Download MBBS Surgery Presentations 11 Breast Carcinoma Lecture Notes

Download MBBS (Bachelor of Medicine, Bachelor of Surgery) 1st Year, 2nd Year, 3rd Year and Final year Surgery 11 Breast Carcinoma PPT-Powerpoint Presentations and lecture notes






BREAST CARCINOMA

Presentation

1. Breast lump
2. Nipple discharge
3. Excoriation/ destruction of nipple
4. Pain
5. Axillary lump
6. Incidental finding on imaging/ microscopy
7. Signs of metastasis: Bone discomfort, fatigue, cough,

dyspnoea




Physical Examination

1. Inspection:

i.

Breast: asymmetry, mass, skin changes

ii. Nipple: retraction, inversion, or excoriation

2. Palpation:

i.

Breast lump

ii. Regional nodes

3. Systemic examination

DIAGNOSIS & STAGING

1. Imaging

2. Cytology/ biopsy




LCIS

DEFINITION

Proliferation of small loosely cohesive cells in terminal

duct- lobular unit, with or without pagetoid

involvement of terminal ducts

PRESENTATION

No specific clinical or mammographic abnormality
Diagnosis made incidentally on microscopy

LCIS: MANAGEMENT

1. Surveillance
2. Chemoprevention: Tamoxifen
3. Prophylactic B/L mastectomy

? Not necessary to obtain negative margins
? No role of RT




DCIS

DEFINITION

Proliferation of malignantly appearing mammary ductal

epithelial cells without invasion of BM

PRESENTATION

i.

Palpable mass

ii.

Pagets disease

iii. Incidental finding at biopsy
iv. Mammographically detected abnormality

DCIS: LOCAL MANAGEMENT

? BREAST

i.

Localized DCIS: BCT + RT

ii.

Multicentric DCIS: Mastectomy

?

AXILLA

i.

No role of routine SLNB

ii.

SLNB only in candidates for mastectomy




DCIS: SYSTEMIC THERAPY

80% OF DCIS ER +ve
Two benefits of ET

i.

Reduced local recurrence

ii. Prevention of development of new primary lesions in

contralateral breast

Follows same principles of ET
Trials of tamoxifen Vs AI ongoing
No role of CT

EARLY CARCINOMA

? DEFINITION

? St I & II

? LOCAL MANAGEMENT

i.

BCT+ RT

ii.

Mastectomy ? breast reconstruction

?

Equivalent survival with BCT & mastectomy

?

Initial systemic therapy may allow BCT in large tumors

?

T3N1 may also be treated similarly




EARLY CARCINOMA :BCT

? Absolute contraindications

i.

Pregnancy

ii. Multicentric/ diffuse tumor
iii. Prior therapeutic irradiation

? Relative contraindications

i.

CVD

ii. Tumor / breast size ratio

EARLY CARCINOMA: MASTECTOMY

In pts with contraindication to BCT
In pts who prefer mastectomy
May be combined with IBR
SLNB to be done
Cytological confirmation of clinically +ve nodes

required before axillary surgery

Axillary irradiation: an acceptablealternative to

axillary surgery




EARLY CARCINOMA:ADJUVANT

SYSTEMIC THERAPY

1. Endocrine Therapy:

i.

Tamoxifen,

ii. AI
iii. Ovarian ablation

2. Anti HER-2 Therapy: Trastuzumab

3. Chemotherapy
? Adjuvant therapy determined by biological behavior

of the tumor

EARLY CARCINOMA: ADJUVANT

CHEMOTHERAPY

Benefit women irrespective of

Age
Hormonal status
Adjuvant ET

Multiple cycles advantageous (4-8)
Anthracycline based regimens superior over CMF
CT recommended for node +ve and higher risk node

?ve patients

Taxanes ? modest advantages, role being studied




LABC & IBC

DEFINITION

Bulky tumors/ extensive nodal disease (T3-4/ N2-3)

IBC: aggressive variant of LABC, presents with diffuse

edema,erythema, rapid course & often without an

underlying palpable mass

LABC & IBC: MANAGEMENT

Substantial risk of metastasis, full workup before

initiating therapy required

Trimodality treatment: Neoadjuvant CT, Surgery, RT
Anthracycline / Taxane based regimens appropriate

as induction CT

Postmastectomy RT mandatory despite complete

pathological response to CT

No surgery in IBC till complete response of

inflammatory skin changes, may require pre-op RT




METASTATIC DISEASE

May disseminate to almost every organ
May present with systemic symptoms or found on

examination or investigations

Goal: decrease tumor burden, control of cancer

related symptoms, prolongation & maintenance of

QOL

Therapy is not considered curative

METASTATIC DISEASE:

MANAGEMENT

Advanced carcinoma

ER&/or PR +ve: ET

ER&/or PR -ve: CT

Refractory to HT

HER2 +ve: CT +

Trastuzumab

HER2 ?ve: CT

This post was last modified on 08 April 2022