Management of Breast Carcinoma
What are the types of breast cancer?
1- Insitu
- Ductal - Lobular 2- Invasive
- Ductal - Lobular
What are the stages of breast cancer?
1- Stage 1 & 2 ( early breast cancer ) - The tumor size less than 5 cm - No skin involvement
- Mobile tumor
- No axillary lymph node enlargement or mobile axillary lymph node - No distant metastasis
2- Stage 3 ( locally advanced ) - Tumor size more than 5 cm
- Or skin involvement as ulceration, inflammatory breast cancer, peau d`orange - Or fixed axillary lymphadenopathy
- Or supraclavicular or lymphadenopathy - No distant metasis
3- Stage 4 ( systemic or metastitic disease ) - Presence of distance metastasis
What is the treatment of invasive breast cancer?
1- For stage 1 & 2 ( early breast cancer ), you have two options
a- Breast conserving therapy which includes (lumpectomy with 2 cm free margin+
axillary dissection of level 1 and part of level 2 axillary lymph nodes and post operative radiotherapy).
b- Modified radical mastectomy + axillary lymph nodes dissection.
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c- Then to give chemotherapy or hormonal therapy is depending on - Lymph node positive or negative (i.e. contain malignant cell or no).
- Size of the tumor
- Is the patient premenepose or post menopause - Estrogen and progesterone receptors
e.g., negative ly mph node – tumor size < 1 cm – no chemo therapy Tumor size > 1 cm – give chemo therapy Positive lymph node -- give chemo therapy
Positive estrogen receptors – give hormonal therapy
2- Treatment of stage 3 breast cancer ( locally advanced )
Down staging with pre operative neoadjuvant chemo therapy, then reassessment. Then modified radical mastectomy and axillary dissection.
- In about 10% of the patients, they will have complete respond to the
neoadjuvant chemo therapy , and disappearance of the tumor, in this case you have to prove this with clinically, radiologically, and by biopsy.
- The role of neoadjuvant chemo therapy is to kill the metastatic cell which is the most common cause of death in this patient.
3- Treatment of stage 4 breast cancer ( metastatic disease ):
- Palliative treatment.
- For liver and lung metastasis – chemotherapy.
- For bone metastasis – hormonal and radiotherapy.
- For spine and brain metastasis – radiotherapy.
For the clinical features and management of ductal and lobular carcinoma in situ, see next lecture.
DR. S. ALDAQAL
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