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Breast Carcinoma PowerPoint Presentation

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Description : This medical presentation on cancer titled "Breast Carcinoma" deals with the topic of breast carcinoma, its signs (Breast lump, Nipple discharge, Excoriation/destruction of nipple, Pain, Axillary lump, Incidental finding on imaging/microscopy, Signs of metastasis), its physical examination, its diagnosis and staging, LCIS, and more.

Tags : Breast Carcinoma, Breast lump, Nipple discharge, Excoriation, destruction of nipple, Pain, Axillary lump, Incidental finding on imaging, microscopy, Signs of metastasis, physical examination, diagnosis, staging, LCIS

Published on : Apr 28, 2021 | Views : 1441 | Downloads : 4

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Slide 1-

BREAST CARCINOMA Dr Amit Gupta Associate Professor Dept Of Surgery
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Presentation Breast lump Nipple discharge Excoriation/ destruction of nipple Pain Axillary lump Incidental finding on imaging/ microscopy Signs of metastasis: Bone discomfort, fatigue, cough, dyspnoea
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Physical Examination Inspection: Breast: asymmetry, mass, skin changes Nipple: retraction, inversion, or excoriation Palpation: Breast lump Regional nodes Systemic examination
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DIAGNOSIS & STAGING Imaging Cytology/ biopsy
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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
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LCIS: MANAGEMENT Surveillance Chemoprevention: Tamoxifen Prophylactic B/L mastectomy Not necessary to obtain negative margins No role of RT
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DCIS DEFINITION Proliferation of malignantly appearing mammary ductal epithelial cells without invasion of BM PRESENTATION Palpable mass Pagets disease Incidental finding at biopsy Mammographically detected abnormality
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DCIS: LOCAL MANAGEMENT BREAST Localized DCIS: BCT + RT Multicentric DCIS: Mastectomy AXILLA No role of routine SLNB SLNB only in candidates for mastectomy
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DCIS: SYSTEMIC THERAPY 80% OF DCIS ER +ve Two benefits of ET Reduced local recurrence 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
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EARLY CARCINOMA DEFINITION St I & II LOCAL MANAGEMENT BCT+ RT Mastectomy ± breast reconstruction Equivalent survival with BCT & mastectomy Initial systemic therapy may allow BCT in large tumors T3N1 may also be treated similarly
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EARLY CARCINOMA :BCT Absolute contraindications Pregnancy Multicentric/ diffuse tumor Prior therapeutic irradiation Relative contraindications CVD Tumor / breast size ratio
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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
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EARLY CARCINOMA:ADJUVANT SYSTEMIC THERAPY Endocrine Therapy: Tamoxifen, AI Ovarian ablation Anti HER-2 Therapy: Trastuzumab Chemotherapy Adjuvant therapy determined by biological behavior of the tumor
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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
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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
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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
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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
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METASTATIC DISEASE: MANAGEMENT ER&/or PR +ve: ET ER&/or PR -ve: CT Refractory to HT HER2 +ve: CT + Trastuzumab HER2 –ve: CT Advanced carcinoma