Management of Breast CA
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Transcript of Management of Breast CA
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8/19/2019 Management of Breast CA
1/22
MANAGEMENT OF BREASTCANCER
BY : ALMA FARHANA BINTI ROSLAM
SUPERVISOR : DR HAFIZUDDIN
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8/19/2019 Management of Breast CA
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Options avaia!" :
S#$%"$&
Ra'iot("$ap& Ho$)on" T("$ap&
C(")ot("$ap&
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8/19/2019 Management of Breast CA
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SURGICAL APPROACHES
Tota *Si)p"+Mast",to)&
Tota Mast",to)& -it(A.ia$& C"a$an,"
Mo'i/"' Ra'i,aMast",to)& 0MRM1
23 Pat"&4s Op"$ation
53 S,anon4s Op"$ation
63 A#,(in,oss4 MRM
Ra'i,a Mast",to)& o7Hast"'
Cons"$vativ" B$"astS#$%"$i"s
23 8i'" Lo,a E.,ision08LE1
53 L#)p",to)&
63 9#a'$ant",to)&
3 Toi"t Mast",to)&;3 S?"&(o"
Mast",to)& 0SSM1
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8/19/2019 Management of Breast CA
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T(" t&p" o7 )ast",to)& '"p"n's on :
A%"
G"n"$a ("at(
M"nopa#s" stat#s
T#)o$ si@"
T#)o$ sta%" *(o- 7a$ its sp$"a'+
T#)o$ %$a'" *its a%%$"ssiv"n"ss+ T#)o$s (o$)on" $","pto$ stat#s
8("t("$ o$ not &)p( no'"s a$" invov"'
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8/19/2019 Management of Breast CA
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23 Tota *Si)p"+Mast",to)&
Tiss#"s $")ov"':
T#)o$ "nti$" !$"ast
a$"oa nipp" s
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8/19/2019 Management of Breast CA
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53 Tota Mast",to)& -it( A.ia$&
C"a$an," *MAC+
Co))onp$o,"'#$"
Tiss#"s $")ov"':
TM A.ia$&7at
A.ia$& 7as,iaL"v" I
an' II a.ia$&LN
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8/19/2019 Management of Breast CA
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63 Mo'i/"' Ra'i,aMast",to)&
1) Patey’s Operation
) Tiss#"s $")ov"':
TM C"a$an," o7 L"v"
I II III A.ia$& LN
P",to$ais )ino$
) Tiss#"s p$"s"$v"':
N"$v" to S"$$at#sant"$io$
N"$v" to Latissi)#s'o$si
Int"$,osto!$a,(ia n"$v"
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8/19/2019 Management of Breast CA
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63 Mo'i/"' Ra'i,a Mast",to)& *2+
2) Scanlon’s Operation
P",to$ais )ino$ incised
L"v" III LN removed
3) Auchincloss’ MRM
P",to$ais )ino$ "7t intact
L"v" III LN not removed
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8/19/2019 Management of Breast CA
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3 Ra'i,a Mast",to)& o7Hast"'
Tiss#"s $")ov"':
T#)o$ "nti$" !$"ast a$"oa nipp" s
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8/19/2019 Management of Breast CA
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;3 B$"ast Cons"$vativ"S#$%"$i"s
Wide Local !cision "WL)# Partial Mastecto$
R")ova o7 #ni,"nt$i, t#)o#$ -it( 2,) ,"a$an,")a$%in3
In,ision : Ov"$ t#)o#$ A.ia$&Diss",tion RT
%uadrantecto$y
R")ova o7 "nti$" #a'$ant -it( '#,ta s&st") -it(
5=6,) no$)a!$"ast tiss#" ,"a$an,"3
Pa$t o7 9UART T("$ap& *9#a'$ant",to)& A.ia$&'iss",tion RT+
Not a'vo,at"' no-3
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RADIOTHERAPY APPROACH
In'i,ations :
23Cons"$vativ" B$"ast S#$%"$& a'#vant 0B$"ast1
53Tota Mast",to)& 0A.ia1
63Hi%(=$is< o7 $"aps" pati"nts
2+ Invasiv" Ca$,ino)a5+ E.t"nsiv" in=sit# Ca$,ino)a
6+ A%" 6; &"a$s
+ M#ti7o,a 'is"as"
3Bon" s",on'a$i"s 0Paiativ"1
;3At$op(i, S,(i$$o#s Ca$,ino)a 0C#$ativ"1J3P$"=Op"$ativ"& *$"'#," t#)o#$ si@" an' 'o-nsta%"+
K3 4v" A.ia$& LN P",to$a 7as,ia invov")"nt positiv"s#$%i,a )a$%ins E.t$a=no'a sp$"a'
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HORMONE THERAPYAPPROACH
P$in,ip"s :
Us"' in ER>PR v" pati"nts on&
A a%" %$o#ps in,#'"' no-
R"ativ"& sa7" Eas& to a')inist"$
A'"#at" p$op(&a.is a%ainst Ca o7 opposit"!$"ast
Us"7# in M"tastati, Ca$,ino)a
R"'#,"s $",#$$"n," i)p$ov"s #ait& o7 i7"an' on%"vit&
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HORMONE THERAPY APPROACH *2+
Medical
i3 O"st$o%"n R","pto$Anta%onists Tamoxifen 5)%
ii3 P$o%"st"$on" $","pto$
Anta%onistiii3 O$a A$o)atas" In(i!ito$s Letrozole 53; )% OD Anastrozole Exemestane
Aminoglutethimide 0M"'i,a A'$"na",to)&1
iv3 An'$o%"ns inj.Testosterone propionate 2)% IM t($""ti)"s a -""
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8/19/2019 Management of Breast CA
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CHEMOTHERAPY APPROACH
T&p"s :
A(Adu*ant Che$otherapy A')inist$ation o7 C&toto.i,s a7t"$ s#$%"$&
Ei)inat" ,ini,a& #n'"t",ta!" 'istant sp$"a'
B(+eoadu*ant Che$otherapy A')inist$ation o7 C&toto.i,s in a$%" op"$a!" t#)o#$s
!"7o$" s#$%"$&
R"'#," o,o=$"%iona t#)o#$ !#$'"n 'o-nsta%"
A)"na!" to s#$%i,a $"s",tion a7t"$ 6 'os"sC(Palliati*e Che$otherapy A'van,"' Ca B$"ast
M"tastati, Ca B$"ast
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CHEMOTHERAPY APPROACH*2+
In'i,ations :
• A no'" 4v" pati"nts
• P$i)a$& t#)o#$ 2,) in si@"
•
Poo$ p$o%nosti, 7a,to$s• A'van,"' Ca B$"ast
• Ina))ato$& Ca B$"ast
• M"tastati, Ca B$"ast
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D$#%s :
CAF an' CMF ,o))on& #s"' )ont(&>6 -""
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8/19/2019 Management of Breast CA
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CAF an' CMF ,o))on& #s"' )ont(&>6-""
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8/19/2019 Management of Breast CA
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EARLY BREAST CA *EBC+
MANAGEMENT
B$"ast Cons"$vation S#$%"$& 8i'" Lo,a E.,ision>9UART> SSM RT o,a&
Pat"&4s Op"$ation 0MRM1
Ta)o.i7"n 2)% BD
S"ntin" L&)p( No'" Biops& 0SNLB1 R"%#a$ 7oo-=#p -it(
Ra'ioisotop" Bon" s,an
CEA t#)o#$ )a$
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ADVANCED BREAST CANCERMANAGEMENT
R"7"$s to :
Lo,a& A'van,"'Ca$,ino)a B$"ast0LACB1
Ina))ato$& CaB$"ast
Biat"$a Ca B$"ast
M"tastati, CaB$"ast
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ADVANCED BREAST CANCERMANAGEMENT *2+
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8/19/2019 Management of Breast CA
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-.A+/ 0O