Presentation
1. Breast lump
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2. Nipple discharge3. Excoriation/ destruction of nipple
4. Pain
5. Axillary lump
6. Incidental finding on imaging/ microscopy
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7. Signs of metastasis: Bone discomfort, fatigue, cough,dyspnoea
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Physical Examination
1. Inspection:
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i.
Breast: asymmetry, mass, skin changes
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ii. Nipple: retraction, inversion, or excoriation2. Palpation:
i.
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Breast lump
ii. Regional nodes
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3. Systemic examinationDIAGNOSIS & STAGING
1. Imaging
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2. Cytology/ biopsy
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LCIS
DEFINITION
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Proliferation of small loosely cohesive cells in terminalduct- lobular unit, with or without pagetoid
involvement of terminal ducts
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PRESENTATION
No specific clinical or mammographic abnormality
Diagnosis made incidentally on microscopy
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LCIS: MANAGEMENT
1. Surveillance
2. Chemoprevention: Tamoxifen
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3. Prophylactic B/L mastectomy? Not necessary to obtain negative margins
? No role of RT
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DCIS
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DEFINITIONProliferation of malignantly appearing mammary ductal
epithelial cells without invasion of BM
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PRESENTATION
i.
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Palpable massii.
Pagets disease
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iii. Incidental finding at biopsy
iv. Mammographically detected abnormality
DCIS: LOCAL MANAGEMENT
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? BREAST
i.
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Localized DCIS: BCT + RTii.
Multicentric DCIS: Mastectomy
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?
AXILLA
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i.No role of routine SLNB
ii.
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SLNB only in candidates for mastectomy
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DCIS: SYSTEMIC THERAPY
80% OF DCIS ER +ve
Two benefits of ET
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i.
Reduced local recurrence
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ii. Prevention of development of new primary lesions incontralateral breast
Follows same principles of ET
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Trials of tamoxifen Vs AI ongoingNo role of CT
EARLY CARCINOMA
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? DEFINITION? St I & II
? LOCAL MANAGEMENT
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i.
BCT+ RT
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ii.Mastectomy ? breast reconstruction
?
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Equivalent survival with BCT & mastectomy
?
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Initial systemic therapy may allow BCT in large tumors?
T3N1 may also be treated similarly
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EARLY CARCINOMA :BCT
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? Absolute contraindications
i.
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Pregnancyii. Multicentric/ diffuse tumor
iii. Prior therapeutic irradiation
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? Relative contraindicationsi.
CVD
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ii. Tumor / breast size ratio
EARLY CARCINOMA: MASTECTOMY
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In pts with contraindication to BCTIn pts who prefer mastectomy
May be combined with IBR
SLNB to be done
Cytological confirmation of clinically +ve nodes
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required before axillary surgery
Axillary irradiation: an acceptablealternative to
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EARLY CARCINOMA:ADJUVANTSYSTEMIC THERAPY
1. Endocrine Therapy:
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i.
Tamoxifen,
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ii. AIiii. Ovarian ablation
2. Anti HER-2 Therapy: Trastuzumab
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3. Chemotherapy? Adjuvant therapy determined by biological behavior
of the tumor
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EARLY CARCINOMA: ADJUVANTCHEMOTHERAPY
Benefit women irrespective of
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Age
Hormonal status
Adjuvant ET
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Multiple cycles advantageous (4-8)Anthracycline based regimens superior over CMF
CT recommended for node +ve and higher risk node
?ve patients
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Taxanes ? modest advantages, role being studied
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LABC & IBC
DEFINITION
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Bulky tumors/ extensive nodal disease (T3-4/ N2-3)IBC: aggressive variant of LABC, presents with diffuse
edema,erythema, rapid course & often without an
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underlying palpable mass
LABC & IBC: MANAGEMENT
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Substantial risk of metastasis, full workup beforeinitiating therapy required
Trimodality treatment: Neoadjuvant CT, Surgery, RT
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Anthracycline / Taxane based regimens appropriateas induction CT
Postmastectomy RT mandatory despite complete
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pathological response to CT
No surgery in IBC till complete response of
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inflammatory skin changes, may require pre-op RT--- Content provided by FirstRanker.com ---
METASTATIC DISEASEMay disseminate to almost every organ
May present with systemic symptoms or found on
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examination or investigationsGoal: decrease tumor burden, control of cancer
related symptoms, prolongation & maintenance of
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QOL
Therapy is not considered curative
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METASTATIC DISEASE:MANAGEMENT
Advanced carcinoma
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ER&/or PR +ve: ET
ER&/or PR -ve: CT
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Refractory to HTHER2 +ve: CT +
Trastuzumab
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HER2 ?ve: CT