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