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Breast Cancer, A Common Problem in Sri Lanka Dr Dehan Gunasekera Consultant Oncologist National Cancer Institute of Sri Lanka.

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Presentation on theme: "Breast Cancer, A Common Problem in Sri Lanka Dr Dehan Gunasekera Consultant Oncologist National Cancer Institute of Sri Lanka."— Presentation transcript:

1 Breast Cancer, A Common Problem in Sri Lanka Dr Dehan Gunasekera Consultant Oncologist National Cancer Institute of Sri Lanka

2 Leading Cancer sites-2010 Male Male  Lip,oral cavity and pharynx 14.1 %  Bronchus and Lung 7.7 %  Oesophagus 5.8 %  Colon rectum 4.4 % Female Female  Breast 18.4 %  Cervix 8.9 %  Ovary 5.9 %  Thyroid 5.6 %

3 new Cancer patients new Cancer patients new Cancer patients new Cancer patients new Cancer patients new Cancer Patients

4 Breast Cancer  Epidemic! Asian-young,ER-,PR-,High grade Asian-young,ER-,PR-,High grade Europian->50 years,ER+,PR+ Europian->50 years,ER+,PR+ Awareness of Breast CA at all ages Presentation Mammographic detection Blood stained nipple discharge Self detected lump Clinical breast examination detected Locally advanced-ulcer,Peud’orange Metastatic-Pleural effusion,Back ache

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7  Diagnosis Triple assesment Triple assesment Clinical Examination-site,size for staging Clinical Examination-site,size for staging Mammogram/US scan in < years Mammogram/US scan in < years FNAC/Core(trucut) biopsy FNAC/Core(trucut) biopsy Metastatic Survey General and systemic examination General and systemic examination Xray chest Xray chest US scan Abdomen and Pelvis US scan Abdomen and Pelvis LFT LFT FBC,SC FBC,SC Bone Scan,CT scan–depending on the Bone Scan,CT scan–depending on the symptom symptom

8 Histology  Preinvasive CA Duct Carcinoma in Situ (DCIS) Duct Carcinoma in Situ (DCIS) Lobuler Carcinoma in Situ (LCIS) Lobuler Carcinoma in Situ (LCIS) Invasive CA Duct CA Mucinous Ca Mucinous Ca Medullary CA Medullary CA Papillary CA Papillary CA Lobuler CA

9  Receptor status is mandatory  General Concept  ER-,PR- Poor prognosis  Her2- Good prognosis  Change in Concepts due to  Complicated cross talk between Receptors  Concept of Triple negative Disease –ER (-) –PR (-) –Her-2/neu (-)

10 Treatment  Early Stage –Surgery Breast Conserving Surgery+RT to the breast Breast Conserving Surgery+RT to the breast Wide local Excission Wide local Excission Qadrantectomy Qadrantectomy Lumpectomy Lumpectomy Mastectomy+immediate or delayed reconstruction Mastectomy+immediate or delayed reconstructionAxilla- US scan axilla (-) LN –Sentinal Lymph node US scan axilla (-) LN –Sentinal Lymph node biopsy biopsy US scan axilla (+) LN- Axillary clearance US scan axilla (+) LN- Axillary clearance

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17  Place for Radiotherapy Mandatory in Breast conservation Mandatory in Breast conservation Lymph nodes in Axilla+ Lymph nodes in Axilla+ Large tumours (>5 cm) Large tumours (>5 cm) Poorly Differentiated CA Poorly Differentiated CA To relieve pain locally-spine To relieve pain locally-spine Place of Chemotherapy Place of Chemotherapy Post operative(Adjuvant) Post operative(Adjuvant) Lymph nodes in Axilla+ Lymph nodes in Axilla+ Poorly Differentiated CA Poorly Differentiated CA Large tumours (>5 cm) Large tumours (>5 cm) ER-,PR-,Her2 + ER-,PR-,Her2 + Metastatic Disease Metastatic Disease

18  Preoperative(Neoajuvant) Locally advanced disease(T3,T4) Locally advanced disease(T3,T4) Inoperable Inoperable Chemothrapy-Anthracyclin based Paclitaxel based Paclitaxel based Place of hormonal Therapy ER+,PR+ Premenapausal-Tamoxifen ER+,PR+ Postmenapausal- Aromatase inhibitors Aromatase inhibitors Anastrazole Anastrazole Letrazole Letrazole Exemestane Exemestane

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20 The occurrence of relapse and survival (Prognosis) are influenced by  1.Stage at presentation (Size,Pathology,Grade,Metastasis)  2.Lymph node status  3.Hormone receptor status  4.Measures of proliferation of the cancer cell  5.Genetics of the cancer and the host  6.Age at diagnosis

21 St Galens Recommendations Low risk Low risk T1 T1 N0 N0 G1 G1 ER+ and /or PR+ ER+ and /or PR+ Her2 – Her2 – >35 years >35 years No lymphovasculer invasion No lymphovasculer invasion

22 Intermediate risk ER and/or PR + ER and/or PR + Her2 – Her2 – N0 N0 No lymphovasculer invasion No lymphovasculer invasion pT>1 or G2-3 pT>1 or G2-3 or <35 years or <35 years or (1-3) LN or (1-3) LN

23 High risk ER- and PR- ER- and PR- LN >3 LN >3 Her2+ Her2+ or or LN 1-3 with lymphovasculer invasion LN 1-3 with lymphovasculer invasion

24  Stage 5 year survival  Stage I T1 NO M0 85%  Stage II T0-1 N1 M0 T2 N0-1 M0 65% T2 N0-1 M0 65% T3 N0 M0 T3 N0 M0  Stage III T0-2 N2 M0 T3 N1-2 M0 T3 N1-2 M0 T4 any N M0 45% T4 any N M0 45% Any T N3 M0 Any T N3 M0  Stage IV Any T any N M1 10%

25 Prevention  All females should do self breast examination monthly  Women over 40 years old should have Clinical breast examination every 3 years  Bilateral Mammogram at perimenapausal age of years  If Clinical Breast examination detects a suspicious lesion under the age of 45 years-US scan breasts and ideally MRI of Breast

26 Thank you


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