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Presented by Katarina Bojanić Mentor A Žmegač Horvat
FACTS amp EPIDEMIOLOGYFACTS amp EPIDEMIOLOGY
bull Most common malignancy in women (25-30)
bull 2nd leading cause of cancer deaths (after lung c)
bull gt 570000 new cases worldwide each year
bull 2300 new cases
gt800 deaths in Croatia (2005)
bull One out of eight women will be diagnosed
bull Strikes a small percentage of men
bull asymp1500 new cases expected to be diagnosed in men next year
Every three minutes a woman in the US is diagnosed with BC
Every 12 minutes a woman dies from BC
All women are at risk (rare in women lt40
10 of palpable masses malignant)
5
bull Each breast = 15 to 20 sections (lobes) arranged like petals of daisy
bull Inside lobe = smaller structures (lobules)
bull End of each lobule = tiny sacs (bulbs) produce milk
Female Breast Anatomy
6
bull Lobes lobules bulbs- linked by network of thin tubes (ducts)
bull Carry milk bulbs rarr dark area of skin (areola)
Duct
Areola
Breast profile
A ducts
B lobules
C dilated section of duct to hold milk
D nipple
E fat
F pectoralis major muscle
G chest wallrib cage
Enlargement
A normal duct cells
B basement membrane (duct wall)
C lumen (center of duct)
Risk FactorsRisk Factors
Gender
Age Race
FamilyPersonal history of BC
Genetic factors
Menstrual history
Certain types of breast disease
Radiation
Weight (obesity)
Exercise
Alcohol
Reproductive history
Hormone replacement therapy
Oral contraceptive use
Breastfeeding
Nonmodifiable risks Modifiable risks
Genetic risk factors
rarr10 of BC familial (hereditary)
bull BRCA 1 amp BRCA 2 rarr tumor suppressor genes (breast cancer gene)
rarrrole in cellular DNA repair
rarrmutation increases risk
bull P53 RAS C-MYC RB gene
Types of Breast CancerTypes of Breast Cancer
Invasive Cancers Noninvasive Cancers (in situ)
spread from
ducts or lobes into
fatty tissue
limited to ducts or lobes amp does not spread into
fatty tissue
Detection methodsDetection methods
bull Self breast exam
bull Clinical examination
bull Mammography gt 35
Ultrasound lt 35
bull Biopsy if indicated
MammographyMammography
X-ray picture of the breast to detect breast cancer
Detects a breast lump before it can be felt
Age Frequency of Mammogram
40 1-2 year
50 Every year
lt49 with family hy of breast cancer
Consult health care providers about risks
BIOPSY RESULTS
bull 80 of all breast biopsies turn out to be benign
Clinical Breast ExamClinical Breast Exam
Performed by doctor
Every 3 y for women 20 ndash 39
Yearly for women gt 40 yrs of age
Breast Self-ExamBreast Self-Exam
Monthly starting at the age of 20
bull Still menstruating2-3 days after period ends
bull No longer menstruatingsame day every month
Two parts of BSE
1) Visual
2) Palpatory
bull Examine each breast separately
bull Use pads of middle three fingers feel the texture
bull Examine the armpits
Patterns
Visual
17
Most common Lump or thickening in breastOften painless
Change in color or appearance of areola
Redness or pitting of skin over the breast like the skin of an orange
Discharge or bleeding
Change in size or contours of breast
Abnormal Breast ChangesAbnormal Breast ChangesChanges in breast size of
shape Lump in the breast
Changes in the skin of the breastNipple discharged or tenderness
TREATMENT OPTIONSTREATMENT OPTIONS amp amp PROGNOSISPROGNOSIS
bull Depend on
ndash Size of the tumor
ndash Invasive or in situ
ndash Histologic type - ductal (85) vs lobular
ndash Estrogenprogesterone receptors (60-70positive)ndash Her-2 neu status (receptor for epidermal growth f)
SURVIVAL
tm size increases-
chance decreases
ndash Lymph node status
ndash Spread to other parts of the body (bones liver lung brain)ndash Age (premenopausal = poor prognostic factor)
TREATMENT TREATMENT
bull Surgery
bull Radiation Therapy (local)
bull Chemotherapy (systemic)
bull Hormonal Therapy (systemic)
bull Immunotherapy
1048708 Therapy is individualized
GoalsCure Control Palliation
SURGERY
bull Mastectomy (completeradical)
bull Breast
conservation (partial)
RECONSTRUCTION
RADIATION THERAPY
Local control of disease
Indicationsbull Adjuvant (after partial mastectomy)
bull Young patients with DCIS
bull High risk of local recurrence
bull High energy rays used to kill cancer cells
CHEMOTHERAPYAnticancer drugs = systemic control of disease
Indications
bull After surgery to reduce risk of recurrence
bull Large + locally advanced cancer to reduce the size prior to surgery (neoadjuvant)
bull Metastatic - to reduce cancer that has spread + relieve symptoms amp prolong life
HORMONAL THERAPYbull Hormones (blood stream) rarr attach ca
cells promote their growth
bull Block the receptor or production of hormones
bull Side effects hot flashes depression
uarr risk of uterine cancer induced manopause blood clots
bull Tamoxifen aromatase inhibitors
Monoclonal antibodies
bull TrastuzumabHerceptin
bull Patients whose cancer cells
over-express Her-2-neu oncogene as measured by IHC or FISH (25 to 30 of
patients)
IMMUNOTHERAPY
bull Through early detection and improved treatments more women than ever are surviving breast cancer
Questions
THANK YOU FOR YOUR ATTENTIONTHANK YOU FOR YOUR ATTENTION
References
bull Kusić ZOnkologijaZagreb2008
bull Damjanov I Jukić S Nola MPatologijaMedicinska nakladaZagreb 2008
bull Kumar P Clark MClinical MedicineSaunders ElsevierLondon2007
bull wwwcancerorgbull wwwcancergov
FACTS amp EPIDEMIOLOGYFACTS amp EPIDEMIOLOGY
bull Most common malignancy in women (25-30)
bull 2nd leading cause of cancer deaths (after lung c)
bull gt 570000 new cases worldwide each year
bull 2300 new cases
gt800 deaths in Croatia (2005)
bull One out of eight women will be diagnosed
bull Strikes a small percentage of men
bull asymp1500 new cases expected to be diagnosed in men next year
Every three minutes a woman in the US is diagnosed with BC
Every 12 minutes a woman dies from BC
All women are at risk (rare in women lt40
10 of palpable masses malignant)
5
bull Each breast = 15 to 20 sections (lobes) arranged like petals of daisy
bull Inside lobe = smaller structures (lobules)
bull End of each lobule = tiny sacs (bulbs) produce milk
Female Breast Anatomy
6
bull Lobes lobules bulbs- linked by network of thin tubes (ducts)
bull Carry milk bulbs rarr dark area of skin (areola)
Duct
Areola
Breast profile
A ducts
B lobules
C dilated section of duct to hold milk
D nipple
E fat
F pectoralis major muscle
G chest wallrib cage
Enlargement
A normal duct cells
B basement membrane (duct wall)
C lumen (center of duct)
Risk FactorsRisk Factors
Gender
Age Race
FamilyPersonal history of BC
Genetic factors
Menstrual history
Certain types of breast disease
Radiation
Weight (obesity)
Exercise
Alcohol
Reproductive history
Hormone replacement therapy
Oral contraceptive use
Breastfeeding
Nonmodifiable risks Modifiable risks
Genetic risk factors
rarr10 of BC familial (hereditary)
bull BRCA 1 amp BRCA 2 rarr tumor suppressor genes (breast cancer gene)
rarrrole in cellular DNA repair
rarrmutation increases risk
bull P53 RAS C-MYC RB gene
Types of Breast CancerTypes of Breast Cancer
Invasive Cancers Noninvasive Cancers (in situ)
spread from
ducts or lobes into
fatty tissue
limited to ducts or lobes amp does not spread into
fatty tissue
Detection methodsDetection methods
bull Self breast exam
bull Clinical examination
bull Mammography gt 35
Ultrasound lt 35
bull Biopsy if indicated
MammographyMammography
X-ray picture of the breast to detect breast cancer
Detects a breast lump before it can be felt
Age Frequency of Mammogram
40 1-2 year
50 Every year
lt49 with family hy of breast cancer
Consult health care providers about risks
BIOPSY RESULTS
bull 80 of all breast biopsies turn out to be benign
Clinical Breast ExamClinical Breast Exam
Performed by doctor
Every 3 y for women 20 ndash 39
Yearly for women gt 40 yrs of age
Breast Self-ExamBreast Self-Exam
Monthly starting at the age of 20
bull Still menstruating2-3 days after period ends
bull No longer menstruatingsame day every month
Two parts of BSE
1) Visual
2) Palpatory
bull Examine each breast separately
bull Use pads of middle three fingers feel the texture
bull Examine the armpits
Patterns
Visual
17
Most common Lump or thickening in breastOften painless
Change in color or appearance of areola
Redness or pitting of skin over the breast like the skin of an orange
Discharge or bleeding
Change in size or contours of breast
Abnormal Breast ChangesAbnormal Breast ChangesChanges in breast size of
shape Lump in the breast
Changes in the skin of the breastNipple discharged or tenderness
TREATMENT OPTIONSTREATMENT OPTIONS amp amp PROGNOSISPROGNOSIS
bull Depend on
ndash Size of the tumor
ndash Invasive or in situ
ndash Histologic type - ductal (85) vs lobular
ndash Estrogenprogesterone receptors (60-70positive)ndash Her-2 neu status (receptor for epidermal growth f)
SURVIVAL
tm size increases-
chance decreases
ndash Lymph node status
ndash Spread to other parts of the body (bones liver lung brain)ndash Age (premenopausal = poor prognostic factor)
TREATMENT TREATMENT
bull Surgery
bull Radiation Therapy (local)
bull Chemotherapy (systemic)
bull Hormonal Therapy (systemic)
bull Immunotherapy
1048708 Therapy is individualized
GoalsCure Control Palliation
SURGERY
bull Mastectomy (completeradical)
bull Breast
conservation (partial)
RECONSTRUCTION
RADIATION THERAPY
Local control of disease
Indicationsbull Adjuvant (after partial mastectomy)
bull Young patients with DCIS
bull High risk of local recurrence
bull High energy rays used to kill cancer cells
CHEMOTHERAPYAnticancer drugs = systemic control of disease
Indications
bull After surgery to reduce risk of recurrence
bull Large + locally advanced cancer to reduce the size prior to surgery (neoadjuvant)
bull Metastatic - to reduce cancer that has spread + relieve symptoms amp prolong life
HORMONAL THERAPYbull Hormones (blood stream) rarr attach ca
cells promote their growth
bull Block the receptor or production of hormones
bull Side effects hot flashes depression
uarr risk of uterine cancer induced manopause blood clots
bull Tamoxifen aromatase inhibitors
Monoclonal antibodies
bull TrastuzumabHerceptin
bull Patients whose cancer cells
over-express Her-2-neu oncogene as measured by IHC or FISH (25 to 30 of
patients)
IMMUNOTHERAPY
bull Through early detection and improved treatments more women than ever are surviving breast cancer
Questions
THANK YOU FOR YOUR ATTENTIONTHANK YOU FOR YOUR ATTENTION
References
bull Kusić ZOnkologijaZagreb2008
bull Damjanov I Jukić S Nola MPatologijaMedicinska nakladaZagreb 2008
bull Kumar P Clark MClinical MedicineSaunders ElsevierLondon2007
bull wwwcancerorgbull wwwcancergov
bull One out of eight women will be diagnosed
bull Strikes a small percentage of men
bull asymp1500 new cases expected to be diagnosed in men next year
Every three minutes a woman in the US is diagnosed with BC
Every 12 minutes a woman dies from BC
All women are at risk (rare in women lt40
10 of palpable masses malignant)
5
bull Each breast = 15 to 20 sections (lobes) arranged like petals of daisy
bull Inside lobe = smaller structures (lobules)
bull End of each lobule = tiny sacs (bulbs) produce milk
Female Breast Anatomy
6
bull Lobes lobules bulbs- linked by network of thin tubes (ducts)
bull Carry milk bulbs rarr dark area of skin (areola)
Duct
Areola
Breast profile
A ducts
B lobules
C dilated section of duct to hold milk
D nipple
E fat
F pectoralis major muscle
G chest wallrib cage
Enlargement
A normal duct cells
B basement membrane (duct wall)
C lumen (center of duct)
Risk FactorsRisk Factors
Gender
Age Race
FamilyPersonal history of BC
Genetic factors
Menstrual history
Certain types of breast disease
Radiation
Weight (obesity)
Exercise
Alcohol
Reproductive history
Hormone replacement therapy
Oral contraceptive use
Breastfeeding
Nonmodifiable risks Modifiable risks
Genetic risk factors
rarr10 of BC familial (hereditary)
bull BRCA 1 amp BRCA 2 rarr tumor suppressor genes (breast cancer gene)
rarrrole in cellular DNA repair
rarrmutation increases risk
bull P53 RAS C-MYC RB gene
Types of Breast CancerTypes of Breast Cancer
Invasive Cancers Noninvasive Cancers (in situ)
spread from
ducts or lobes into
fatty tissue
limited to ducts or lobes amp does not spread into
fatty tissue
Detection methodsDetection methods
bull Self breast exam
bull Clinical examination
bull Mammography gt 35
Ultrasound lt 35
bull Biopsy if indicated
MammographyMammography
X-ray picture of the breast to detect breast cancer
Detects a breast lump before it can be felt
Age Frequency of Mammogram
40 1-2 year
50 Every year
lt49 with family hy of breast cancer
Consult health care providers about risks
BIOPSY RESULTS
bull 80 of all breast biopsies turn out to be benign
Clinical Breast ExamClinical Breast Exam
Performed by doctor
Every 3 y for women 20 ndash 39
Yearly for women gt 40 yrs of age
Breast Self-ExamBreast Self-Exam
Monthly starting at the age of 20
bull Still menstruating2-3 days after period ends
bull No longer menstruatingsame day every month
Two parts of BSE
1) Visual
2) Palpatory
bull Examine each breast separately
bull Use pads of middle three fingers feel the texture
bull Examine the armpits
Patterns
Visual
17
Most common Lump or thickening in breastOften painless
Change in color or appearance of areola
Redness or pitting of skin over the breast like the skin of an orange
Discharge or bleeding
Change in size or contours of breast
Abnormal Breast ChangesAbnormal Breast ChangesChanges in breast size of
shape Lump in the breast
Changes in the skin of the breastNipple discharged or tenderness
TREATMENT OPTIONSTREATMENT OPTIONS amp amp PROGNOSISPROGNOSIS
bull Depend on
ndash Size of the tumor
ndash Invasive or in situ
ndash Histologic type - ductal (85) vs lobular
ndash Estrogenprogesterone receptors (60-70positive)ndash Her-2 neu status (receptor for epidermal growth f)
SURVIVAL
tm size increases-
chance decreases
ndash Lymph node status
ndash Spread to other parts of the body (bones liver lung brain)ndash Age (premenopausal = poor prognostic factor)
TREATMENT TREATMENT
bull Surgery
bull Radiation Therapy (local)
bull Chemotherapy (systemic)
bull Hormonal Therapy (systemic)
bull Immunotherapy
1048708 Therapy is individualized
GoalsCure Control Palliation
SURGERY
bull Mastectomy (completeradical)
bull Breast
conservation (partial)
RECONSTRUCTION
RADIATION THERAPY
Local control of disease
Indicationsbull Adjuvant (after partial mastectomy)
bull Young patients with DCIS
bull High risk of local recurrence
bull High energy rays used to kill cancer cells
CHEMOTHERAPYAnticancer drugs = systemic control of disease
Indications
bull After surgery to reduce risk of recurrence
bull Large + locally advanced cancer to reduce the size prior to surgery (neoadjuvant)
bull Metastatic - to reduce cancer that has spread + relieve symptoms amp prolong life
HORMONAL THERAPYbull Hormones (blood stream) rarr attach ca
cells promote their growth
bull Block the receptor or production of hormones
bull Side effects hot flashes depression
uarr risk of uterine cancer induced manopause blood clots
bull Tamoxifen aromatase inhibitors
Monoclonal antibodies
bull TrastuzumabHerceptin
bull Patients whose cancer cells
over-express Her-2-neu oncogene as measured by IHC or FISH (25 to 30 of
patients)
IMMUNOTHERAPY
bull Through early detection and improved treatments more women than ever are surviving breast cancer
Questions
THANK YOU FOR YOUR ATTENTIONTHANK YOU FOR YOUR ATTENTION
References
bull Kusić ZOnkologijaZagreb2008
bull Damjanov I Jukić S Nola MPatologijaMedicinska nakladaZagreb 2008
bull Kumar P Clark MClinical MedicineSaunders ElsevierLondon2007
bull wwwcancerorgbull wwwcancergov
Every three minutes a woman in the US is diagnosed with BC
Every 12 minutes a woman dies from BC
All women are at risk (rare in women lt40
10 of palpable masses malignant)
5
bull Each breast = 15 to 20 sections (lobes) arranged like petals of daisy
bull Inside lobe = smaller structures (lobules)
bull End of each lobule = tiny sacs (bulbs) produce milk
Female Breast Anatomy
6
bull Lobes lobules bulbs- linked by network of thin tubes (ducts)
bull Carry milk bulbs rarr dark area of skin (areola)
Duct
Areola
Breast profile
A ducts
B lobules
C dilated section of duct to hold milk
D nipple
E fat
F pectoralis major muscle
G chest wallrib cage
Enlargement
A normal duct cells
B basement membrane (duct wall)
C lumen (center of duct)
Risk FactorsRisk Factors
Gender
Age Race
FamilyPersonal history of BC
Genetic factors
Menstrual history
Certain types of breast disease
Radiation
Weight (obesity)
Exercise
Alcohol
Reproductive history
Hormone replacement therapy
Oral contraceptive use
Breastfeeding
Nonmodifiable risks Modifiable risks
Genetic risk factors
rarr10 of BC familial (hereditary)
bull BRCA 1 amp BRCA 2 rarr tumor suppressor genes (breast cancer gene)
rarrrole in cellular DNA repair
rarrmutation increases risk
bull P53 RAS C-MYC RB gene
Types of Breast CancerTypes of Breast Cancer
Invasive Cancers Noninvasive Cancers (in situ)
spread from
ducts or lobes into
fatty tissue
limited to ducts or lobes amp does not spread into
fatty tissue
Detection methodsDetection methods
bull Self breast exam
bull Clinical examination
bull Mammography gt 35
Ultrasound lt 35
bull Biopsy if indicated
MammographyMammography
X-ray picture of the breast to detect breast cancer
Detects a breast lump before it can be felt
Age Frequency of Mammogram
40 1-2 year
50 Every year
lt49 with family hy of breast cancer
Consult health care providers about risks
BIOPSY RESULTS
bull 80 of all breast biopsies turn out to be benign
Clinical Breast ExamClinical Breast Exam
Performed by doctor
Every 3 y for women 20 ndash 39
Yearly for women gt 40 yrs of age
Breast Self-ExamBreast Self-Exam
Monthly starting at the age of 20
bull Still menstruating2-3 days after period ends
bull No longer menstruatingsame day every month
Two parts of BSE
1) Visual
2) Palpatory
bull Examine each breast separately
bull Use pads of middle three fingers feel the texture
bull Examine the armpits
Patterns
Visual
17
Most common Lump or thickening in breastOften painless
Change in color or appearance of areola
Redness or pitting of skin over the breast like the skin of an orange
Discharge or bleeding
Change in size or contours of breast
Abnormal Breast ChangesAbnormal Breast ChangesChanges in breast size of
shape Lump in the breast
Changes in the skin of the breastNipple discharged or tenderness
TREATMENT OPTIONSTREATMENT OPTIONS amp amp PROGNOSISPROGNOSIS
bull Depend on
ndash Size of the tumor
ndash Invasive or in situ
ndash Histologic type - ductal (85) vs lobular
ndash Estrogenprogesterone receptors (60-70positive)ndash Her-2 neu status (receptor for epidermal growth f)
SURVIVAL
tm size increases-
chance decreases
ndash Lymph node status
ndash Spread to other parts of the body (bones liver lung brain)ndash Age (premenopausal = poor prognostic factor)
TREATMENT TREATMENT
bull Surgery
bull Radiation Therapy (local)
bull Chemotherapy (systemic)
bull Hormonal Therapy (systemic)
bull Immunotherapy
1048708 Therapy is individualized
GoalsCure Control Palliation
SURGERY
bull Mastectomy (completeradical)
bull Breast
conservation (partial)
RECONSTRUCTION
RADIATION THERAPY
Local control of disease
Indicationsbull Adjuvant (after partial mastectomy)
bull Young patients with DCIS
bull High risk of local recurrence
bull High energy rays used to kill cancer cells
CHEMOTHERAPYAnticancer drugs = systemic control of disease
Indications
bull After surgery to reduce risk of recurrence
bull Large + locally advanced cancer to reduce the size prior to surgery (neoadjuvant)
bull Metastatic - to reduce cancer that has spread + relieve symptoms amp prolong life
HORMONAL THERAPYbull Hormones (blood stream) rarr attach ca
cells promote their growth
bull Block the receptor or production of hormones
bull Side effects hot flashes depression
uarr risk of uterine cancer induced manopause blood clots
bull Tamoxifen aromatase inhibitors
Monoclonal antibodies
bull TrastuzumabHerceptin
bull Patients whose cancer cells
over-express Her-2-neu oncogene as measured by IHC or FISH (25 to 30 of
patients)
IMMUNOTHERAPY
bull Through early detection and improved treatments more women than ever are surviving breast cancer
Questions
THANK YOU FOR YOUR ATTENTIONTHANK YOU FOR YOUR ATTENTION
References
bull Kusić ZOnkologijaZagreb2008
bull Damjanov I Jukić S Nola MPatologijaMedicinska nakladaZagreb 2008
bull Kumar P Clark MClinical MedicineSaunders ElsevierLondon2007
bull wwwcancerorgbull wwwcancergov
5
bull Each breast = 15 to 20 sections (lobes) arranged like petals of daisy
bull Inside lobe = smaller structures (lobules)
bull End of each lobule = tiny sacs (bulbs) produce milk
Female Breast Anatomy
6
bull Lobes lobules bulbs- linked by network of thin tubes (ducts)
bull Carry milk bulbs rarr dark area of skin (areola)
Duct
Areola
Breast profile
A ducts
B lobules
C dilated section of duct to hold milk
D nipple
E fat
F pectoralis major muscle
G chest wallrib cage
Enlargement
A normal duct cells
B basement membrane (duct wall)
C lumen (center of duct)
Risk FactorsRisk Factors
Gender
Age Race
FamilyPersonal history of BC
Genetic factors
Menstrual history
Certain types of breast disease
Radiation
Weight (obesity)
Exercise
Alcohol
Reproductive history
Hormone replacement therapy
Oral contraceptive use
Breastfeeding
Nonmodifiable risks Modifiable risks
Genetic risk factors
rarr10 of BC familial (hereditary)
bull BRCA 1 amp BRCA 2 rarr tumor suppressor genes (breast cancer gene)
rarrrole in cellular DNA repair
rarrmutation increases risk
bull P53 RAS C-MYC RB gene
Types of Breast CancerTypes of Breast Cancer
Invasive Cancers Noninvasive Cancers (in situ)
spread from
ducts or lobes into
fatty tissue
limited to ducts or lobes amp does not spread into
fatty tissue
Detection methodsDetection methods
bull Self breast exam
bull Clinical examination
bull Mammography gt 35
Ultrasound lt 35
bull Biopsy if indicated
MammographyMammography
X-ray picture of the breast to detect breast cancer
Detects a breast lump before it can be felt
Age Frequency of Mammogram
40 1-2 year
50 Every year
lt49 with family hy of breast cancer
Consult health care providers about risks
BIOPSY RESULTS
bull 80 of all breast biopsies turn out to be benign
Clinical Breast ExamClinical Breast Exam
Performed by doctor
Every 3 y for women 20 ndash 39
Yearly for women gt 40 yrs of age
Breast Self-ExamBreast Self-Exam
Monthly starting at the age of 20
bull Still menstruating2-3 days after period ends
bull No longer menstruatingsame day every month
Two parts of BSE
1) Visual
2) Palpatory
bull Examine each breast separately
bull Use pads of middle three fingers feel the texture
bull Examine the armpits
Patterns
Visual
17
Most common Lump or thickening in breastOften painless
Change in color or appearance of areola
Redness or pitting of skin over the breast like the skin of an orange
Discharge or bleeding
Change in size or contours of breast
Abnormal Breast ChangesAbnormal Breast ChangesChanges in breast size of
shape Lump in the breast
Changes in the skin of the breastNipple discharged or tenderness
TREATMENT OPTIONSTREATMENT OPTIONS amp amp PROGNOSISPROGNOSIS
bull Depend on
ndash Size of the tumor
ndash Invasive or in situ
ndash Histologic type - ductal (85) vs lobular
ndash Estrogenprogesterone receptors (60-70positive)ndash Her-2 neu status (receptor for epidermal growth f)
SURVIVAL
tm size increases-
chance decreases
ndash Lymph node status
ndash Spread to other parts of the body (bones liver lung brain)ndash Age (premenopausal = poor prognostic factor)
TREATMENT TREATMENT
bull Surgery
bull Radiation Therapy (local)
bull Chemotherapy (systemic)
bull Hormonal Therapy (systemic)
bull Immunotherapy
1048708 Therapy is individualized
GoalsCure Control Palliation
SURGERY
bull Mastectomy (completeradical)
bull Breast
conservation (partial)
RECONSTRUCTION
RADIATION THERAPY
Local control of disease
Indicationsbull Adjuvant (after partial mastectomy)
bull Young patients with DCIS
bull High risk of local recurrence
bull High energy rays used to kill cancer cells
CHEMOTHERAPYAnticancer drugs = systemic control of disease
Indications
bull After surgery to reduce risk of recurrence
bull Large + locally advanced cancer to reduce the size prior to surgery (neoadjuvant)
bull Metastatic - to reduce cancer that has spread + relieve symptoms amp prolong life
HORMONAL THERAPYbull Hormones (blood stream) rarr attach ca
cells promote their growth
bull Block the receptor or production of hormones
bull Side effects hot flashes depression
uarr risk of uterine cancer induced manopause blood clots
bull Tamoxifen aromatase inhibitors
Monoclonal antibodies
bull TrastuzumabHerceptin
bull Patients whose cancer cells
over-express Her-2-neu oncogene as measured by IHC or FISH (25 to 30 of
patients)
IMMUNOTHERAPY
bull Through early detection and improved treatments more women than ever are surviving breast cancer
Questions
THANK YOU FOR YOUR ATTENTIONTHANK YOU FOR YOUR ATTENTION
References
bull Kusić ZOnkologijaZagreb2008
bull Damjanov I Jukić S Nola MPatologijaMedicinska nakladaZagreb 2008
bull Kumar P Clark MClinical MedicineSaunders ElsevierLondon2007
bull wwwcancerorgbull wwwcancergov
6
bull Lobes lobules bulbs- linked by network of thin tubes (ducts)
bull Carry milk bulbs rarr dark area of skin (areola)
Duct
Areola
Breast profile
A ducts
B lobules
C dilated section of duct to hold milk
D nipple
E fat
F pectoralis major muscle
G chest wallrib cage
Enlargement
A normal duct cells
B basement membrane (duct wall)
C lumen (center of duct)
Risk FactorsRisk Factors
Gender
Age Race
FamilyPersonal history of BC
Genetic factors
Menstrual history
Certain types of breast disease
Radiation
Weight (obesity)
Exercise
Alcohol
Reproductive history
Hormone replacement therapy
Oral contraceptive use
Breastfeeding
Nonmodifiable risks Modifiable risks
Genetic risk factors
rarr10 of BC familial (hereditary)
bull BRCA 1 amp BRCA 2 rarr tumor suppressor genes (breast cancer gene)
rarrrole in cellular DNA repair
rarrmutation increases risk
bull P53 RAS C-MYC RB gene
Types of Breast CancerTypes of Breast Cancer
Invasive Cancers Noninvasive Cancers (in situ)
spread from
ducts or lobes into
fatty tissue
limited to ducts or lobes amp does not spread into
fatty tissue
Detection methodsDetection methods
bull Self breast exam
bull Clinical examination
bull Mammography gt 35
Ultrasound lt 35
bull Biopsy if indicated
MammographyMammography
X-ray picture of the breast to detect breast cancer
Detects a breast lump before it can be felt
Age Frequency of Mammogram
40 1-2 year
50 Every year
lt49 with family hy of breast cancer
Consult health care providers about risks
BIOPSY RESULTS
bull 80 of all breast biopsies turn out to be benign
Clinical Breast ExamClinical Breast Exam
Performed by doctor
Every 3 y for women 20 ndash 39
Yearly for women gt 40 yrs of age
Breast Self-ExamBreast Self-Exam
Monthly starting at the age of 20
bull Still menstruating2-3 days after period ends
bull No longer menstruatingsame day every month
Two parts of BSE
1) Visual
2) Palpatory
bull Examine each breast separately
bull Use pads of middle three fingers feel the texture
bull Examine the armpits
Patterns
Visual
17
Most common Lump or thickening in breastOften painless
Change in color or appearance of areola
Redness or pitting of skin over the breast like the skin of an orange
Discharge or bleeding
Change in size or contours of breast
Abnormal Breast ChangesAbnormal Breast ChangesChanges in breast size of
shape Lump in the breast
Changes in the skin of the breastNipple discharged or tenderness
TREATMENT OPTIONSTREATMENT OPTIONS amp amp PROGNOSISPROGNOSIS
bull Depend on
ndash Size of the tumor
ndash Invasive or in situ
ndash Histologic type - ductal (85) vs lobular
ndash Estrogenprogesterone receptors (60-70positive)ndash Her-2 neu status (receptor for epidermal growth f)
SURVIVAL
tm size increases-
chance decreases
ndash Lymph node status
ndash Spread to other parts of the body (bones liver lung brain)ndash Age (premenopausal = poor prognostic factor)
TREATMENT TREATMENT
bull Surgery
bull Radiation Therapy (local)
bull Chemotherapy (systemic)
bull Hormonal Therapy (systemic)
bull Immunotherapy
1048708 Therapy is individualized
GoalsCure Control Palliation
SURGERY
bull Mastectomy (completeradical)
bull Breast
conservation (partial)
RECONSTRUCTION
RADIATION THERAPY
Local control of disease
Indicationsbull Adjuvant (after partial mastectomy)
bull Young patients with DCIS
bull High risk of local recurrence
bull High energy rays used to kill cancer cells
CHEMOTHERAPYAnticancer drugs = systemic control of disease
Indications
bull After surgery to reduce risk of recurrence
bull Large + locally advanced cancer to reduce the size prior to surgery (neoadjuvant)
bull Metastatic - to reduce cancer that has spread + relieve symptoms amp prolong life
HORMONAL THERAPYbull Hormones (blood stream) rarr attach ca
cells promote their growth
bull Block the receptor or production of hormones
bull Side effects hot flashes depression
uarr risk of uterine cancer induced manopause blood clots
bull Tamoxifen aromatase inhibitors
Monoclonal antibodies
bull TrastuzumabHerceptin
bull Patients whose cancer cells
over-express Her-2-neu oncogene as measured by IHC or FISH (25 to 30 of
patients)
IMMUNOTHERAPY
bull Through early detection and improved treatments more women than ever are surviving breast cancer
Questions
THANK YOU FOR YOUR ATTENTIONTHANK YOU FOR YOUR ATTENTION
References
bull Kusić ZOnkologijaZagreb2008
bull Damjanov I Jukić S Nola MPatologijaMedicinska nakladaZagreb 2008
bull Kumar P Clark MClinical MedicineSaunders ElsevierLondon2007
bull wwwcancerorgbull wwwcancergov
Risk FactorsRisk Factors
Gender
Age Race
FamilyPersonal history of BC
Genetic factors
Menstrual history
Certain types of breast disease
Radiation
Weight (obesity)
Exercise
Alcohol
Reproductive history
Hormone replacement therapy
Oral contraceptive use
Breastfeeding
Nonmodifiable risks Modifiable risks
Genetic risk factors
rarr10 of BC familial (hereditary)
bull BRCA 1 amp BRCA 2 rarr tumor suppressor genes (breast cancer gene)
rarrrole in cellular DNA repair
rarrmutation increases risk
bull P53 RAS C-MYC RB gene
Types of Breast CancerTypes of Breast Cancer
Invasive Cancers Noninvasive Cancers (in situ)
spread from
ducts or lobes into
fatty tissue
limited to ducts or lobes amp does not spread into
fatty tissue
Detection methodsDetection methods
bull Self breast exam
bull Clinical examination
bull Mammography gt 35
Ultrasound lt 35
bull Biopsy if indicated
MammographyMammography
X-ray picture of the breast to detect breast cancer
Detects a breast lump before it can be felt
Age Frequency of Mammogram
40 1-2 year
50 Every year
lt49 with family hy of breast cancer
Consult health care providers about risks
BIOPSY RESULTS
bull 80 of all breast biopsies turn out to be benign
Clinical Breast ExamClinical Breast Exam
Performed by doctor
Every 3 y for women 20 ndash 39
Yearly for women gt 40 yrs of age
Breast Self-ExamBreast Self-Exam
Monthly starting at the age of 20
bull Still menstruating2-3 days after period ends
bull No longer menstruatingsame day every month
Two parts of BSE
1) Visual
2) Palpatory
bull Examine each breast separately
bull Use pads of middle three fingers feel the texture
bull Examine the armpits
Patterns
Visual
17
Most common Lump or thickening in breastOften painless
Change in color or appearance of areola
Redness or pitting of skin over the breast like the skin of an orange
Discharge or bleeding
Change in size or contours of breast
Abnormal Breast ChangesAbnormal Breast ChangesChanges in breast size of
shape Lump in the breast
Changes in the skin of the breastNipple discharged or tenderness
TREATMENT OPTIONSTREATMENT OPTIONS amp amp PROGNOSISPROGNOSIS
bull Depend on
ndash Size of the tumor
ndash Invasive or in situ
ndash Histologic type - ductal (85) vs lobular
ndash Estrogenprogesterone receptors (60-70positive)ndash Her-2 neu status (receptor for epidermal growth f)
SURVIVAL
tm size increases-
chance decreases
ndash Lymph node status
ndash Spread to other parts of the body (bones liver lung brain)ndash Age (premenopausal = poor prognostic factor)
TREATMENT TREATMENT
bull Surgery
bull Radiation Therapy (local)
bull Chemotherapy (systemic)
bull Hormonal Therapy (systemic)
bull Immunotherapy
1048708 Therapy is individualized
GoalsCure Control Palliation
SURGERY
bull Mastectomy (completeradical)
bull Breast
conservation (partial)
RECONSTRUCTION
RADIATION THERAPY
Local control of disease
Indicationsbull Adjuvant (after partial mastectomy)
bull Young patients with DCIS
bull High risk of local recurrence
bull High energy rays used to kill cancer cells
CHEMOTHERAPYAnticancer drugs = systemic control of disease
Indications
bull After surgery to reduce risk of recurrence
bull Large + locally advanced cancer to reduce the size prior to surgery (neoadjuvant)
bull Metastatic - to reduce cancer that has spread + relieve symptoms amp prolong life
HORMONAL THERAPYbull Hormones (blood stream) rarr attach ca
cells promote their growth
bull Block the receptor or production of hormones
bull Side effects hot flashes depression
uarr risk of uterine cancer induced manopause blood clots
bull Tamoxifen aromatase inhibitors
Monoclonal antibodies
bull TrastuzumabHerceptin
bull Patients whose cancer cells
over-express Her-2-neu oncogene as measured by IHC or FISH (25 to 30 of
patients)
IMMUNOTHERAPY
bull Through early detection and improved treatments more women than ever are surviving breast cancer
Questions
THANK YOU FOR YOUR ATTENTIONTHANK YOU FOR YOUR ATTENTION
References
bull Kusić ZOnkologijaZagreb2008
bull Damjanov I Jukić S Nola MPatologijaMedicinska nakladaZagreb 2008
bull Kumar P Clark MClinical MedicineSaunders ElsevierLondon2007
bull wwwcancerorgbull wwwcancergov
Genetic risk factors
rarr10 of BC familial (hereditary)
bull BRCA 1 amp BRCA 2 rarr tumor suppressor genes (breast cancer gene)
rarrrole in cellular DNA repair
rarrmutation increases risk
bull P53 RAS C-MYC RB gene
Types of Breast CancerTypes of Breast Cancer
Invasive Cancers Noninvasive Cancers (in situ)
spread from
ducts or lobes into
fatty tissue
limited to ducts or lobes amp does not spread into
fatty tissue
Detection methodsDetection methods
bull Self breast exam
bull Clinical examination
bull Mammography gt 35
Ultrasound lt 35
bull Biopsy if indicated
MammographyMammography
X-ray picture of the breast to detect breast cancer
Detects a breast lump before it can be felt
Age Frequency of Mammogram
40 1-2 year
50 Every year
lt49 with family hy of breast cancer
Consult health care providers about risks
BIOPSY RESULTS
bull 80 of all breast biopsies turn out to be benign
Clinical Breast ExamClinical Breast Exam
Performed by doctor
Every 3 y for women 20 ndash 39
Yearly for women gt 40 yrs of age
Breast Self-ExamBreast Self-Exam
Monthly starting at the age of 20
bull Still menstruating2-3 days after period ends
bull No longer menstruatingsame day every month
Two parts of BSE
1) Visual
2) Palpatory
bull Examine each breast separately
bull Use pads of middle three fingers feel the texture
bull Examine the armpits
Patterns
Visual
17
Most common Lump or thickening in breastOften painless
Change in color or appearance of areola
Redness or pitting of skin over the breast like the skin of an orange
Discharge or bleeding
Change in size or contours of breast
Abnormal Breast ChangesAbnormal Breast ChangesChanges in breast size of
shape Lump in the breast
Changes in the skin of the breastNipple discharged or tenderness
TREATMENT OPTIONSTREATMENT OPTIONS amp amp PROGNOSISPROGNOSIS
bull Depend on
ndash Size of the tumor
ndash Invasive or in situ
ndash Histologic type - ductal (85) vs lobular
ndash Estrogenprogesterone receptors (60-70positive)ndash Her-2 neu status (receptor for epidermal growth f)
SURVIVAL
tm size increases-
chance decreases
ndash Lymph node status
ndash Spread to other parts of the body (bones liver lung brain)ndash Age (premenopausal = poor prognostic factor)
TREATMENT TREATMENT
bull Surgery
bull Radiation Therapy (local)
bull Chemotherapy (systemic)
bull Hormonal Therapy (systemic)
bull Immunotherapy
1048708 Therapy is individualized
GoalsCure Control Palliation
SURGERY
bull Mastectomy (completeradical)
bull Breast
conservation (partial)
RECONSTRUCTION
RADIATION THERAPY
Local control of disease
Indicationsbull Adjuvant (after partial mastectomy)
bull Young patients with DCIS
bull High risk of local recurrence
bull High energy rays used to kill cancer cells
CHEMOTHERAPYAnticancer drugs = systemic control of disease
Indications
bull After surgery to reduce risk of recurrence
bull Large + locally advanced cancer to reduce the size prior to surgery (neoadjuvant)
bull Metastatic - to reduce cancer that has spread + relieve symptoms amp prolong life
HORMONAL THERAPYbull Hormones (blood stream) rarr attach ca
cells promote their growth
bull Block the receptor or production of hormones
bull Side effects hot flashes depression
uarr risk of uterine cancer induced manopause blood clots
bull Tamoxifen aromatase inhibitors
Monoclonal antibodies
bull TrastuzumabHerceptin
bull Patients whose cancer cells
over-express Her-2-neu oncogene as measured by IHC or FISH (25 to 30 of
patients)
IMMUNOTHERAPY
bull Through early detection and improved treatments more women than ever are surviving breast cancer
Questions
THANK YOU FOR YOUR ATTENTIONTHANK YOU FOR YOUR ATTENTION
References
bull Kusić ZOnkologijaZagreb2008
bull Damjanov I Jukić S Nola MPatologijaMedicinska nakladaZagreb 2008
bull Kumar P Clark MClinical MedicineSaunders ElsevierLondon2007
bull wwwcancerorgbull wwwcancergov
Types of Breast CancerTypes of Breast Cancer
Invasive Cancers Noninvasive Cancers (in situ)
spread from
ducts or lobes into
fatty tissue
limited to ducts or lobes amp does not spread into
fatty tissue
Detection methodsDetection methods
bull Self breast exam
bull Clinical examination
bull Mammography gt 35
Ultrasound lt 35
bull Biopsy if indicated
MammographyMammography
X-ray picture of the breast to detect breast cancer
Detects a breast lump before it can be felt
Age Frequency of Mammogram
40 1-2 year
50 Every year
lt49 with family hy of breast cancer
Consult health care providers about risks
BIOPSY RESULTS
bull 80 of all breast biopsies turn out to be benign
Clinical Breast ExamClinical Breast Exam
Performed by doctor
Every 3 y for women 20 ndash 39
Yearly for women gt 40 yrs of age
Breast Self-ExamBreast Self-Exam
Monthly starting at the age of 20
bull Still menstruating2-3 days after period ends
bull No longer menstruatingsame day every month
Two parts of BSE
1) Visual
2) Palpatory
bull Examine each breast separately
bull Use pads of middle three fingers feel the texture
bull Examine the armpits
Patterns
Visual
17
Most common Lump or thickening in breastOften painless
Change in color or appearance of areola
Redness or pitting of skin over the breast like the skin of an orange
Discharge or bleeding
Change in size or contours of breast
Abnormal Breast ChangesAbnormal Breast ChangesChanges in breast size of
shape Lump in the breast
Changes in the skin of the breastNipple discharged or tenderness
TREATMENT OPTIONSTREATMENT OPTIONS amp amp PROGNOSISPROGNOSIS
bull Depend on
ndash Size of the tumor
ndash Invasive or in situ
ndash Histologic type - ductal (85) vs lobular
ndash Estrogenprogesterone receptors (60-70positive)ndash Her-2 neu status (receptor for epidermal growth f)
SURVIVAL
tm size increases-
chance decreases
ndash Lymph node status
ndash Spread to other parts of the body (bones liver lung brain)ndash Age (premenopausal = poor prognostic factor)
TREATMENT TREATMENT
bull Surgery
bull Radiation Therapy (local)
bull Chemotherapy (systemic)
bull Hormonal Therapy (systemic)
bull Immunotherapy
1048708 Therapy is individualized
GoalsCure Control Palliation
SURGERY
bull Mastectomy (completeradical)
bull Breast
conservation (partial)
RECONSTRUCTION
RADIATION THERAPY
Local control of disease
Indicationsbull Adjuvant (after partial mastectomy)
bull Young patients with DCIS
bull High risk of local recurrence
bull High energy rays used to kill cancer cells
CHEMOTHERAPYAnticancer drugs = systemic control of disease
Indications
bull After surgery to reduce risk of recurrence
bull Large + locally advanced cancer to reduce the size prior to surgery (neoadjuvant)
bull Metastatic - to reduce cancer that has spread + relieve symptoms amp prolong life
HORMONAL THERAPYbull Hormones (blood stream) rarr attach ca
cells promote their growth
bull Block the receptor or production of hormones
bull Side effects hot flashes depression
uarr risk of uterine cancer induced manopause blood clots
bull Tamoxifen aromatase inhibitors
Monoclonal antibodies
bull TrastuzumabHerceptin
bull Patients whose cancer cells
over-express Her-2-neu oncogene as measured by IHC or FISH (25 to 30 of
patients)
IMMUNOTHERAPY
bull Through early detection and improved treatments more women than ever are surviving breast cancer
Questions
THANK YOU FOR YOUR ATTENTIONTHANK YOU FOR YOUR ATTENTION
References
bull Kusić ZOnkologijaZagreb2008
bull Damjanov I Jukić S Nola MPatologijaMedicinska nakladaZagreb 2008
bull Kumar P Clark MClinical MedicineSaunders ElsevierLondon2007
bull wwwcancerorgbull wwwcancergov
Detection methodsDetection methods
bull Self breast exam
bull Clinical examination
bull Mammography gt 35
Ultrasound lt 35
bull Biopsy if indicated
MammographyMammography
X-ray picture of the breast to detect breast cancer
Detects a breast lump before it can be felt
Age Frequency of Mammogram
40 1-2 year
50 Every year
lt49 with family hy of breast cancer
Consult health care providers about risks
BIOPSY RESULTS
bull 80 of all breast biopsies turn out to be benign
Clinical Breast ExamClinical Breast Exam
Performed by doctor
Every 3 y for women 20 ndash 39
Yearly for women gt 40 yrs of age
Breast Self-ExamBreast Self-Exam
Monthly starting at the age of 20
bull Still menstruating2-3 days after period ends
bull No longer menstruatingsame day every month
Two parts of BSE
1) Visual
2) Palpatory
bull Examine each breast separately
bull Use pads of middle three fingers feel the texture
bull Examine the armpits
Patterns
Visual
17
Most common Lump or thickening in breastOften painless
Change in color or appearance of areola
Redness or pitting of skin over the breast like the skin of an orange
Discharge or bleeding
Change in size or contours of breast
Abnormal Breast ChangesAbnormal Breast ChangesChanges in breast size of
shape Lump in the breast
Changes in the skin of the breastNipple discharged or tenderness
TREATMENT OPTIONSTREATMENT OPTIONS amp amp PROGNOSISPROGNOSIS
bull Depend on
ndash Size of the tumor
ndash Invasive or in situ
ndash Histologic type - ductal (85) vs lobular
ndash Estrogenprogesterone receptors (60-70positive)ndash Her-2 neu status (receptor for epidermal growth f)
SURVIVAL
tm size increases-
chance decreases
ndash Lymph node status
ndash Spread to other parts of the body (bones liver lung brain)ndash Age (premenopausal = poor prognostic factor)
TREATMENT TREATMENT
bull Surgery
bull Radiation Therapy (local)
bull Chemotherapy (systemic)
bull Hormonal Therapy (systemic)
bull Immunotherapy
1048708 Therapy is individualized
GoalsCure Control Palliation
SURGERY
bull Mastectomy (completeradical)
bull Breast
conservation (partial)
RECONSTRUCTION
RADIATION THERAPY
Local control of disease
Indicationsbull Adjuvant (after partial mastectomy)
bull Young patients with DCIS
bull High risk of local recurrence
bull High energy rays used to kill cancer cells
CHEMOTHERAPYAnticancer drugs = systemic control of disease
Indications
bull After surgery to reduce risk of recurrence
bull Large + locally advanced cancer to reduce the size prior to surgery (neoadjuvant)
bull Metastatic - to reduce cancer that has spread + relieve symptoms amp prolong life
HORMONAL THERAPYbull Hormones (blood stream) rarr attach ca
cells promote their growth
bull Block the receptor or production of hormones
bull Side effects hot flashes depression
uarr risk of uterine cancer induced manopause blood clots
bull Tamoxifen aromatase inhibitors
Monoclonal antibodies
bull TrastuzumabHerceptin
bull Patients whose cancer cells
over-express Her-2-neu oncogene as measured by IHC or FISH (25 to 30 of
patients)
IMMUNOTHERAPY
bull Through early detection and improved treatments more women than ever are surviving breast cancer
Questions
THANK YOU FOR YOUR ATTENTIONTHANK YOU FOR YOUR ATTENTION
References
bull Kusić ZOnkologijaZagreb2008
bull Damjanov I Jukić S Nola MPatologijaMedicinska nakladaZagreb 2008
bull Kumar P Clark MClinical MedicineSaunders ElsevierLondon2007
bull wwwcancerorgbull wwwcancergov
MammographyMammography
X-ray picture of the breast to detect breast cancer
Detects a breast lump before it can be felt
Age Frequency of Mammogram
40 1-2 year
50 Every year
lt49 with family hy of breast cancer
Consult health care providers about risks
BIOPSY RESULTS
bull 80 of all breast biopsies turn out to be benign
Clinical Breast ExamClinical Breast Exam
Performed by doctor
Every 3 y for women 20 ndash 39
Yearly for women gt 40 yrs of age
Breast Self-ExamBreast Self-Exam
Monthly starting at the age of 20
bull Still menstruating2-3 days after period ends
bull No longer menstruatingsame day every month
Two parts of BSE
1) Visual
2) Palpatory
bull Examine each breast separately
bull Use pads of middle three fingers feel the texture
bull Examine the armpits
Patterns
Visual
17
Most common Lump or thickening in breastOften painless
Change in color or appearance of areola
Redness or pitting of skin over the breast like the skin of an orange
Discharge or bleeding
Change in size or contours of breast
Abnormal Breast ChangesAbnormal Breast ChangesChanges in breast size of
shape Lump in the breast
Changes in the skin of the breastNipple discharged or tenderness
TREATMENT OPTIONSTREATMENT OPTIONS amp amp PROGNOSISPROGNOSIS
bull Depend on
ndash Size of the tumor
ndash Invasive or in situ
ndash Histologic type - ductal (85) vs lobular
ndash Estrogenprogesterone receptors (60-70positive)ndash Her-2 neu status (receptor for epidermal growth f)
SURVIVAL
tm size increases-
chance decreases
ndash Lymph node status
ndash Spread to other parts of the body (bones liver lung brain)ndash Age (premenopausal = poor prognostic factor)
TREATMENT TREATMENT
bull Surgery
bull Radiation Therapy (local)
bull Chemotherapy (systemic)
bull Hormonal Therapy (systemic)
bull Immunotherapy
1048708 Therapy is individualized
GoalsCure Control Palliation
SURGERY
bull Mastectomy (completeradical)
bull Breast
conservation (partial)
RECONSTRUCTION
RADIATION THERAPY
Local control of disease
Indicationsbull Adjuvant (after partial mastectomy)
bull Young patients with DCIS
bull High risk of local recurrence
bull High energy rays used to kill cancer cells
CHEMOTHERAPYAnticancer drugs = systemic control of disease
Indications
bull After surgery to reduce risk of recurrence
bull Large + locally advanced cancer to reduce the size prior to surgery (neoadjuvant)
bull Metastatic - to reduce cancer that has spread + relieve symptoms amp prolong life
HORMONAL THERAPYbull Hormones (blood stream) rarr attach ca
cells promote their growth
bull Block the receptor or production of hormones
bull Side effects hot flashes depression
uarr risk of uterine cancer induced manopause blood clots
bull Tamoxifen aromatase inhibitors
Monoclonal antibodies
bull TrastuzumabHerceptin
bull Patients whose cancer cells
over-express Her-2-neu oncogene as measured by IHC or FISH (25 to 30 of
patients)
IMMUNOTHERAPY
bull Through early detection and improved treatments more women than ever are surviving breast cancer
Questions
THANK YOU FOR YOUR ATTENTIONTHANK YOU FOR YOUR ATTENTION
References
bull Kusić ZOnkologijaZagreb2008
bull Damjanov I Jukić S Nola MPatologijaMedicinska nakladaZagreb 2008
bull Kumar P Clark MClinical MedicineSaunders ElsevierLondon2007
bull wwwcancerorgbull wwwcancergov
BIOPSY RESULTS
bull 80 of all breast biopsies turn out to be benign
Clinical Breast ExamClinical Breast Exam
Performed by doctor
Every 3 y for women 20 ndash 39
Yearly for women gt 40 yrs of age
Breast Self-ExamBreast Self-Exam
Monthly starting at the age of 20
bull Still menstruating2-3 days after period ends
bull No longer menstruatingsame day every month
Two parts of BSE
1) Visual
2) Palpatory
bull Examine each breast separately
bull Use pads of middle three fingers feel the texture
bull Examine the armpits
Patterns
Visual
17
Most common Lump or thickening in breastOften painless
Change in color or appearance of areola
Redness or pitting of skin over the breast like the skin of an orange
Discharge or bleeding
Change in size or contours of breast
Abnormal Breast ChangesAbnormal Breast ChangesChanges in breast size of
shape Lump in the breast
Changes in the skin of the breastNipple discharged or tenderness
TREATMENT OPTIONSTREATMENT OPTIONS amp amp PROGNOSISPROGNOSIS
bull Depend on
ndash Size of the tumor
ndash Invasive or in situ
ndash Histologic type - ductal (85) vs lobular
ndash Estrogenprogesterone receptors (60-70positive)ndash Her-2 neu status (receptor for epidermal growth f)
SURVIVAL
tm size increases-
chance decreases
ndash Lymph node status
ndash Spread to other parts of the body (bones liver lung brain)ndash Age (premenopausal = poor prognostic factor)
TREATMENT TREATMENT
bull Surgery
bull Radiation Therapy (local)
bull Chemotherapy (systemic)
bull Hormonal Therapy (systemic)
bull Immunotherapy
1048708 Therapy is individualized
GoalsCure Control Palliation
SURGERY
bull Mastectomy (completeradical)
bull Breast
conservation (partial)
RECONSTRUCTION
RADIATION THERAPY
Local control of disease
Indicationsbull Adjuvant (after partial mastectomy)
bull Young patients with DCIS
bull High risk of local recurrence
bull High energy rays used to kill cancer cells
CHEMOTHERAPYAnticancer drugs = systemic control of disease
Indications
bull After surgery to reduce risk of recurrence
bull Large + locally advanced cancer to reduce the size prior to surgery (neoadjuvant)
bull Metastatic - to reduce cancer that has spread + relieve symptoms amp prolong life
HORMONAL THERAPYbull Hormones (blood stream) rarr attach ca
cells promote their growth
bull Block the receptor or production of hormones
bull Side effects hot flashes depression
uarr risk of uterine cancer induced manopause blood clots
bull Tamoxifen aromatase inhibitors
Monoclonal antibodies
bull TrastuzumabHerceptin
bull Patients whose cancer cells
over-express Her-2-neu oncogene as measured by IHC or FISH (25 to 30 of
patients)
IMMUNOTHERAPY
bull Through early detection and improved treatments more women than ever are surviving breast cancer
Questions
THANK YOU FOR YOUR ATTENTIONTHANK YOU FOR YOUR ATTENTION
References
bull Kusić ZOnkologijaZagreb2008
bull Damjanov I Jukić S Nola MPatologijaMedicinska nakladaZagreb 2008
bull Kumar P Clark MClinical MedicineSaunders ElsevierLondon2007
bull wwwcancerorgbull wwwcancergov
Clinical Breast ExamClinical Breast Exam
Performed by doctor
Every 3 y for women 20 ndash 39
Yearly for women gt 40 yrs of age
Breast Self-ExamBreast Self-Exam
Monthly starting at the age of 20
bull Still menstruating2-3 days after period ends
bull No longer menstruatingsame day every month
Two parts of BSE
1) Visual
2) Palpatory
bull Examine each breast separately
bull Use pads of middle three fingers feel the texture
bull Examine the armpits
Patterns
Visual
17
Most common Lump or thickening in breastOften painless
Change in color or appearance of areola
Redness or pitting of skin over the breast like the skin of an orange
Discharge or bleeding
Change in size or contours of breast
Abnormal Breast ChangesAbnormal Breast ChangesChanges in breast size of
shape Lump in the breast
Changes in the skin of the breastNipple discharged or tenderness
TREATMENT OPTIONSTREATMENT OPTIONS amp amp PROGNOSISPROGNOSIS
bull Depend on
ndash Size of the tumor
ndash Invasive or in situ
ndash Histologic type - ductal (85) vs lobular
ndash Estrogenprogesterone receptors (60-70positive)ndash Her-2 neu status (receptor for epidermal growth f)
SURVIVAL
tm size increases-
chance decreases
ndash Lymph node status
ndash Spread to other parts of the body (bones liver lung brain)ndash Age (premenopausal = poor prognostic factor)
TREATMENT TREATMENT
bull Surgery
bull Radiation Therapy (local)
bull Chemotherapy (systemic)
bull Hormonal Therapy (systemic)
bull Immunotherapy
1048708 Therapy is individualized
GoalsCure Control Palliation
SURGERY
bull Mastectomy (completeradical)
bull Breast
conservation (partial)
RECONSTRUCTION
RADIATION THERAPY
Local control of disease
Indicationsbull Adjuvant (after partial mastectomy)
bull Young patients with DCIS
bull High risk of local recurrence
bull High energy rays used to kill cancer cells
CHEMOTHERAPYAnticancer drugs = systemic control of disease
Indications
bull After surgery to reduce risk of recurrence
bull Large + locally advanced cancer to reduce the size prior to surgery (neoadjuvant)
bull Metastatic - to reduce cancer that has spread + relieve symptoms amp prolong life
HORMONAL THERAPYbull Hormones (blood stream) rarr attach ca
cells promote their growth
bull Block the receptor or production of hormones
bull Side effects hot flashes depression
uarr risk of uterine cancer induced manopause blood clots
bull Tamoxifen aromatase inhibitors
Monoclonal antibodies
bull TrastuzumabHerceptin
bull Patients whose cancer cells
over-express Her-2-neu oncogene as measured by IHC or FISH (25 to 30 of
patients)
IMMUNOTHERAPY
bull Through early detection and improved treatments more women than ever are surviving breast cancer
Questions
THANK YOU FOR YOUR ATTENTIONTHANK YOU FOR YOUR ATTENTION
References
bull Kusić ZOnkologijaZagreb2008
bull Damjanov I Jukić S Nola MPatologijaMedicinska nakladaZagreb 2008
bull Kumar P Clark MClinical MedicineSaunders ElsevierLondon2007
bull wwwcancerorgbull wwwcancergov
Breast Self-ExamBreast Self-Exam
Monthly starting at the age of 20
bull Still menstruating2-3 days after period ends
bull No longer menstruatingsame day every month
Two parts of BSE
1) Visual
2) Palpatory
bull Examine each breast separately
bull Use pads of middle three fingers feel the texture
bull Examine the armpits
Patterns
Visual
17
Most common Lump or thickening in breastOften painless
Change in color or appearance of areola
Redness or pitting of skin over the breast like the skin of an orange
Discharge or bleeding
Change in size or contours of breast
Abnormal Breast ChangesAbnormal Breast ChangesChanges in breast size of
shape Lump in the breast
Changes in the skin of the breastNipple discharged or tenderness
TREATMENT OPTIONSTREATMENT OPTIONS amp amp PROGNOSISPROGNOSIS
bull Depend on
ndash Size of the tumor
ndash Invasive or in situ
ndash Histologic type - ductal (85) vs lobular
ndash Estrogenprogesterone receptors (60-70positive)ndash Her-2 neu status (receptor for epidermal growth f)
SURVIVAL
tm size increases-
chance decreases
ndash Lymph node status
ndash Spread to other parts of the body (bones liver lung brain)ndash Age (premenopausal = poor prognostic factor)
TREATMENT TREATMENT
bull Surgery
bull Radiation Therapy (local)
bull Chemotherapy (systemic)
bull Hormonal Therapy (systemic)
bull Immunotherapy
1048708 Therapy is individualized
GoalsCure Control Palliation
SURGERY
bull Mastectomy (completeradical)
bull Breast
conservation (partial)
RECONSTRUCTION
RADIATION THERAPY
Local control of disease
Indicationsbull Adjuvant (after partial mastectomy)
bull Young patients with DCIS
bull High risk of local recurrence
bull High energy rays used to kill cancer cells
CHEMOTHERAPYAnticancer drugs = systemic control of disease
Indications
bull After surgery to reduce risk of recurrence
bull Large + locally advanced cancer to reduce the size prior to surgery (neoadjuvant)
bull Metastatic - to reduce cancer that has spread + relieve symptoms amp prolong life
HORMONAL THERAPYbull Hormones (blood stream) rarr attach ca
cells promote their growth
bull Block the receptor or production of hormones
bull Side effects hot flashes depression
uarr risk of uterine cancer induced manopause blood clots
bull Tamoxifen aromatase inhibitors
Monoclonal antibodies
bull TrastuzumabHerceptin
bull Patients whose cancer cells
over-express Her-2-neu oncogene as measured by IHC or FISH (25 to 30 of
patients)
IMMUNOTHERAPY
bull Through early detection and improved treatments more women than ever are surviving breast cancer
Questions
THANK YOU FOR YOUR ATTENTIONTHANK YOU FOR YOUR ATTENTION
References
bull Kusić ZOnkologijaZagreb2008
bull Damjanov I Jukić S Nola MPatologijaMedicinska nakladaZagreb 2008
bull Kumar P Clark MClinical MedicineSaunders ElsevierLondon2007
bull wwwcancerorgbull wwwcancergov
Two parts of BSE
1) Visual
2) Palpatory
bull Examine each breast separately
bull Use pads of middle three fingers feel the texture
bull Examine the armpits
Patterns
Visual
17
Most common Lump or thickening in breastOften painless
Change in color or appearance of areola
Redness or pitting of skin over the breast like the skin of an orange
Discharge or bleeding
Change in size or contours of breast
Abnormal Breast ChangesAbnormal Breast ChangesChanges in breast size of
shape Lump in the breast
Changes in the skin of the breastNipple discharged or tenderness
TREATMENT OPTIONSTREATMENT OPTIONS amp amp PROGNOSISPROGNOSIS
bull Depend on
ndash Size of the tumor
ndash Invasive or in situ
ndash Histologic type - ductal (85) vs lobular
ndash Estrogenprogesterone receptors (60-70positive)ndash Her-2 neu status (receptor for epidermal growth f)
SURVIVAL
tm size increases-
chance decreases
ndash Lymph node status
ndash Spread to other parts of the body (bones liver lung brain)ndash Age (premenopausal = poor prognostic factor)
TREATMENT TREATMENT
bull Surgery
bull Radiation Therapy (local)
bull Chemotherapy (systemic)
bull Hormonal Therapy (systemic)
bull Immunotherapy
1048708 Therapy is individualized
GoalsCure Control Palliation
SURGERY
bull Mastectomy (completeradical)
bull Breast
conservation (partial)
RECONSTRUCTION
RADIATION THERAPY
Local control of disease
Indicationsbull Adjuvant (after partial mastectomy)
bull Young patients with DCIS
bull High risk of local recurrence
bull High energy rays used to kill cancer cells
CHEMOTHERAPYAnticancer drugs = systemic control of disease
Indications
bull After surgery to reduce risk of recurrence
bull Large + locally advanced cancer to reduce the size prior to surgery (neoadjuvant)
bull Metastatic - to reduce cancer that has spread + relieve symptoms amp prolong life
HORMONAL THERAPYbull Hormones (blood stream) rarr attach ca
cells promote their growth
bull Block the receptor or production of hormones
bull Side effects hot flashes depression
uarr risk of uterine cancer induced manopause blood clots
bull Tamoxifen aromatase inhibitors
Monoclonal antibodies
bull TrastuzumabHerceptin
bull Patients whose cancer cells
over-express Her-2-neu oncogene as measured by IHC or FISH (25 to 30 of
patients)
IMMUNOTHERAPY
bull Through early detection and improved treatments more women than ever are surviving breast cancer
Questions
THANK YOU FOR YOUR ATTENTIONTHANK YOU FOR YOUR ATTENTION
References
bull Kusić ZOnkologijaZagreb2008
bull Damjanov I Jukić S Nola MPatologijaMedicinska nakladaZagreb 2008
bull Kumar P Clark MClinical MedicineSaunders ElsevierLondon2007
bull wwwcancerorgbull wwwcancergov
Patterns
Visual
17
Most common Lump or thickening in breastOften painless
Change in color or appearance of areola
Redness or pitting of skin over the breast like the skin of an orange
Discharge or bleeding
Change in size or contours of breast
Abnormal Breast ChangesAbnormal Breast ChangesChanges in breast size of
shape Lump in the breast
Changes in the skin of the breastNipple discharged or tenderness
TREATMENT OPTIONSTREATMENT OPTIONS amp amp PROGNOSISPROGNOSIS
bull Depend on
ndash Size of the tumor
ndash Invasive or in situ
ndash Histologic type - ductal (85) vs lobular
ndash Estrogenprogesterone receptors (60-70positive)ndash Her-2 neu status (receptor for epidermal growth f)
SURVIVAL
tm size increases-
chance decreases
ndash Lymph node status
ndash Spread to other parts of the body (bones liver lung brain)ndash Age (premenopausal = poor prognostic factor)
TREATMENT TREATMENT
bull Surgery
bull Radiation Therapy (local)
bull Chemotherapy (systemic)
bull Hormonal Therapy (systemic)
bull Immunotherapy
1048708 Therapy is individualized
GoalsCure Control Palliation
SURGERY
bull Mastectomy (completeradical)
bull Breast
conservation (partial)
RECONSTRUCTION
RADIATION THERAPY
Local control of disease
Indicationsbull Adjuvant (after partial mastectomy)
bull Young patients with DCIS
bull High risk of local recurrence
bull High energy rays used to kill cancer cells
CHEMOTHERAPYAnticancer drugs = systemic control of disease
Indications
bull After surgery to reduce risk of recurrence
bull Large + locally advanced cancer to reduce the size prior to surgery (neoadjuvant)
bull Metastatic - to reduce cancer that has spread + relieve symptoms amp prolong life
HORMONAL THERAPYbull Hormones (blood stream) rarr attach ca
cells promote their growth
bull Block the receptor or production of hormones
bull Side effects hot flashes depression
uarr risk of uterine cancer induced manopause blood clots
bull Tamoxifen aromatase inhibitors
Monoclonal antibodies
bull TrastuzumabHerceptin
bull Patients whose cancer cells
over-express Her-2-neu oncogene as measured by IHC or FISH (25 to 30 of
patients)
IMMUNOTHERAPY
bull Through early detection and improved treatments more women than ever are surviving breast cancer
Questions
THANK YOU FOR YOUR ATTENTIONTHANK YOU FOR YOUR ATTENTION
References
bull Kusić ZOnkologijaZagreb2008
bull Damjanov I Jukić S Nola MPatologijaMedicinska nakladaZagreb 2008
bull Kumar P Clark MClinical MedicineSaunders ElsevierLondon2007
bull wwwcancerorgbull wwwcancergov
Visual
17
Most common Lump or thickening in breastOften painless
Change in color or appearance of areola
Redness or pitting of skin over the breast like the skin of an orange
Discharge or bleeding
Change in size or contours of breast
Abnormal Breast ChangesAbnormal Breast ChangesChanges in breast size of
shape Lump in the breast
Changes in the skin of the breastNipple discharged or tenderness
TREATMENT OPTIONSTREATMENT OPTIONS amp amp PROGNOSISPROGNOSIS
bull Depend on
ndash Size of the tumor
ndash Invasive or in situ
ndash Histologic type - ductal (85) vs lobular
ndash Estrogenprogesterone receptors (60-70positive)ndash Her-2 neu status (receptor for epidermal growth f)
SURVIVAL
tm size increases-
chance decreases
ndash Lymph node status
ndash Spread to other parts of the body (bones liver lung brain)ndash Age (premenopausal = poor prognostic factor)
TREATMENT TREATMENT
bull Surgery
bull Radiation Therapy (local)
bull Chemotherapy (systemic)
bull Hormonal Therapy (systemic)
bull Immunotherapy
1048708 Therapy is individualized
GoalsCure Control Palliation
SURGERY
bull Mastectomy (completeradical)
bull Breast
conservation (partial)
RECONSTRUCTION
RADIATION THERAPY
Local control of disease
Indicationsbull Adjuvant (after partial mastectomy)
bull Young patients with DCIS
bull High risk of local recurrence
bull High energy rays used to kill cancer cells
CHEMOTHERAPYAnticancer drugs = systemic control of disease
Indications
bull After surgery to reduce risk of recurrence
bull Large + locally advanced cancer to reduce the size prior to surgery (neoadjuvant)
bull Metastatic - to reduce cancer that has spread + relieve symptoms amp prolong life
HORMONAL THERAPYbull Hormones (blood stream) rarr attach ca
cells promote their growth
bull Block the receptor or production of hormones
bull Side effects hot flashes depression
uarr risk of uterine cancer induced manopause blood clots
bull Tamoxifen aromatase inhibitors
Monoclonal antibodies
bull TrastuzumabHerceptin
bull Patients whose cancer cells
over-express Her-2-neu oncogene as measured by IHC or FISH (25 to 30 of
patients)
IMMUNOTHERAPY
bull Through early detection and improved treatments more women than ever are surviving breast cancer
Questions
THANK YOU FOR YOUR ATTENTIONTHANK YOU FOR YOUR ATTENTION
References
bull Kusić ZOnkologijaZagreb2008
bull Damjanov I Jukić S Nola MPatologijaMedicinska nakladaZagreb 2008
bull Kumar P Clark MClinical MedicineSaunders ElsevierLondon2007
bull wwwcancerorgbull wwwcancergov
Abnormal Breast ChangesAbnormal Breast ChangesChanges in breast size of
shape Lump in the breast
Changes in the skin of the breastNipple discharged or tenderness
TREATMENT OPTIONSTREATMENT OPTIONS amp amp PROGNOSISPROGNOSIS
bull Depend on
ndash Size of the tumor
ndash Invasive or in situ
ndash Histologic type - ductal (85) vs lobular
ndash Estrogenprogesterone receptors (60-70positive)ndash Her-2 neu status (receptor for epidermal growth f)
SURVIVAL
tm size increases-
chance decreases
ndash Lymph node status
ndash Spread to other parts of the body (bones liver lung brain)ndash Age (premenopausal = poor prognostic factor)
TREATMENT TREATMENT
bull Surgery
bull Radiation Therapy (local)
bull Chemotherapy (systemic)
bull Hormonal Therapy (systemic)
bull Immunotherapy
1048708 Therapy is individualized
GoalsCure Control Palliation
SURGERY
bull Mastectomy (completeradical)
bull Breast
conservation (partial)
RECONSTRUCTION
RADIATION THERAPY
Local control of disease
Indicationsbull Adjuvant (after partial mastectomy)
bull Young patients with DCIS
bull High risk of local recurrence
bull High energy rays used to kill cancer cells
CHEMOTHERAPYAnticancer drugs = systemic control of disease
Indications
bull After surgery to reduce risk of recurrence
bull Large + locally advanced cancer to reduce the size prior to surgery (neoadjuvant)
bull Metastatic - to reduce cancer that has spread + relieve symptoms amp prolong life
HORMONAL THERAPYbull Hormones (blood stream) rarr attach ca
cells promote their growth
bull Block the receptor or production of hormones
bull Side effects hot flashes depression
uarr risk of uterine cancer induced manopause blood clots
bull Tamoxifen aromatase inhibitors
Monoclonal antibodies
bull TrastuzumabHerceptin
bull Patients whose cancer cells
over-express Her-2-neu oncogene as measured by IHC or FISH (25 to 30 of
patients)
IMMUNOTHERAPY
bull Through early detection and improved treatments more women than ever are surviving breast cancer
Questions
THANK YOU FOR YOUR ATTENTIONTHANK YOU FOR YOUR ATTENTION
References
bull Kusić ZOnkologijaZagreb2008
bull Damjanov I Jukić S Nola MPatologijaMedicinska nakladaZagreb 2008
bull Kumar P Clark MClinical MedicineSaunders ElsevierLondon2007
bull wwwcancerorgbull wwwcancergov
TREATMENT OPTIONSTREATMENT OPTIONS amp amp PROGNOSISPROGNOSIS
bull Depend on
ndash Size of the tumor
ndash Invasive or in situ
ndash Histologic type - ductal (85) vs lobular
ndash Estrogenprogesterone receptors (60-70positive)ndash Her-2 neu status (receptor for epidermal growth f)
SURVIVAL
tm size increases-
chance decreases
ndash Lymph node status
ndash Spread to other parts of the body (bones liver lung brain)ndash Age (premenopausal = poor prognostic factor)
TREATMENT TREATMENT
bull Surgery
bull Radiation Therapy (local)
bull Chemotherapy (systemic)
bull Hormonal Therapy (systemic)
bull Immunotherapy
1048708 Therapy is individualized
GoalsCure Control Palliation
SURGERY
bull Mastectomy (completeradical)
bull Breast
conservation (partial)
RECONSTRUCTION
RADIATION THERAPY
Local control of disease
Indicationsbull Adjuvant (after partial mastectomy)
bull Young patients with DCIS
bull High risk of local recurrence
bull High energy rays used to kill cancer cells
CHEMOTHERAPYAnticancer drugs = systemic control of disease
Indications
bull After surgery to reduce risk of recurrence
bull Large + locally advanced cancer to reduce the size prior to surgery (neoadjuvant)
bull Metastatic - to reduce cancer that has spread + relieve symptoms amp prolong life
HORMONAL THERAPYbull Hormones (blood stream) rarr attach ca
cells promote their growth
bull Block the receptor or production of hormones
bull Side effects hot flashes depression
uarr risk of uterine cancer induced manopause blood clots
bull Tamoxifen aromatase inhibitors
Monoclonal antibodies
bull TrastuzumabHerceptin
bull Patients whose cancer cells
over-express Her-2-neu oncogene as measured by IHC or FISH (25 to 30 of
patients)
IMMUNOTHERAPY
bull Through early detection and improved treatments more women than ever are surviving breast cancer
Questions
THANK YOU FOR YOUR ATTENTIONTHANK YOU FOR YOUR ATTENTION
References
bull Kusić ZOnkologijaZagreb2008
bull Damjanov I Jukić S Nola MPatologijaMedicinska nakladaZagreb 2008
bull Kumar P Clark MClinical MedicineSaunders ElsevierLondon2007
bull wwwcancerorgbull wwwcancergov
ndash Lymph node status
ndash Spread to other parts of the body (bones liver lung brain)ndash Age (premenopausal = poor prognostic factor)
TREATMENT TREATMENT
bull Surgery
bull Radiation Therapy (local)
bull Chemotherapy (systemic)
bull Hormonal Therapy (systemic)
bull Immunotherapy
1048708 Therapy is individualized
GoalsCure Control Palliation
SURGERY
bull Mastectomy (completeradical)
bull Breast
conservation (partial)
RECONSTRUCTION
RADIATION THERAPY
Local control of disease
Indicationsbull Adjuvant (after partial mastectomy)
bull Young patients with DCIS
bull High risk of local recurrence
bull High energy rays used to kill cancer cells
CHEMOTHERAPYAnticancer drugs = systemic control of disease
Indications
bull After surgery to reduce risk of recurrence
bull Large + locally advanced cancer to reduce the size prior to surgery (neoadjuvant)
bull Metastatic - to reduce cancer that has spread + relieve symptoms amp prolong life
HORMONAL THERAPYbull Hormones (blood stream) rarr attach ca
cells promote their growth
bull Block the receptor or production of hormones
bull Side effects hot flashes depression
uarr risk of uterine cancer induced manopause blood clots
bull Tamoxifen aromatase inhibitors
Monoclonal antibodies
bull TrastuzumabHerceptin
bull Patients whose cancer cells
over-express Her-2-neu oncogene as measured by IHC or FISH (25 to 30 of
patients)
IMMUNOTHERAPY
bull Through early detection and improved treatments more women than ever are surviving breast cancer
Questions
THANK YOU FOR YOUR ATTENTIONTHANK YOU FOR YOUR ATTENTION
References
bull Kusić ZOnkologijaZagreb2008
bull Damjanov I Jukić S Nola MPatologijaMedicinska nakladaZagreb 2008
bull Kumar P Clark MClinical MedicineSaunders ElsevierLondon2007
bull wwwcancerorgbull wwwcancergov
TREATMENT TREATMENT
bull Surgery
bull Radiation Therapy (local)
bull Chemotherapy (systemic)
bull Hormonal Therapy (systemic)
bull Immunotherapy
1048708 Therapy is individualized
GoalsCure Control Palliation
SURGERY
bull Mastectomy (completeradical)
bull Breast
conservation (partial)
RECONSTRUCTION
RADIATION THERAPY
Local control of disease
Indicationsbull Adjuvant (after partial mastectomy)
bull Young patients with DCIS
bull High risk of local recurrence
bull High energy rays used to kill cancer cells
CHEMOTHERAPYAnticancer drugs = systemic control of disease
Indications
bull After surgery to reduce risk of recurrence
bull Large + locally advanced cancer to reduce the size prior to surgery (neoadjuvant)
bull Metastatic - to reduce cancer that has spread + relieve symptoms amp prolong life
HORMONAL THERAPYbull Hormones (blood stream) rarr attach ca
cells promote their growth
bull Block the receptor or production of hormones
bull Side effects hot flashes depression
uarr risk of uterine cancer induced manopause blood clots
bull Tamoxifen aromatase inhibitors
Monoclonal antibodies
bull TrastuzumabHerceptin
bull Patients whose cancer cells
over-express Her-2-neu oncogene as measured by IHC or FISH (25 to 30 of
patients)
IMMUNOTHERAPY
bull Through early detection and improved treatments more women than ever are surviving breast cancer
Questions
THANK YOU FOR YOUR ATTENTIONTHANK YOU FOR YOUR ATTENTION
References
bull Kusić ZOnkologijaZagreb2008
bull Damjanov I Jukić S Nola MPatologijaMedicinska nakladaZagreb 2008
bull Kumar P Clark MClinical MedicineSaunders ElsevierLondon2007
bull wwwcancerorgbull wwwcancergov
SURGERY
bull Mastectomy (completeradical)
bull Breast
conservation (partial)
RECONSTRUCTION
RADIATION THERAPY
Local control of disease
Indicationsbull Adjuvant (after partial mastectomy)
bull Young patients with DCIS
bull High risk of local recurrence
bull High energy rays used to kill cancer cells
CHEMOTHERAPYAnticancer drugs = systemic control of disease
Indications
bull After surgery to reduce risk of recurrence
bull Large + locally advanced cancer to reduce the size prior to surgery (neoadjuvant)
bull Metastatic - to reduce cancer that has spread + relieve symptoms amp prolong life
HORMONAL THERAPYbull Hormones (blood stream) rarr attach ca
cells promote their growth
bull Block the receptor or production of hormones
bull Side effects hot flashes depression
uarr risk of uterine cancer induced manopause blood clots
bull Tamoxifen aromatase inhibitors
Monoclonal antibodies
bull TrastuzumabHerceptin
bull Patients whose cancer cells
over-express Her-2-neu oncogene as measured by IHC or FISH (25 to 30 of
patients)
IMMUNOTHERAPY
bull Through early detection and improved treatments more women than ever are surviving breast cancer
Questions
THANK YOU FOR YOUR ATTENTIONTHANK YOU FOR YOUR ATTENTION
References
bull Kusić ZOnkologijaZagreb2008
bull Damjanov I Jukić S Nola MPatologijaMedicinska nakladaZagreb 2008
bull Kumar P Clark MClinical MedicineSaunders ElsevierLondon2007
bull wwwcancerorgbull wwwcancergov
RECONSTRUCTION
RADIATION THERAPY
Local control of disease
Indicationsbull Adjuvant (after partial mastectomy)
bull Young patients with DCIS
bull High risk of local recurrence
bull High energy rays used to kill cancer cells
CHEMOTHERAPYAnticancer drugs = systemic control of disease
Indications
bull After surgery to reduce risk of recurrence
bull Large + locally advanced cancer to reduce the size prior to surgery (neoadjuvant)
bull Metastatic - to reduce cancer that has spread + relieve symptoms amp prolong life
HORMONAL THERAPYbull Hormones (blood stream) rarr attach ca
cells promote their growth
bull Block the receptor or production of hormones
bull Side effects hot flashes depression
uarr risk of uterine cancer induced manopause blood clots
bull Tamoxifen aromatase inhibitors
Monoclonal antibodies
bull TrastuzumabHerceptin
bull Patients whose cancer cells
over-express Her-2-neu oncogene as measured by IHC or FISH (25 to 30 of
patients)
IMMUNOTHERAPY
bull Through early detection and improved treatments more women than ever are surviving breast cancer
Questions
THANK YOU FOR YOUR ATTENTIONTHANK YOU FOR YOUR ATTENTION
References
bull Kusić ZOnkologijaZagreb2008
bull Damjanov I Jukić S Nola MPatologijaMedicinska nakladaZagreb 2008
bull Kumar P Clark MClinical MedicineSaunders ElsevierLondon2007
bull wwwcancerorgbull wwwcancergov
RADIATION THERAPY
Local control of disease
Indicationsbull Adjuvant (after partial mastectomy)
bull Young patients with DCIS
bull High risk of local recurrence
bull High energy rays used to kill cancer cells
CHEMOTHERAPYAnticancer drugs = systemic control of disease
Indications
bull After surgery to reduce risk of recurrence
bull Large + locally advanced cancer to reduce the size prior to surgery (neoadjuvant)
bull Metastatic - to reduce cancer that has spread + relieve symptoms amp prolong life
HORMONAL THERAPYbull Hormones (blood stream) rarr attach ca
cells promote their growth
bull Block the receptor or production of hormones
bull Side effects hot flashes depression
uarr risk of uterine cancer induced manopause blood clots
bull Tamoxifen aromatase inhibitors
Monoclonal antibodies
bull TrastuzumabHerceptin
bull Patients whose cancer cells
over-express Her-2-neu oncogene as measured by IHC or FISH (25 to 30 of
patients)
IMMUNOTHERAPY
bull Through early detection and improved treatments more women than ever are surviving breast cancer
Questions
THANK YOU FOR YOUR ATTENTIONTHANK YOU FOR YOUR ATTENTION
References
bull Kusić ZOnkologijaZagreb2008
bull Damjanov I Jukić S Nola MPatologijaMedicinska nakladaZagreb 2008
bull Kumar P Clark MClinical MedicineSaunders ElsevierLondon2007
bull wwwcancerorgbull wwwcancergov
CHEMOTHERAPYAnticancer drugs = systemic control of disease
Indications
bull After surgery to reduce risk of recurrence
bull Large + locally advanced cancer to reduce the size prior to surgery (neoadjuvant)
bull Metastatic - to reduce cancer that has spread + relieve symptoms amp prolong life
HORMONAL THERAPYbull Hormones (blood stream) rarr attach ca
cells promote their growth
bull Block the receptor or production of hormones
bull Side effects hot flashes depression
uarr risk of uterine cancer induced manopause blood clots
bull Tamoxifen aromatase inhibitors
Monoclonal antibodies
bull TrastuzumabHerceptin
bull Patients whose cancer cells
over-express Her-2-neu oncogene as measured by IHC or FISH (25 to 30 of
patients)
IMMUNOTHERAPY
bull Through early detection and improved treatments more women than ever are surviving breast cancer
Questions
THANK YOU FOR YOUR ATTENTIONTHANK YOU FOR YOUR ATTENTION
References
bull Kusić ZOnkologijaZagreb2008
bull Damjanov I Jukić S Nola MPatologijaMedicinska nakladaZagreb 2008
bull Kumar P Clark MClinical MedicineSaunders ElsevierLondon2007
bull wwwcancerorgbull wwwcancergov
HORMONAL THERAPYbull Hormones (blood stream) rarr attach ca
cells promote their growth
bull Block the receptor or production of hormones
bull Side effects hot flashes depression
uarr risk of uterine cancer induced manopause blood clots
bull Tamoxifen aromatase inhibitors
Monoclonal antibodies
bull TrastuzumabHerceptin
bull Patients whose cancer cells
over-express Her-2-neu oncogene as measured by IHC or FISH (25 to 30 of
patients)
IMMUNOTHERAPY
bull Through early detection and improved treatments more women than ever are surviving breast cancer
Questions
THANK YOU FOR YOUR ATTENTIONTHANK YOU FOR YOUR ATTENTION
References
bull Kusić ZOnkologijaZagreb2008
bull Damjanov I Jukić S Nola MPatologijaMedicinska nakladaZagreb 2008
bull Kumar P Clark MClinical MedicineSaunders ElsevierLondon2007
bull wwwcancerorgbull wwwcancergov
Monoclonal antibodies
bull TrastuzumabHerceptin
bull Patients whose cancer cells
over-express Her-2-neu oncogene as measured by IHC or FISH (25 to 30 of
patients)
IMMUNOTHERAPY
bull Through early detection and improved treatments more women than ever are surviving breast cancer
Questions
THANK YOU FOR YOUR ATTENTIONTHANK YOU FOR YOUR ATTENTION
References
bull Kusić ZOnkologijaZagreb2008
bull Damjanov I Jukić S Nola MPatologijaMedicinska nakladaZagreb 2008
bull Kumar P Clark MClinical MedicineSaunders ElsevierLondon2007
bull wwwcancerorgbull wwwcancergov
bull Through early detection and improved treatments more women than ever are surviving breast cancer
Questions
THANK YOU FOR YOUR ATTENTIONTHANK YOU FOR YOUR ATTENTION
References
bull Kusić ZOnkologijaZagreb2008
bull Damjanov I Jukić S Nola MPatologijaMedicinska nakladaZagreb 2008
bull Kumar P Clark MClinical MedicineSaunders ElsevierLondon2007
bull wwwcancerorgbull wwwcancergov
Questions
THANK YOU FOR YOUR ATTENTIONTHANK YOU FOR YOUR ATTENTION
References
bull Kusić ZOnkologijaZagreb2008
bull Damjanov I Jukić S Nola MPatologijaMedicinska nakladaZagreb 2008
bull Kumar P Clark MClinical MedicineSaunders ElsevierLondon2007
bull wwwcancerorgbull wwwcancergov
References
bull Kusić ZOnkologijaZagreb2008
bull Damjanov I Jukić S Nola MPatologijaMedicinska nakladaZagreb 2008
bull Kumar P Clark MClinical MedicineSaunders ElsevierLondon2007
bull wwwcancerorgbull wwwcancergov