management of breast ca

8/19/2019 Management of Breast CA

1/22

MANAGEMENT OF BREASTCANCER

BY : ALMA FARHANA BINTI ROSLAM

SUPERVISOR : DR HAFIZUDDIN


2/22

Options avaia!" :

S#$%"$&

Ra'iot("$ap& Ho$)on" T("$ap&

C(")ot("$ap&


3/22

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


4/22

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"'


5/22

23 Tota *Si)p"+Mast",to)&

Tiss#"s $")ov"':

T#)o$ "nti$" !$"ast

a$"oa nipp" s


6/22

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


7/22

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"


8/22

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


9/22

3 Ra'i,a Mast",to)& o7Hast"'

Tiss#"s $")ov"':

T#)o$ "nti$" !$"ast a$"oa nipp" s


10/22


11/22

;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


12/22

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'


13/22

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&


14/22

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 -""


15/22

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


16/22

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


17/22

D$#%s :

CAF an' CMF ,o))on& #s"' )ont(&>6 -""


18/22

CAF an' CMF ,o))on& #s"' )ont(&>6-""


19/22

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$


20/22

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


21/22

ADVANCED BREAST CANCERMANAGEMENT *2+


22/22

-.A+/ 0O

management of breast ca

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