What are danger signals for cancer? – (the red flags)<br /><ul><li>Bleeding from a body orifice
  22. 22. Development of a lump which grows rapidly
  23. 23. A mole which starts to bleed or develops a halo
  24. 24. A mouth ulcer which does not heal is 2 weeks</li></li></ul><li>What is screening?<br />
  25. 25. Mammography detection<br />
  26. 26. Who should get screening?<br />
  27. 27. What is the biggest problem faced by this nation?<br />
  28. 28. What can we do as society in this regard?<br />
  29. 29. Health Education of Community – a neglected field in our country<br />
  30. 30. Early vs late presentation<br />
  31. 31. How common is Breast Cancer here?<br />
  32. 32. The usual story of Ca breast presentation in Pakistan<br />February7, 2007<br /><ul><li> All 5 of these patients in our ward have Ca Breast
  33. 33. Four have advanced 3b disease
  34. 34. One has stage 3a disease</li></li></ul><li>2 ½ years later 9 patients (2 stage 2)<br />Oct 24, 2009<br />
  35. 35. Lump in breast<br />Lymph nodes in axilla<br />8 cm lump above nipple<br />
  36. 36. TIME SPAN OF DELAY<br />
  37. 37. CLINICAL PRESENTATIONS OF PATIENTS<br />
  38. 38. Cancer frequently presents at an advanced stage in this country<br />
  39. 39. Fungating tumor is a distressing site<br />
  40. 40. Locally advanced CA<br />
  41. 41. Locally advanced CA<br />
  42. 42. Locally advanced CA<br />
  43. 43.
  44. 44. How common is locally advanced and metastatic Ca Breast<br />At least 2/3 in our country<br />
  45. 45. What are the factors which influence survival?<br />
  46. 46. Survival<br />Depends on<br />Stage at diagnosis<br />Axillary LN involvement<br />Other Prognostic factors<br />Tumor grade<br />Estrogen & Progestin Receptors <br />Her 2 nue<br />
  47. 47. Early Diagnosis<br />Breast Self Examination & Education<br />Breast Clinical Examination<br />Mammography<br />Genetic Screening?<br />
  48. 48. First Issue in Oncology is of the tissue – 4 ways of getting tissue<br />Fine needle aspiration cytology<br />Core needle biopsy<br />Incisional biopsy<br />Excision biopsy<br />
  49. 49. Surgery <br />Conservative (NSABP trial B06)<br />Lumpectomy + Radiotherapy <br />Mastectomy<br />Radical (Halsted)<br />Modified radical (Patey)<br />Spares pecmaj muscle<br />
  50. 50. In the late 20th century, breast-conserving surgery (BCS) was introduced as an alternative to mastectomy<br /> Although no differences in overall survival were found between these two surgical procedures, BCS was associated with a significantly increased risk of local recurrence if radiotherapy was omitted. <br />
  51. 51. To Conserve or not?<br />The choice between mastectomy or BCS is influenced by various factors, including<br />Age at diagnosis<br />tumor size / breast size<br />Geographical residence / access to healthcare facilities / ability to follow up<br />Patient’s or physician’s preference, <br />
  52. 52. Conservative Surgery<br />Invasive ca < 4 cm<br />Axillary Dissection & Radiation<br />Disease free survival similar to mastectomy<br />Needs careful follow up<br />
  53. 53.
  54. 54. Majority of breast cancer presents as locally advanced disease<br />
  55. 55. Raw smelly wound<br />
  56. 56. Real Life Scenarios<br />
  57. 57. Patient with bilateral tumourLeft tumour bleeding 200-300 ml /day<br />
  58. 58.
  59. 59. Wound closure with LD Flap<br />
  60. 60. Outcome of the mastectomy wound<br />
  61. 61. Recipient and Donor site Closure after LD Flap<br />
  62. 62. Tumour in the Right Breast<br />
  63. 63.
  64. 64.
  65. 65. Donor and Recipient area after Bilateral LD Flap<br />
  66. 66. Histopathology<br />Invasive ductal carcinoma<br />8/20 lymph nodes involved<br />ER -ve PR -ve<br />
  67. 67. 26 months post-operative<br />She received post op radiation to chest<br />6 cycles of CMF<br />On follow up remains tumor free 26 months after surgery <br />
  68. 68. Submandibular Gland tumor<br />
  69. 69. Submandibular Gland tumor managed by excision and Pec major flap<br />
  70. 70. October is celebrated asBreast Cancer Awareness Monththe pink ribbon campaign <br />
  71. 71. There is urgent need for public health education<br />so that patients can be diagnosed at early stage <br />when conservation is possible <br />with chances of long term survival<br />
  72. 72. Summary<br />Early detection maximizes chances of cure<br />Pay heed to warning signs – See a doctor<br />Get screened if you are among high risk population<br />
  73. 73. You are welcome to<br />3rd National Cancer Surgery Conference<br />Feb 2-5, 2011<br />Organized by<br />Surgical Oncology Society Pakistan (SOS-PK)<br />www.cancersurgerypk.org<br />
  74. 74. Dr. Muhammad Arshad Cheema FRCS<br />President Surgical Oncology Society Pakistan<br />Professor & Chairman Department of Surgery<br />King Edward Medical University<br />

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