may become infected. If this happens, one treatment option is a tonsillectomy.
A tonsillectomy is a surgical procedure to remove the tonsils. Tonsils are two small glands located in the back of your throat. Tonsils house white blood cells to help you fight infection, but sometimes the tonsils themselves become infected.
Tonsillitis is an infection of the tonsils that can make your tonsils swell and give you a sore throat. Frequent episodes of tonsillitis might be a reason you need to have a tonsillectomy. Other symptoms of tonsillitis include fever, trouble swallowing, and swollen glands around your neck. Your doctor may notice that your throat is red and your tonsils are covered in a whitish or yellow coating. Sometimes, the swelling can go away on its own. In other cases, antibiotics or a tonsillectomy might be necessary.
A tonsillectomy can also be a treatment for breathing problems like heavy snoring and sleep apnea.
Breast self Examination for Nursing Student. Procedure Of Breast Self examination. Component of Breast self Examination. Nurses Role in Breast Self Examination.
Breast self Examination for Nursing Student. Procedure Of Breast Self examination. Component of Breast self Examination. Nurses Role in Breast Self Examination.
Position patient supine, with the hand on the side you're examining behind their head.
Palpate the asymptomatic breast first.
Palpate using the flat palmar surface of your fingers.
Palpate using a systematic technique to ensure you examine all of the breast regions.
Position patient supine, with the hand on the side you're examining behind their head.
Palpate the asymptomatic breast first.
Palpate using the flat palmar surface of your fingers.
Palpate using a systematic technique to ensure you examine all of the breast regions.
The Art Pastor's Guide to Sabbath | Steve ThomasonSteve Thomason
What is the purpose of the Sabbath Law in the Torah. It is interesting to compare how the context of the law shifts from Exodus to Deuteronomy. Who gets to rest, and why?
Basic Civil Engineering Notes of Chapter-6, Topic- Ecosystem, Biodiversity Green house effect & Hydrological cycle
Types of Ecosystem
(1) Natural Ecosystem
(2) Artificial Ecosystem
component of ecosystem
Biotic Components
Abiotic Components
Producers
Consumers
Decomposers
Functions of Ecosystem
Types of Biodiversity
Genetic Biodiversity
Species Biodiversity
Ecological Biodiversity
Importance of Biodiversity
Hydrological Cycle
Green House Effect
This is a presentation by Dada Robert in a Your Skill Boost masterclass organised by the Excellence Foundation for South Sudan (EFSS) on Saturday, the 25th and Sunday, the 26th of May 2024.
He discussed the concept of quality improvement, emphasizing its applicability to various aspects of life, including personal, project, and program improvements. He defined quality as doing the right thing at the right time in the right way to achieve the best possible results and discussed the concept of the "gap" between what we know and what we do, and how this gap represents the areas we need to improve. He explained the scientific approach to quality improvement, which involves systematic performance analysis, testing and learning, and implementing change ideas. He also highlighted the importance of client focus and a team approach to quality improvement.
We all have good and bad thoughts from time to time and situation to situation. We are bombarded daily with spiraling thoughts(both negative and positive) creating all-consuming feel , making us difficult to manage with associated suffering. Good thoughts are like our Mob Signal (Positive thought) amidst noise(negative thought) in the atmosphere. Negative thoughts like noise outweigh positive thoughts. These thoughts often create unwanted confusion, trouble, stress and frustration in our mind as well as chaos in our physical world. Negative thoughts are also known as “distorted thinking”.
Extraction Of Natural Dye From Beetroot (Beta Vulgaris) And Preparation Of He...SachinKumar945617
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2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
Synthetic Fiber Construction in lab .pptxPavel ( NSTU)
Synthetic fiber production is a fascinating and complex field that blends chemistry, engineering, and environmental science. By understanding these aspects, students can gain a comprehensive view of synthetic fiber production, its impact on society and the environment, and the potential for future innovations. Synthetic fibers play a crucial role in modern society, impacting various aspects of daily life, industry, and the environment. ynthetic fibers are integral to modern life, offering a range of benefits from cost-effectiveness and versatility to innovative applications and performance characteristics. While they pose environmental challenges, ongoing research and development aim to create more sustainable and eco-friendly alternatives. Understanding the importance of synthetic fibers helps in appreciating their role in the economy, industry, and daily life, while also emphasizing the need for sustainable practices and innovation.
5. BREAST CANCER INCIDENCE
• Most common cancer in women worldwide.
• Most common cause of death from cancer among women.
• More than three fourths of these women in developing countries are
diagnosed in advanced stage of the disease. If these lesions are detected
early, most breast cancers can be effectively treated with good outcome.
• In India 144,937 women were newly detected with breast cancer in 2012, of
which 70,218 women died. Roughly, for every 2 women newly diagnosed
with breast cancer in India, one dies of this disease.
6. WHO TO BE SCREENED
• Women between the ages of 40-60 years of age
• All women identified with a breast mass that has previously not been clinically
evaluated need to be screened for breast cancer
• Women with high Risk factors can be offered screening from age 30 years such as
• Age over 40
• No children or children after 30 years of age
• Mother or sister with breast cancer
• History of breast biopsies or breast cancer
• Initiation of menses before 12 years of age
• Overweight
• Screening to be every 2 years
7. CLINICAL BREAST EXAMINATION - TIPS
• Be sensitive to the woman by giving her opportunities to express any concerns before and during
the examination.
• Respect the woman’s sense of privacy.
• If the woman is anxious, assure her that you will do your best to make the examination
comfortable.
• Throughout the examination, approach the woman slowly and avoid any sudden or unexpected
movements.
• Do not rush through the examination. Perform each step gently and ask her if she is having any
discomfort during any part of the examination. Be aware of her facial expressions and body
movements as indications that she is uncomfortable.
• Always take into consideration any cultural factors when deciding what clothing the woman should
remove. Have a clean sheet or drape to cover the woman’s breast if needed.
• These examinations should be performed in a clean, well-lit, private examination or procedure
room that has a source of clean water. A female assistant should be available to accompany the
woman when a male clinician is the examiner.
8.
9. GETTING READY
• Tell the woman you are going to examine her breasts.
• This is a good time to ask if she has noted any changes in her breasts and whether she
does monthly breast self-examinations. Tell the woman that you will show her how to do
a breast self-examination before she leaves.
• Wash your hands thoroughly with soap and water and dry them with a clean, dry cloth or
allow them to air dry before beginning the examination.
• If there are open sores or nipple discharge, put new examination or high-level
disinfected surgical gloves on both hands.
• Ask the woman to undress till the waist. With the woman undressed from the waist up,
have her sit on the examining table with her arms at her sides.
• Examine both in sitting and lying down position
10. PERFORMING A CBE
• Steps of examination - CBE involves two main parts:
• Inspection to identify physical signs of breast cancer.
• Palpation which involves using the finger pads to physically examine all areas of
breast tissue including lymph nodes (underarm area) to identify lumps
• 4 positions
• Arms by the side of trunk.
• Raising arms over the head.
• Pressing on the hips.
• Leaning forward.
11. INSPECTION
• In the sitting position first visually inspect
the breast, initially when woman is sitting
up right with arms on her hips, and then
with her arms raised over head.
• Note any change in symmetry of breast
shape, size, skin changes–skin dimpling
or retraction or ulceration the level of
both nipples, retraction of nipple(s),
inverted nipple.
•
12.
13. • Look at the breasts for shape and
size.
• Note any difference in shape, size,
nipple or skin puckering or dimpling.
Although some difference in size of
the breasts is normal, irregularities
or difference in size and shape may
indicate masses.
• Swelling, increased warmth or
tenderness in either breast may
suggest infection, especially if the
woman is breastfeeding.
14. • Look at the nipples and note their size
and shape and the direction in which they
point (e.g., do her breasts hang evenly?).
Also check for rashes or sores and any
nipple discharge.
• Have the woman first raise her arms over
her head and then press her hands on
her hips to contract her chest wall
(pectoral) muscles. In each position,
inspect the size, shape and symmetry,
nipple or skin puckering or dimpling of
the breast and note any abnormalities.
(These positions will also show skin
puckering or dimpling if either is present.)
Then have the woman lean forward to
see if her breasts hang evenly.
15. PALPATION
• Have the woman lie down on the examining table.
• Placing a pillow under her shoulder on the side being examined will spread the
breast tissue and may help in examining the breast.
• Place a clean sheet or drape over the breast you are not examining.
• Place the woman’s left arm over her head. Look at the left breast to see if it looks
similar to the right breast and whether there is puckering or dimpling.
• Use “Dial of clock method” for palpation, first use the finger pads of the middle three
fingers to palpate the entire breast, in overlapping circular motions, one area at a
time. Repeat both parts of the examination on both the left and rights breasts.
16. WOMAN IN LYING DOWN POSITION
• Light pressure for
superficial breast
tissue
• Medium pressure
for intermediate
layer
• Deep pressure for
tissue close to
chest wall
The finger pads of middle three
fingers should be used to palpate
the breast in circular motion
Palpation pressure
17. PALPATION
Pads of three middle fingers, hand
bowed up
Slide between palpations without
lifting fingers
Dime size circles
JAMA, Vol. 282, No 13, Oct. 1999
18. SPIRAL TECHNIQUE
• Using the pads of your three middle
fingers, palpate the breast using the
spiral technique. Start at the top
outermost edge of the breast. Press the
breast tissue firmly against the ribcage
as you complete each spiral and
gradually move your fingers toward the
areola. Continue this until you have
examined every part of the breast. Note
any lumps or tenderness.
19. CHECK FOR NIPPLE DISCHARGE
• Using the thumb and index finger, gently
squeeze the nipple of the breast. Note any
discharge: clear, cloudy or bloody. Any cloudy
or bloody discharge expressed from the nipple
should be noted in the woman’s record.
Although it is normal to have some cloudy
discharge from either or both breasts up to a
year after giving birth or stopping
breastfeeding, rarely it may be due to cancer,
infection or a benign tumor or cyst. Repeat
these steps for the right breast.
20. AXILLARY TAIL/ LYMPH NODES
• To palpate the tail of the breast, have
the woman sit up and raise her left arm
to shoulder level. If needed, have her
rest her hand on your shoulder. Press
along the outside edge of the pectoral
muscle while gradually moving your
fingers up into the axilla to check for
enlarged lymph nodes or tenderness. It
is essential to include the tail of the
breast in the palpation because this is
where most cancer occurs.
21. DIAL OF A CLOCK METHOD
Palpation will be done in each segment until entire breast is covered.
• Pads of finger (not tips of fingers) of middle three fingers (index, middle and ring) with hand held in slightly bowed
position will be used for palpation.
• In the “dial of a clock” method the whole breast is palpated as if it was a dial of a clock, 12 O’ clock being the highest
point at upper edge of breast just below the midclavicular point and 6 O’ clock being at the inframammary crease. The
palpation is begun at 12 O’clock from periphery to the nipple by describing small circles of about 3 cm in diameter.
Following circular movement of the “pad of fingers” 3 times with increasing pressure and without lifting the fingers, the
next circle is felt towards the nipple , overlapping with the previous circle to about half in diameter. Once the areola and
nipple area is reached, the next segment /sector is palpated at 1-O’clock. The procedure of palpation with “pad of 3
fingers” is repeated sequentially at 2 0’ clock, 3 0’, 4 0’, 5 0’, 6 0’, 7 0’, 8 0’, 9 0’, 10 0’ and 11 0’. If a lump is detected, its
size should be measured using a Vernier caliper. The palpation of mammary ducts is done by gently rolling the ducts
between the index finger and the thumb. Any thickening, tenderness or discharge is noted while palpating the mammary
ducts. In case of retraction of the nipple an attempt is made to pull the nipple forward to see if the nipple could be
brought forward or not and if any lump is present underneath the areola, whether the nipple and the ducts are tethered to
the lump or not. The skin overlying the lump is gently pinched and moved with the fingers to see if the skin could be
moved freely from /off the lump. If the skin is free from the lump but the movement of lump away from skin causes
dimpling of skin, the skin is considered “tethered”. If no movement of skin is possible, it is considered “fixed”. The fixity of
lump to underlying pectoralis major muscle is ascertained by requesting the lady to push her hand against the hip to
contract the muscle and then moving the lump.
22.
23.
24. • Note any discharge from the nipple(s), colour of the discharge, swelling/ lumps,
consistency of the lumps, swelling in the armpit (axillary area), above the collar bone
(supraclavicluar area) and root of the neck (infraclavicular area).
• Repeat this step for the right side.
• After completing the examination, have the woman dress herself. Explain any abnormal
findings and what, if anything, needs to be done. If the examination is entirely normal,
tell her everything is normal and healthy and when she should return for a repeat
examination (i.e., annually or if she finds any changes on breast self-examination).
• The optimal time for a CBE in a premenopausal woman is 5-10 days after the onset of
menses, avoiding the week before the period is preferable. Postmenopausal women
may have CBE performed at any time. On average, the time required to perform a CBE
ranges is 6 to 8 minutes
• Show the woman how to perform breast self-examination.
• Record your findings
25. LYMPH NODE EXAMINATION
• Request the patient to sit on a bed or a stool. For axillary nodes palpation,
pectoralis muscle is relaxed by examiner supporting patient’s forearm with
his own forearm, while facing the patient. The medial or central, pectoral and
lateral axillary nodes were palpated from in front while supraclavicular,
infraclavicular and posterior axillary nodes were palpated in sitting position
with examiner standing behind the patient.
• Please record the findings of a skin change, nipple change, nipple
discharge, any lump and lymph node enlargement in axilla or neck on Case
record form in a pictorial manner.
26. INTERPRETATION & DOCUMENTATION
The results of CBE will be interpreted in the following ways:
• Normal/negative: No abnormality on visual inspection or palpation
• Abnormal: Definite asymmetric finding on either visual inspection or
palpation. Presence of lump(s) in the breast, any swellings in the
armpit, recent nipple retraction or distortion, skin dimpling or retraction
,ulceration, any nipple discharge
27. WARNING SIGNS
The changes that can be seen are:
Unusual increase in the size of one
breast
One breast hangs unusually lower
Puckering of the skin Dimpling or puckering of a nipple or areola
Swelling in upper arm Change in the appearance of the nipple
Milky or bloody discharge from the
nipple
The changes that can be found on feeling the breasts are:
Lump in the breast Enlargement of lymph nodes in axilla or
neck
28. BREAST SELF EXAMINATION
• It is best to examine your breasts 7–10 days after the first day of the menstrual
period. (This is the time when the breasts are less likely to be swollen and tender).
• You should examine your breasts every month, even after your menstrual
period has stopped forever. If you are no longer menstruating, you should pick the
same day each month (e.g., the first day of the month) to examine your breasts.
• Breast self-examination can be done after bathing or before going to sleep.
Examining your breasts as you bathe will allow your hands to move easily over your
wet skin.
29. BREAST SELF EXAMINATION
• First, look at your breasts.
• Stand in front of a mirror with your arms
at your sides and look for any changes
in your breasts. Note any changes in
their size, shape or skin color or if there
is any puckering or dimpling.
• Look at both breasts again, first with
your arms raised above your head and
then with your hands pressed on your
hips to contract your chest muscles.
Bend forward to see if both breasts
hang evenly.
30. BREAST SELF EXAMINATION
• Size, shape, color
• Even ,no distortion
• Swelling
• Dimpling, puckering, bulging of
skin,
• Nipple discharge, position
• Red, sore, rash
32. • Then, feel your breasts.
• You may examine your breasts while standing up or
lying down. If you examine your breasts while lying
down, it will help to place a folded towel or pillow
under the shoulder of the breast you are examining.
• Raise your left arm over your head. Use your right
hand to press firmly on your left breast with the flat
surface (fat pads) of your three middle fingers. Start
at the top of the left breast and move your fingers
around the entire breast in a large spiral or circular
motion. Feel for any lumps or thickening. Continue to
move around the breast in a spiral direction and
inward toward the nipple until you reach the nipple.
• Be sure to check the areas between the breast and
the underarm and the breast and the collarbone.
• Raise your right arm over your head and repeat the
examination for the right breast.
Lie flat, arm below, with opposite hand and
rotatory movements, feel for any irregularity in
breast. Collarbone to abdomen, armpit to
cleavage.
34. WHAT TO LOOK FOR
• A change in the size or shape of the breast.
• A puckering or dimpling of the breast skin.
• A lump or thickening in or near the breast or underarm area. If the lump is smooth or
rubbery and moves under the skin when you push it with your fingers, do not worry about it.
But if it is hard, has an uneven shape and is painless, especially if the lump is in only one
breast and does not move even when you push it, you should report it to your healthcare
provider.
• If your breasts are usually lumpy, you should note how many lumps you feel and their
locations. Next month, you should note if there are any changes in the size or shape (smooth
or irregular). Using the same technique every month will help you know if any changes occur.
• Any nipple discharge that looks like blood or pus, especially if you are not breastfeeding,
should be reported to your healthcare provider.
• There may be some discharge from one or both breasts for up to a year after having a baby
or stopping breastfeeding
35. CLINICAL ALGORITHM
Negative Positive
Evaluation by surgeons
Mammography
Ultrasonography
FNAC
Core biopsy
CBE
Normal
Reentry into primary screening
Suspicious of malignancy
Refer to Medical College/ Regional
Cancer Centre for staging/treatment
41. RISK FACTORS FOR BREAST CANCER
• Female
• Aging
• First degree relative had breast cancer /
ovarian cancer.
• Menstrual history: early onset, late
menopause
• Child birth >30yrs
• Long term HRT, 30% increased risk.
• Oral Contraceptives, risk slight, risk
returns to normal once the use of OC’s
has been discontinued.
• Prior radiation exposure to breast at
young age.
• Breast disease
• Atpyical Hyperplasia
• Intraductal carcinoma in situ
• Intralobular carcinoma in situ
• Obesity, high BMI
• Diet rich in Fats, Alcohol
• Genetic risk factor
• BRCA-1
• BRCA-2
• P53
• Her-2/neu
42. BREAST CANCER RISK ASSESSMENT
Modified Gail model, 7 factors to calculate risk:
• Age>35 years
• First degree relative with breast cancer
• Prior breast biopsies – atypical ductal hyperplasia
• Age at menarche
• Age at first child birth
• Ethinicity
Risk of developing breast cancer is indicated by composite score of relative risk for
each factor.
43.
44. FACTORS THAT INFLUENCE SURVIVAL
• Age at diagnosis
• Tumor size
• Stage at diagnosis
• Biologic characteristics of tumor:
• Hormone receptor status (less
significant)
• HER 2
45. MAMMOGRAPHY
Look for:
• Masses
• Microcalcifications: Tiny flecks of calcium – like grains of salt – in the soft tissue of the
breast that can sometimes indicate an early cancer.
• spiculated appearance
46.
47. THE STAGES OF BREAST CANCER
Breast Cancer is diagnosed according to stages (stages 0 through IV) under the TNM
classification.
Factors used in staging of Breast Cancer:
• Tumor Size
Size of primary tumor
• Nodal status
Indicates presence or absence of cancer cells in lymph nodes
• Metastasis
Indicates if cancer cells have spread from the affected breast to other areas of the
body (i.e. skin, liver, lungs, bone)
Source: National Cancer Institute
48. STAGING BREAST CANCER
Stage 0
Ductal carcinoma in situ (DCIS) is very early breast cancer that has not
spread beyond the duct.
Stage I
Tumor is < 2 cm and has not spread outside the breast.
Stage IIA
No tumor is found in the breast, but cancer is found in the axillary lymph
nodes, or tumor is ≤ 2 cm and has spread to the axillary lymph nodes, or
tumor is 2-5 cm but has not spread to the axillary lymph nodes.
Stage IIB
Tumor is 2-5 cm and has spread to the axillary lymph nodes or is > 5 cm
but still confined to the breast.
Source: National Cancer Institute
49. ADVANCED BREAST CANCER
Stage IIIA
The tumor in the breast is smaller than 5 centimeters and the cancer has spread to underarm lymph nodes
that are attached to each other or to other structures, OR the tumor is more than 5 centimeters across and
the cancer has spread to the underarm lymph nodes.
Stage IIIB
Tumor has spread to tissue near the breast (i.e. the skin or chest wall) and may have spread to lymph
nodes within the breast area or under the arm.
Stage IIIC
Tumor has spread to the lymph nodes beneath the collarbone and near the neck, and may have spread to
the lymph nodes within the breast area or under the arm and to the tissues near the breast.
Stage IV
Tumor has spread to other organs of the body (i.e. lungs, liver, or brain).
Source: National Cancer Institute
50. BREAST CANCER TREATMENT
Surveillance LCIS, DCIS Physical exam, mammography, MRI
Surgery DCIS: Lumpectomy if DCIS in 1 area,
Mastectomy if DCIS in 2 area or large
or multifocal
Radiotherapy DCIS Usually accompanies lumpectomy
Hormonal therapy DCIS In selected ER+ve, for 5yrs lowers
cancer risk.
TNM stage 0
51. BREAST CANCER TREATMENT
Breast conservative Surgery Lumpectomy
Quadrantectomy
Radiotherapy Axillary dissection
Affected breast chest wall
Adjuvant chemotherapy Combination chemotherapy 3-6 mths
Adjuvant Hormonal therapy Premenopausal: tamoxifen in ER+ve,
Postmenopausal: Tamoxifen &
aromatase inhibitor.
TNM stage 1 & 2
52. BREAST CANCER TREATMENT
Surgery Lumpectomy
Mastectomy
Radiotherapy Chest wall, regional lymph nodes
Adjuvant chemotherapy Combination chemotherapy 4-6 mths
Adjuvant Hormonal therapy If ER+ve or PR+ve,
TNM stage 3
53. BREAST CANCER TREATMENT
Surgery Select cases to relieve symptoms
Radiotherapy Select cases to relieve symptoms and
control local disease.
Chemotherapy Primary treatment, single agent or
Combination chemotherapy.
Hormonal therapy If ER+ve or PR+ve,
Monoclonal antibody HER 2 +ve
TNM stage 4
54. LOCAL THERAPY: SURGERY
Local therapy provides adequate control of locoregional disease, includes surgery and
radiotherapy.
Surgery:
• Mastectomy:
Modified radical with sentinel LN evaluation
Radical /total mastectomy with sentinel LN evaluation
May include breast reconstruction
• Breast conservation surgery:
Wide local excision
Quadrantectomy
Lumpectomy , includes axillary dissection if disease invasive.
55. COMPLICATIONS OF SURGERY
• Lymphedema
• 10-305 women who undergo axillary dissection
• 3% if sentinel node biopsy only
• Numbness
• Reduced shoulder mobility
• Psychosocial problems of mastectomy
• Phantom breast sensation
56. LOCAL THERAPY: RADIOTHERAPY
• Adjuvant radiotherapy in ESBC
• Reduces risk of recurrence
• May improve survival
• Radiotherapy in MBC
• Relieves symptoms such as pain, in pts with bone, brain metastasis while not
effecting a cure.
57. RT: METHODS OF DELIVERY
• External beam irradiation, to entire breast.
• Partial breast irradiation, including brachytherapy
• Radioactive seeds/pellets placed internally near site of tumor for local effects.
• Can deliver high dose rate radiation, allowing shorter treatment regimes
compared to traditional RT
• 5yr survival rates comparable to whole breast RT.
58. SYSTEMIC THERAPY FOR BREAST CANCER
• Hormonal therapy
• Chemotherapy
• Targeted therapy
• Clinical trails provide support for optimal implementation for above
therapies in pts with breast cancer.
59. EVOLUTION OF SYSTEMIC ADJUVANT
THERAPY FOR ESBC
Mastectomy alone
Adjuvant CMF
Adjuvant CAF, CEF
Adjuvant AC, EC, FEC
Adjuvant AC + T
Dose dense AC+T TAC
Addition of
Tamoxifen/
Aromatase
inhibitor
Progressive
improvement in
disease free and
overall survival
61. PREFERRED CT: MBC
Single agent options:
• Anthracycline – doxorubicin, epirubicin
• taxane: - paclitaxel, docetaxel
• Capecitabine
• Others – vinoretbine, irinotecan
Combination options
• CAF/FAC -docetaxel, capecitabine
• AT – paclitaxel, gemcitabine
• FEC
• CMF
• AC, EC – paclitaxel, carboplatin, trastuzumab.
• Single drug/combination controversial topic
• Combinations preferred in MBC
• Newer combinations improve outcome &
manageable safety profile
• Sequential therapy may be appropriate for pts
with indolent disease or nonvisceral MBC>
62. SUMMARY: ADJUVANT CT IN ESBC
• Adjuvant CT improves survival inESBC
• Improved survival outcomes demonstrated with CMF
• Regimes with anthracycline or a taxane improve outcome
• Dose dense approach has demonstrated benefit in disease free and
overall survival.
63. TARGETED THERAPY OPTIONS IN BC
• HER2 inhibitor family
• Antibodies
• Trastuzumab
• Small molecules
• Gefitinib
• Erlotinib
• Lapafarnib
• Angiogenesis inhibitor
• Antibodies
• Bevacizumab
64. CONCLUSIONS
• Although breast cancer incidence has increased, mortality rates due to
breast cancer are reducing.
• Advances in conventional therapy include less radical surgery and reduced
radiation field.
• Cytotoxic CT advances include improved types, doses, scheduling.
• Improvements in hormonal therapy.
• Newer target therapy
• Treatment regimes: individualized.