Male breast cancer is rare, accounting for less than 1% of breast cancers. Risk factors include Klinefelter syndrome, genetic mutations like BRCA2, and family history. Treatment typically involves mastectomy with lymph node dissection and tamoxifen therapy. Occult breast cancer presents as axillary lymph node metastases without a detectable primary tumor. Further workup with imaging and biopsy is needed. Standard treatment is axillary lymph node dissection along with mastectomy or radiation therapy to the breast. Prognosis depends on stage but can be similar to typical breast cancer outcomes with proper treatment.
This slide explains about Germ cell tumor ovary (GCT Ovary). It explains how a various stages developmental anomaly could give rise to various types of GCT.
breast cancer is the malignent condition of breast and it is the 2nd most common cancer in females with needs to be special attention as it its a very private things for female for early detection and its treatment, and provide a brief knowledge regarding breast cancer to all the nursing students and for their application in their c
This slide explains about Germ cell tumor ovary (GCT Ovary). It explains how a various stages developmental anomaly could give rise to various types of GCT.
breast cancer is the malignent condition of breast and it is the 2nd most common cancer in females with needs to be special attention as it its a very private things for female for early detection and its treatment, and provide a brief knowledge regarding breast cancer to all the nursing students and for their application in their c
It contains details about breast carcinoma-pathology,investigations and diagnosis,NACT,surgery and adjuvant therapy. Hope you will find it helpful.....
a nice presentation about the Ovarian Cancer its include an introduction with brief notes about the epidemiology and risk factors then shift to pathology and pathogenesis and diagnosis with signs , symptoms and lab tests with imaging modules , screening , management
Globally, breast cancer is the most diagnosed cancer and the leading cause of cancer death among females.
representing 23% of the total cancer cases and 14% of the cancer deaths.
Breast cancer is now also the leading cause of death among women from all cancers in developing countries .
Additionally, breast cancer mortality rates in African women are higher in comparison to women living in Western countries .
Manegement of adenexal masses in pregnancyWafaa Benjamin
Over the last 20 years, the use of ultrasound in pregnancy has dramatically increased the numbers of ovarian cysts diagnosed.
The majority of these ovarian cysts in pregnancy either resolve spontaneously or are due to benign conditions.
Ovarian cancer is extremely rare in women of childbearing age and thus most of these cysts can be managed conservatively.
In terms of malignancy potential, those that are malignant are likely to be borderline.
Unless there is a suspicion of malignancy or there is a significant cyst complication, such as torsion, surgery is not indicated.
MRI is a safe and useful tool to help evaluate cysts in more detail in situations where ultrasound provides an inconclusive answer.
If surgery is planned, this should take place during the second trimester to minimise the risk of miscarriage.
Whether surgery is done laparoscopically or using a traditional open approach, it is largely dependent on operator experience and patient preference.
Aspiration of ovarian cysts is only indicated where they appear simple on ultrasound and where they are causing pain or are thought to be obstructing the birth canal.
If surgery does not take place, then ultrasound follow-up during and after pregnancy may be advised accordingly.
Tumour Markers are substances present in the tumour, produced by the tumour or by the host as a response to the presence of the tumour, providing information about biological characteristics of the tumour. these tumour markers may specific for the tissue but often get elevated in neoplastic as well non-neoplastic lesions, further Various analytical platforms available for serum tumour markers lack standardisation. These factors add to interpretative challenges in serum tumour markers
Similar to Male breast cancer and occult primary (20)
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
3. EPIDEMIOLOGY
In the US, app. 2140 new cases of breast cancer in men
are diagnosed annually, and 450 deaths occur; this
represents less than 0.5 percent of all cancer deaths in
men annually.
By contrast, in Tanzania and areas of central Africa,
breast cancer accounts for up to 6 % of cancers in men.
In the United States, the ratio of female to male breast
cancer is approximately 100:1 in whites, but lower (70:1)
in blacks.
Blacks also have a poorer prognosis, even after
adjustment for clinical, demographic, and treatment
factors.
4. The median age of onset of breast cancer in men is
65 to 67, approximately 5 to 10 years older than in
women
Race:- Afro caraibbean men (6%)> white men (0.5
%)
(later and more advancerd disease)
Incidence of breast cancer in men has been
increasing, it has increased 26 %over the past 25
years
7. Klinefelter’s syndrome (XXY )
Males with Klinefelter’s syndrome have a 50-fold
greater risk of breast cancer over the general
male population.
KS may be present in 3%–7% of men with breast
cancer.
The syndrome consists of atrophic testes,
gynecomastia, high serum concentrations of
gonadotropins ( FSH and LH)and low serum
testosterone levels; the net effect is a high ratio of
estrogen-to-testosterone.
9. BRCA-2 mutations
More common in MBC.(4-16 % mutation carriers)
Younger age
Poorer survival
Highest prevalence in Iceland where founder mutation
is present in 40 % cases.
Other possible mutations
PALB2
Androgen receptor
CYP17
CHEK2
PTEN
hMLH1
10. Family history
2.5 times greater risk
15 to 20 percent of men with breast cancer have a
family history of the disease
Prior irradiation
Chest wall radiation
Mantle radiation for Hodgkin’s disease
11. Benign breast disease
Gynecomastia
Alcohal use
Liver disease
Electromagnetic fields
Heat
Volatile organic compounds (e.g.
tetrachloroethylene,perchloroethylene,
trichloroethylene, dichloroethylene, and benzene)
12. •Painless subareolar mass (M C presentation)
•Nipple Retraction, ulceration
•Fixation to skin or underlying muscle
•Nipple involvement is 40 to 50 percent, possibly because of the scarcity of breast
tissue, and the central location of most tumors
13. WORKUP
Mammogram
(92 % sensitive and 90% specific)
Spiculation,calcification, mass ecentric to nipple.
USG is a useful adjunct (nodal)
Biopsy from suspicious mass
ER, PR and her-2 neu testing
Metastatic workup(chest imaging , CT abdomen
and bone scan)
14. PATHOLOGIC CHARACTERSTICS
90 % of breast cancers in men are invasive ductal
carcinomas.
Lobular cancer :- 1.5 %
The lack of a lobular histologic subtype is due to lack of acini
and lobules in the normal male breast, although these can be
induced in the context of estrogenic stimulation.
DCIS more common in FBC (20 % v/s 7 to 11% )
DCIS in men tends to occur at a later age, presents more
frequently in an intraductal papillary form, and is more often
low-grade.
Paget disease and inflammatory breast cancer are rare.
15. MOLECULAR CHARACTERSTICS
High rates of hormone receptor (ER/PR) expresssion.
ER- 90% +
PR-81% +
Her-2 neu expression is less likely- 5-15%
Triple negative :- 4%
Younger patients were more likely to be diagnosed with
a HER2-positive tumor.
Non-Hispanic black men were more likely to have triple-negative
breast cancer compared to non-Hispanic white
or Hispanic men (9 versus 3 and 6 percent,respectively).
17. DIFFERENCES FROM FEMALE CANCER
Average age of presentation is late (5-10 yrs).
Presents in more advanced stages with retroareolar
location and chest wall involvment.
BRCA-2 > >BRCA-1
Lobular histologies uncommon (15 % v/s 1.5%)
High rates of hormone receptor expression
18. SURGERY
MRM + ALND is standard approch.
Extensive chest wall muscle involvment :- Radical
mastectomy
BCS less appropriate
Presentation in more advanced stage
Retroareolar & chest wall inv
Scarcity of breast tissue
SLN :- data is limited but feasible.
ASCO expert -acceptable
19. Reconstructive surgery
40% - stage III /IV
Extensive resection, skin closure difficult
Goal is adequate skin coverage in comparison to
volume replacement in FBC
20. HORMONAL THERAPY
High expression of ER/ PR receptor
Tamoxifen for 5 years recommended
Based largely upon the benefits that have been observed in
clinical trials performed in women
Paucity of Prospective trials to confirm the validity of this
approach in men.
Retrospective comparisons support a survival benefit from
adjuvant tamoxifen in MBC (61 versus 44 percent) and disease-free
survival (56 versus 28 percent) compared with a group of
historical controls who underwent mastectomy alone
Low adherence:- VTE, Decrease libido, hot flushes,wt gain,
social support
21. Aromatase inhibitors
There are insufficient data to support the use of an AI in
the adjuvant setting for breast cancers in men.
Unable to prevent testes derived estrogen synthesis
which is the source of 20% of endogeneous estrogen in
men.
The recommended choice is tamoxifen rather than an
AI in the adjuvant setting for men with breast cancer.
Her-2 – Transtuzumab
Insufficient data
22. CHEMOTHERAPY
Chemo less frequently used than FBC
Hormone unresponsive tumors (ER-)
Retrospective studies revealed NS trend in men
with node + disease toward better outcome
23. METASTATIC DISEASE
Hormonal manipulation :- Ist line therapy
Origionally performed surgically via orchidectomy,
adrenalectomy or hypophsectomy.(morbid)
Tamoxifen:- as effective as Sx
AI :- shown benefit in metastatic setting
AI+ orchidectomy Complete estro supp.
AI+ LHRH analogues
Hormone refrectory :- chemo
24. CONTRALATERAL BREAST CANCER
The risk of a C/L breast cancer appears to be higher for men than it is
FBC.
Compared to the general population, the standardized incidence ratio
(SIR) for C/L breast cancer in male survivors was 30. However, for
men diagnosed < 50 yrs the SIR was 110.
Men with a h/o breast cancer had a 93-fold higher risk of developing
c/l breast cancer than men without such a history.
The absolute risk for an individual man with breast cancer developing
a c/l breast cancer was 1.75 %
Despite the significantly increased risk of a c/l cancer in men with a
h/o breast cancer, the absolute risk of a c/l breast cancer is much
greater in women because of the higher prevalence of the disease.
The role of screening mammography for the c/l breast in men with
MBC has not been explored.
25. SURVIVORSHIP ISSUES
¼ discontinue T/t
Socially isolating for men, stigmatized by their
diagnosis.
Greater adjustment diff
Poor physical and mental health
Late age presentation :- more CV risks.
27. Cancer of unknown primary site (CUP), defined as the
presence of metastatic cancer with an undetectable
primary site at the time of presentation.
2 % of all cancer diagnoses.
Occult breast cancer (OBC), which manifests as an
axillary lymph node metastasis without a detectable
primary breast tumor on clinical examination or
radiography, is a rare presentation.
OBC accounts for 0.3-1% of all breast cancers.
28. Occult primary breast cancer was first recognized
by William Halsted, who described three patients
presenting with axillary masses that were
eventually found to represent breast cancer.
In modern series, occult breast cancer accounts for
0.1 to 0.8 percent of all newly diagnosed breast
cancers and the incidence has not decreased with
improvements in breast imaging
29.
30. DIAGNOSTIC WORK-UP
The first step in the diagnostic workup of a patient
with unexplained axillary adenopathy is a biopsy.
Besides standard light microscopic examination of
H & E stained sections, other techniques such as
IHC and sometimes electron microscopy can help
to narrow the differential diagnosis.
31. Histologies
70 % are adenocarcinomas
15 to 20 % are poorly differentiated carcinomas
10 % represent poorly differentiated
adenocarcinomas.
The remainder are squamous cell, neuroendocrine,
or poorly differentiated neoplasms.
32. DIFFERENTIAL DIAGNOSIS
Lymphomas
Melanomas
Sarcomas
Thyroid cancers
Skin cancers
Lung cancers
Less often, uterine, ovarian, sweat gland, or gastric
cancers.
In approximately 30 percent of cases, the primary
site is never identified
33. IHC MARKERS
CEA
CK- 7 and CK-20
ER/PR
Gross cystic disease fluid protein-15 (GCDFP)
Mammaglobin
Thyroid transcription factor (TTF-1)
CA-125
In men :- Markers for prostste cancer
34.
35.
36.
37.
38. Advantages of MRI
Breast MRI is more sensitive.
Breast MRI can detect a primary breast cancer in
approximately 75 % of women who present with ALN mets
with negative clinical exam & imaging.
Identification of a primary breast cancer by MRI may
facilitate BCS instead of mastectomy.
Some lesions found on MRI can be identified on
subsequent, targeted "second-look” ultrasound and may
then be biopsied under US guidance.
Disadvantages
High false positive results. (29 %)
All suspicious findings on MRI require pathologic
confirmation.
42. Patients with OBC who present with axillary lymph
node metastasis should receive the standard
treatment.
No differences in outcomes were observed
between patients who received ALND followed by
subsequent breast radiotherapy and patients who
underwent mastectomy plus ALND.
43. MANAGMENT
Local treatment for breast is necessary in conjunction with ALND.
Mastectomy —
A standard approach is to perform a modified radical mastectomy
(MRM) at the time of ALND.
A breast malignancy will be found upon histologic review of the
mastectomy specimen in approximately 65 percent of patients.
ALND + XRT
Observation alone is deterimental.
44. Radiation — The role of WBI as a breast-conserving
alternative to mastectomy is unclear.
No RCT comparing MRM + ALND to WBI + ALND.
Only available data are from small retrospective case
series.
Local
control
73-100%
46. SUMMARY OF TREATMENT
All patients should undergo ALND
Optimal treatment for the ipsilateral breast is controversial. Standard
approach is to perform MRM at the time of ALND.
For women who wish to preserve their breast, WBI is an acceptable
option.
Observation alone for the ipsilateral breast is not recommended.
Systemic adjuvant therapy according to published guidelines for stage
II primary breast cancer is recommended.
Women with ALN mets who have adenoca or poorly differentiated
carcinoma histology, compatible IHC staining, and no evidence of a
breast cancer primary but who have evidence of other distant
metastases should be treated according to guidelines for metastatic
breast cancer