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

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

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

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

5. RISK FACTORS • 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

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

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

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

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

10. 2. Clinical breast examination 3. Breast self examination

11. DIAGNOSTIC INVESTIGATIONS • Diagnostic mammography • Ultrasonography • Biopsy - F N A C - 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 CXRLFTLIVER 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} No lymphedema/no limb dysfunction new

13. Breast reconstruction surgery After huge tumours resection • TRANS RECTUS ABDOMINUS flap • 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 • Newer less toxic drugs 1.anthracyclines-adriamycin/cyciophosphamide 2.taxanes-paclitaxel/docetaxel • Indications- • Lymph node positive tumour • Poor prognostic lymph node negative • As palliative therapy • As neoadjuvant therapy

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

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

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

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

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

21. Complementary medicine • Meditation • Acupuncture • Nutrition • 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. • 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