BREAST EXAMINATION PPT.pptx
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Breast examination involves several cytological and histopathological studies and procedures to accurately diagnose breast lesions. These include FNAC, cell block preparation, nipple discharge and ductal lavage cytology, core needle biopsy, and examination of sentinel lymph nodes through serial sectioning and histopathological analysis according to standardized reporting protocols. Proper specimen handling and timely processing are important for accurate hormone receptor assessment and diagnosis.
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The key to a good grip on asthma is proper knowledge and management strategies. Understanding the patient-specific symptoms and carving out an effective treatment likewise is the best way to keep asthma under control.
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Breast cancer: Post menopausal endocrine therapy
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
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- 1. BREAST EXAMINATION : Histopathological consideration By Dr. Shilpi Sahu HOD Pathology
- 12. Cytological Studies • FNAC • Cell block • Nipple discharge cytology • Ductal lavage cytology • Imprint cytology (intra-op, can be done for Sentinel Lymph Node too)
- 13. FNAC
- 15. Cytology Reporting Categories • C1 – Unsatisfactory • C2 – Benign • C3 – Atypia probably benign • C4 – Suspicious of Malignancy • C5 – Malignant
- 16. Investigative Procedures ABBI : Advanced Breast Biopsy Instrumentation
- 20. Specimen Sectioning - Grid
- 21. Serial Sections
- 23. Breast Histopathological Reporting – CAP Protocol
- 31. Take Home Message • Breast Self Examination is must for early detection of lesions. • Clinico-pathological correlation is important. • Fresh specimens to be sent as soon as possible to histopathology lab for proper fixation and accurate ER/PR studies.
- 32. ITS NEVER THIS