PowerPoint Presentation

DR.S.G.BALAMURUGAN M.CH.,

SURGICAL ONCOLOGIST GURU CANCER HOSPITAL . MADURAI

BREAST CANCER - CURRENT CONCEPT

GURU CANCER HOSPITAL

World: Commonest in female,

30% of Total body cancer in female

India: upto 2010

2nd most commonest in women, 2011 - Commonest

BREAST CANCER

TODAYS AGENDA

To discuss about BREAST CANCER

How to approach pt with Oncological norms

Recent updates in cancer management

Mismanagement QUALITY

BREAST CANCER AWARENESS

APPROACH

PALPABLE BREAST MASSES

fibrocystic changes (40%)

no disease (30%)

benign NOS (13%)

fibroadenoma (7%)

CANCER (10%)

DIAGNOSIS

Triple assessment

Clinical examination + imaging +FNAC/Corebiopsy

MALIGNANT LESION

Lump in breast usually painless

Bloody nipple discharge

Recent inversion of nipple

Destruction of nipple

Thickening of skin orange peel like

Node in the Axilla

Peaudeorange

Axillary vein thrombosis

Mammographic appearance of Cancer

A mass

Associated calcification

Architectural distortion

Irregular border

Skin or nipple change

WHAT TO DO?
SUSPECTED MALIGNANT LESION

FNAC - if inconclusive

Trucut biopsy - if inconclusive Small lesion excision biopsy Large lesion incision biopsy

CONFIRMATION OF DIAGNOSIS

trucut biopsy open biopsy

IDEAL - BIOPSY

BIOPSY INCISIONS

Incision must be transverse or curvilinear

Scars should be included in the future definitive incision

. NO VERTICAL INCISION Adversely affects the plan of treatment both in definitive surgery & RT planning

NO VERTICAL INCISION

ORDER OF INVESTIGATION INBREAST

CONFIRMATION OF DIAGNOSIS

fnac trucut biopsy incision biopsy

METASTATIC WORKUP

X-ray chest

US abdomen

Bone scan

THE NEED OF THIS ERA

Multidisciplinary Tumor Board

Finalize Tumor stagingFormulates treatment plan

MANAGEMENT

MULTIMODAL

Pt to be treated by all three weapons (surgery,RT,chemotherapy) by appropriate sequence that results in high success rate

and less complications

MANAGEMENT
CLASSIFICATION

EARLY CANCER (INTENT CURE)

SURGERY

LOCALLY ADVANCED CANCER (INTENT CURE) NEOADJUVANT CHEMO

METASTATIC CANCER (INTENT PALLIATION)

PALLIATIVE

MANAGEMENT
CLASSIFICATION

EARLY CANCER

Size < 5cm

Mobile axillary node

NO skin involment

LOCALLY ADVANCED CANCER

Size > 5 cm

Fixed Axillary node / SCLN involvement

Skin involvement

METASTATIC CANCER

CHANGING TRENDS

CHANGING TRENDS

M.R,M = W.L.E + RADIOTHERAPY

EARLY CASES - OPTIONS OF SURGERY

Modified radical mastectomy

OR

Breast Conservative surgery

FOR PRIMARY

FOR AXILLA

EARLY CASES - OPTIONS OF SURGERY

Whether Modified radical Mastectomy or Breast conservative surgery

Axillary dissection is mandatory

20TH CENTURY

21 CENTURY

BREAST CONSERVATIVE SURGERY

Brachytherapy

Alternative

BCT is not possible

Solution ?

Breast

Reconstruction

ONCO SURGEONS VISION SHOULD BE

BEYOND CURE

Breast reconstruction

BREAST RECONSTRUCTION
TRAM FLAP

BREAST RECONSTRUCTION
LD FLAP

LOCALY ADVANCED BREAST CANCER

WHAT TO DO LABC?

3 cycles of Neo adjuvant Chemo

Review

Responds well

No Response

Surgery

RT & Review for Surgery

MRI-before treatment

After treatment

Early Nipple retraction

Orange peel like skin

Ulcer

LABC- POOR SURGICAL SELECTION

Dont's

HOW TO MANAGE METASTATIC DISEASE?

Palliative treatment

Chemotherapy

Commonest metastasic site BONE

MASTECTOMY

NO ROLE IN METASTATIC DISEASE WITH OUT BLEEDING , FUNGATION

Toilet mastectomy indicated only for bleeding and fungating tumor

MICRO METASTASIS

IMAGE OCCULT MATASTASIS

risk of recurrence and death from breast cancer with local therapy alone

30% with node-negative disease

75% with node-positive disease

Principles of Adjuvant Therapy

FOR WHOM ADJUVANT CHEMOTHERAPY TO BE GIVEN?

For all cases except1. Node negative status2. Tumor size