BREAST CANCER - CURRENT CONCEPT

DR.S.G.BALAMURUGAN M.CH., SURGICAL ONCOLOGIST GURU CANCER HOSPITAL . MADURAI

GURU CANCER HOSPITAL

BREAST CANCER

World: Commonest in female, 30% of Total body cancer in female India: upto 2010 2nd most commonest in women, 2011 Commonest

TODAYS AGENDA

To discuss about

!"#$T C#%C"!

How to approach pt with Oncological norms Recent updates in cancer management ismanagement !"UA#$T% BREAST CANCER A&ARENESS

APPROACH

PALPABLE BREAST MASSES

CANCE (10%) fibrocystic changes (40%) fibroadenoma (7%)

benign NOS (13%)

no disease (30%)

DIAGNOSIS
Triple assessment Clinical e'amination ( imaging ()NAC*Core+iops,

MALIGNANT LESION
o o o o o o

#ump in +reast ! usuall, painless Blood, nipple discharge Recent in-ersion o. nipple /estruction o. nipple Thic0ening o. s0in ! orange peel li0e Node in the A'illa

A$i%%ary &ein thrombosis

!ea"de#orange

Mammographic appeara ce o! Ca

# mass #ssociated calcification #rc&itectural distortion Irre'ular border $(in or nipple c&an'e

"HAT TO DO# SUSPECTED MALIGNANT LESION

)%#C - if inconclusi*e Trucut biopsy - if inconclusi*e $mall lesion + e,cision biopsy -ar'e lesion + incision biopsy

$/EA# - B$OPS%

C.%)I!/#TI.% .) 0I#1%.$I$

trucut biopsy

open biopsy

BIOPSY INCISIONS

Incision must be trans*erse or cur*ilinear $cars s&ould be included in t&e future definiti*e incision 2 %. 3"!TIC#- I%CI$I.% #d*ersely affects t&e plan of treatment bot& in definiti*e sur'ery 4 !T plannin'

ORDER O$ IN%ESTIGATION IN BREAST

C.%)I!/#TI.% .) 0I#1%.$I$

fnac

trucut biopsy

incision biopsy

/"T#$T#TIC W.!567

8-ray c&est 6$ abdomen one scan

THE NEED O$ THIS ERA

M&'(i)i*cip'i ar+ T&mor Boar) $i a'i,e T&mor *(agi g $orm&'a(e* (rea(me ( p'a

MANAGEMENT

MULTIMODAL

7t to be treated by all t&ree weapons 9sur'ery,!T,c&emot&erapy: by appropriate se;uence t&at results in &i'& success rate and less complications

MANAGEMENT
CLASSI$ICATION

EAR#% CANCER 1$NTENT ! CURE2 $6!1"!< #OCA##% A/3ANCE/ CANCER 1$NTENT ! CURE2 %".#0=63#%T C>"/. ETASTAT$C CANCER 1$NTENT !PA##$AT$ON2 7#--I#TI3"

MANAGEMENT
CLASSI$ICATION

EAR#% CANCER

Si4e 5 6cm o+ile a'illar, node NO s0in in-olment

#OCA##% A/3ANCE/ CANCER

Si4e 7 6 cm )i'ed A'illar, node * SC#N in-ol-ement S0in in-ol-ement

ETASTAT$C CANCER

CHAN8$N8 TREN/S

CHAN8$N8 TREN/S

EARLY CASES - OPTIONS O$ SURGERY

/odified radical mastectomy .! reast Conser*ati*e sur'ery

EAR#% CASES - OPT$ONS O) SUR8ER%

W&et&er /odified radical /astectomy or reast conser*ati*e sur'ery #,illary dissection is mandatory

9:TH CENTUR%

9; CENTUR%

BREAST CONSER3AT$3E SUR8ER%

rac&yt&erapy

CT is not possible

Alternative

Breast Reconstruction

Breast reconstruction

BREAST RECONSTRUCTION TRAM FLAP

BREAST RECONSTRUCTION LD FLAP

LOCALY AD%ANCED BREAST CANCER

"HAT TO DO LABC#
3 cycles of %eo ad?u*ant C&emo !e*iew !esponds well %o !esponse

$ur'ery

!T 4 !e*iew for $ur'ery

' ()before treatment

After treatment

LABC-

POOR SURGICAL SELECTION

Ulcer Earl, Nipple retraction

Orange peel li0e s0in

HO" TO MANAGE METASTATIC DISEASE#

7alliati*e treatment

C&emot&erapy

Commonest metastasic site + .%"

MASTECTOMY

%. !.-" I% /"T#$T#TIC 0I$"#$" WIT> .6T -""0I%1 , )6%1#TI.% Toilet mastectomy indicated only for bleedin' and fun'atin' tumor

Pri cip'e* o! A).&/a ( Therap+ MICRO METASTASIS

I/#1" .CC6-T /#T#$T#$I$

ris( of recurrence and deat& from breast cancer wit& local t&erapy alone 30% wit& node-ne'ati*e disease @A% wit& node-positi*e disease

$OR "HOM AD0U%ANT CHEMOTHERAPY TO BE GI%EN#

)or all cases e,cept 12 %ode ne'ati*e status 22 Tumor siBe C1cm 32 1rade 1 + Well differentiated cancer

7referable re'imen )#C

$OR "HOM AD0U%ANT RADIOTHERAPY TO BE GI%EN#

%ode positi*e status Incomplete a,illary dissection Tumor siBe more t&an Acm

$OR "HOM AD0U%ANT HORMONAL THERAPY TO BE GI%EN# "! and D or 7! positi*e tumors 7!"/"%.7#6$#- + T#/.8I)"% 7.$T/"%.7#6$#- + #2I9-"T!.E.-": A years

1UALITY GUIDELINE

HO" TO ASSESS "HETHER THE SURGERY IS COMPLETE# $pecimen s&ould contains atleast 10 a,illary node

MISMANAGEMENT

Incomplete /astectomy Inade;uate or no a,illary dissection 0irect sur'ery in locally ad*anced cancers -umpectomy wit&out )%#C or Trucut Improperly placed incision Incomplete data w&ile referrin'

!esidual reast mass

!esidual reast wit& recurrence

!esidual reast wit& Tumor - 7re operati*e !T

LOCAL RECURRENCE DUE TO INADE1UATE SURGERY

IS OPERATING SURGEON REALLY A PROGNOSTIC $ACTOR#

)act< alwa,s 0nown +ut scienti.icall, and statisticall, accepted onl, recentl,

BREAST CANCER
Annals o. surgical oncolog,

Treatment +, surgical oncologists resulted in a ==> reduction in the ris0 o. death at 6 ,ears? An anal,sis o. @=<@;; cases< cancer sur-eillance program data +ase - #os Angeles
Annals o. surgical oncolog, ;:AB:B-B;619:;92

POSITI%E ATTITUDE

!rognosis* +ym,h Nodes

#0 "0 !0 0 40 30 20 10 0 0 1 2 3 4 !$10 11$1 1!$20 %20

% -i&e).ear S"r&i&a%

N"mber of (n&o%&ed +ym,h Nodes

(adapted from /arris et a%0 Cancer* !rinci,%es and !ractice of Onco%ogy0 1 th ed0)

)uture treatment
9:th centur, Toda, 9;st centur,

C,toto'ic therap, Radiotherap, Hormonal therap, Surger,

Oncogene-+ased diagnosis Targeted therap, Patient-speci.ic therap,

7aclita,el 4 0oceta,el

;CD;
7acific <ew: Taxus brevifolia
OH

;CEB
"uropean <ew: Taxus baccata

&ENETIC

PROGNOSIS
disease state nonin&asi&e in&asi&e3 %oca% in&asi&e3 metastatic 1 year s"r&i&a% 27% 74% 55%

T.0#<

A0% of cancer is curable 2A% it is possible to ac&ie*e lon' term sur*i*al

Brea't Can(er A)arene''

reast cancer screenin' in women: t&e problem

N6 1000

4 malignant Cancer
1F eni'n lesions

N6 240
Norma%

G /illion Cancer $ur*i*ors

FProgress with a PurposeA Eliminating the /eath and Su..ering .rom Cancer +, 9:;6G

reast Cancer #wareness:

THE CANCER TO CURE OR NOT TO CURE

$S $N %OUR HAN/S

Ca cer i* a 2or) o( a *e (e ce

/R?S?8?BA#A URU8AN

?Ch?<

T>#%5 <.6