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TOPIC: NEWER TREATMENT IN BREAST CANCER BY Chaitra.t.m 9 th term Bangalore medical college.

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Presentation on theme: "TOPIC: NEWER TREATMENT IN BREAST CANCER BY Chaitra.t.m 9 th term Bangalore medical college."— Presentation transcript:

1 TOPIC: NEWER TREATMENT IN BREAST CANCER BY Chaitra.t.m 9 th term Bangalore medical college

2 TOPIC: NEWER TREATMENT IN BREAST CANCER BY Chaitra.t.m 9th term Bangalore medical college

3 Breast cancer Chance of developing This at some Point of womens Life is 13% whereas in man is <2%. 2 nd leading cause of death

4 TYPES Ductular(85%) Lobular(15 %)

5 AGE - MORE THAN 40yrs GENDER- FEMALE GEOGRAPHY- WESTERN COUNTRIES ENDOCRINE- NULLIPAROUS NO CHILD UPTO 30yrs HARMONE REPLACEMENT THERAPY NO BREAST FEEDING HIGH FAT DIET OCPs OBESITY GENETIC RISK FACTORS

6 MYTHS ABOUT BREAST CANCER Antiperspirents Antiperspirents Induced abortion Induced abortion Breast implants Breast implants Environmental pollution Environmental pollution Night shift working Night shift working Thought to be carcinogens

7 CLINICAL STAGING TUMOUR SIZE METASTASIS NODES Stage 0- DCIS Stage 1- tumour confined To breast & <2 cm Stage cm, may involve Same side body lymph nodes Stage 3- >5cm, any lymph node No mets Stage 4- metastatic breast cancer One more type of classification = manchesters

8 Whats new in Breast cancer treatment PATIENT INVOLVEMENT Health education TECHNOLOGY Diagnostic Treatment POST OP Better arm function Cosmesis Quality of life

9 SCREENING INVESTIGATIONS 1. Mammography – all patients with family history -Sensitive for even 2- 3cm tumour

10 2. Clinical breast examination 3. Breast self examination

11 DIAGNOSTIC INVESTIGATIONS 1. Diagnostic mammography 2. Ultrasonography 3. Biopsy - F N A C - F N A C - core biopsy - surgical biopsy-lumpectomy/ stereotactic localisation (nonpalpable tumours) - core biopsy - surgical biopsy-lumpectomy/ stereotactic localisation (nonpalpable tumours) 4. Scintimammography ( 99mm Tc- Sestamibi ) 5. MRI (localisation ) 6. CT 7. PET(mets work up & effective chemotherapy) METS WORK UP CXR LFT LIVER USG Isotope bone scan

12 SURGERY Halsteds –radical mastectomy Patey’s –modified radical mastectomy BREAST CONSERVATIVE SURGERY= (wide local excision-margin +/-) /QUART {quadrantectomy+axillary dissection+ Radiotherapy} new No lymphedema/no limb dysfunction

13 Breast reconstruction surgery After huge tumours resection 1. TRANS RECTUS ABDOMINUS flap 2. LATTISIMUS DORSI flap Breast prosthesis

14 ADJUVANT THERAPY= (Chemotherapy/harmonotherapy/ radiotherapy/immunotherapy).RADIOTHERAPY- 1. to tumour bed only 2. peroperative 3. palliative

15 Chemotherapy- (given in 6 cycles at an interval of 28 days with heamatological monitoring) conventional CMF regime conventional CMF regime Newer less toxic drugs Newer less toxic drugs 1.anthracyclines- adriamycin/cyciophosphamide 1.anthracyclines- adriamycin/cyciophosphamide 2.taxanes-paclitaxel/docetaxel 2.taxanes-paclitaxel/docetaxel Indications- Lymph node positive tumour Poor prognostic lymph node negative As palliative therapy As neoadjuvant therapy

16 Hormonotherapy Conventional oophorectomy Conventional oophorectomy antioestrogens antioestrogens - SERMS-tamoxifen(gold standard) -aromatase inhibitor-anastrazole(postmenopausal women)ATAC trials show more beneficial in preventing reccurence Estrogen receptor down regulator Estrogen receptor down regulator -fluvanstrant(once a month dose) ER

17 HER2 receptor positive cancer (25%)do respond to herceptin HER2 receptor positive cancer (25%)do respond to herceptin (herceptin trial shows 50% relapse prevention) (herceptin trial shows 50% relapse prevention) FDA approved avastin is a trial drug which acts on VEGF preventing tumour progression FDA approved avastin is a trial drug which acts on VEGF preventing tumour progression

18 Immunotherapy Make tumour cells to be recognised as foreign Make tumour cells to be recognised as foreign Boost up host immunity to destroy them Boost up host immunity to destroy them

19 In advanced breast carcinoma its less of surgery more of palliation therapy(hormonal/chemotherapy/ra diotherapy)

20 Australian couple who underwent fertility tretment following detection of massive cancer running in family.

21 Complementary medicine Meditation Meditation Acupuncture Acupuncture Nutrition Nutrition Vitamin tablets Vitamin tablets

22 "The smaller the tumor, the greater your options. So if you feel something you're concerned about, you need to get in and get it taken care of. That's a key thing. Because a lot of people have this fear that they're going to lose their breast, and it's just not true anymore."

23 Take home MESSAGE Patient education regarding BSE (breast self examination) is the key point in our country. Patient education regarding BSE (breast self examination) is the key point in our country. With numerous options in treatment of carcinoma breast is now a realistic challenge to we doctors and we got to individualise the treatment With numerous options in treatment of carcinoma breast is now a realistic challenge to we doctors and we got to individualise the treatment

24 THANK YOU


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