Breast Cancer 2023 UG
Breast Cancer 2023 UG
Breast Cancer 2023 UG
Common Terms
▪ Carcinoma
▪ A cancer that begins in the lining layer (epithelial cells) of
organs like the breast.
▪ Nearly all breast cancers are carcinomas (either ductal
carcinomas or lobular carcinomas).
▪ Adenocarcinoma
▪ Carcinoma that starts in glandular tissue (tissue that makes
and secretes a substance).
▪ The ducts and lobules of the breast are glandular tissue
(they make breast milk).
Common Terms …..Con’t (1)
Carcinoma in situ
▪ Early stage of cancer
▪ When the cancer is confined to the layer of cells where it
began
▪ The cells have not grown into (invaded) deeper tissues in the
breast or spread to other organs in the body.
▪ In breast cancer: cancer cells remain confined to ducts
cancer
Common Terms….Con’t(2)
Ductal carcinoma in situ (DCIS)
▪ Also known as Intraductal Carcinoma
Alcohol
▪ Linked to an increased risk of developing breast cancer.
▪ The risk increases with the amount of alcohol consumed
▪ Women who consume 1 alcoholic drink a day have a very
small increase in risk.
▪ But those who have 2 to 5 drinks daily have about 1½ times
the risk of women who drink no alcohol.
▪ Excessive alcohol use is also known to increase the risk of
developing several other types of cancer.
Life Style Related Risks….Con’t(1)
Being Overweight or Obese
▪ Has been found to increase breast cancer risk especially for
women after menopause.
▪ Before menopause the ovaries produce most of the
estrogen, and fat tissue produces a small amount of
estrogen But after menopause, most of a woman's estrogen
comes from fat tissue.
▪ Having more fat tissue after menopause can increase the chance
of getting breast cancer by raising estrogen levels.
▪ Also, women who are overweight tend to have higher blood
insulin levels which have been linked to some cancers including
breast cancer.
Breast Cancer Chemoprevention
Tamoxifen
▪ Is a drug that blocks the effects of estrogen on breast tissue.
▪ Although it has anti-estrogenic effect on breast, it possess
estrogenic effect on other tissues
▪ That is why it is called selective estrogen receptor
modulators
▪ It is used :
▪ To reduce breast cancer risk in women at high risk
▪ To reduce the risk of recurrence in localized breast cancer
and
▪ As a treatment for advanced breast cancer when the tumor
is estrogen-receptor positive
Breast Cancer Chemoprevention…Con’t(1)
Raloxifene
▪ Like tamoxifen, raloxifene also blocks the effect of
estrogen on breast tissue.
▪ Raloxifene is FDA approved to:
▪ Help reduce breast cancer risk in post menopause
Side effects
▪ Hot flashes and vaginal bleeding due to estrogen withdrawal
▪ T2, N2, M0
▪ T4, N0, M0
▪ T1, N1, M0
▪ Any T, Any N, M1
Breast Cancer Staging…Con’t(1I)
Early Breast Cancers Locally Advanced
Stage 0: Carcinoma in situ Stage III: A large tumor with
Stage 1: Small without LN extensive LN
involvement involvement
▪ T1N0M0 ▪ IIIA: T3, N1, M0
▪ Stage 0 100%
▪ Stage I 98%
▪ Stage IIA 88%
▪ Stage IIB 76%
▪ Stage IIIA 56%
▪ Stage IIIB 49%
▪ Stage IV 16%
Surgery
▪
▪ Adjuvant therapy
▪ Chemotherapy, radiotherapy, hormone therapy,
biological therapy
Early breast cancer
Local-Regional Therapy
Surgery alone
◼ can cure most patients with in situ cancers, 70% to 80% of
stage I and approximately one half of those with stage II.
Breast-conserving therapy (BCT)
◼ is often primary therapy for stage I and stage II disease;
◼ it is preferable to modified radical mastectomy because it
produces equivalent survival rates with cosmetically
superior results.
◼ includes removal of part of the breast, surgical evaluation
of axillary lymph nodes, and radiation therapy (RT) to
prevent local recurrence.
Early breast cancer….Con’t(1)
Local-Regional Therapy….
RT is administered to the entire breast over 3 to 5 weeks
to eradicate residual disease after BCT.
Simple or total mastectomy involves removal of the entire
breast without dissection of underlying muscle or axillary
nodes.
◼ This procedure is used for carcinoma in situ where the
incidence of axillary node involvement is only 1% or with
local recurrence following BCT.
Axillarylymph nodes should be sampled for staging and
prognostic information.
Early breast cancer….Con’t(2)
Systemic Adjuvant Therapy
It is the administration of systemic therapy following
definitive local therapy (surgery, radiation, or in
combination) when there is no evidence of metastatic
disease but a high likelihood of disease recurrence.
◼ The goal of such therapy is cure.
Administration of chemotherapy, endocrine therapy,
targeted therapy, or some combination of these
agents results in
◼ Improved disease-free survival (DFS) and/or overall
survival (OS) for all treated patients.
Adjuvant Chemotherapy
Trastuzumab
▪ HER2-positive disease has a worse prognosis than HER2-negative disease
▪ Indicated in HER2-positive early invasive breast cancer
▪ following surgery, chemotherapy, and radiotherapy when applicable:
▪ Should be offered as
▪ An adjuvant treatment given at every 7 days or every 21 days for one
year or until disease recurrence (whichever is the shorter)
▪ It reduces the risk of recurrence of relapse by..
▪ about 50%, and the risk of death by about 31%
▪ Cardiac side effects — mainly heart failure.
Questions
1. The 5 year survival rate for Stage IV of breast cancer is
16%
2. Chemotherapy should be initiated within ___of surgical
removal of the primary tumor with optimal duration of
about _____
3. Aromatase inhibitors are indicated only for prevention of
recurrence of breast cancer in premenopausal women.
4. Which two classes of chemotherapy drugs indicated for
advanced breast cancer treatment.
Advanced Breast Cancer Treatment Pathway
Decision support
Systemic disease-modifying
therapy
• Hormonal therapy
• Chemotherapy
• Biological therapy
Managing complications