Case Studies UNDP: SRI LANKA WILDLIFE CONSERVATION SOCIETY, Sri Lanka
Breast Cancer, A Common Problem in Sri Lanka Dr Dehan Gunasekera Consultant Oncologist National...
-
Upload
tierra-arras -
Category
Documents
-
view
218 -
download
2
Transcript of Breast Cancer, A Common Problem in Sri Lanka Dr Dehan Gunasekera Consultant Oncologist National...
Breast Cancer,A Common Problem in
Sri Lanka
Dr Dehan GunasekeraConsultant Oncologist
National Cancer Institute of Sri Lanka
Leading Cancer sites-2010
Male Lip ,oral cavity and pharynx 14.1 % Bronchus and Lung 7.7 % Oesophagus 5.8 % Colon rectum 4.4 %
Female Breast 18.4 % Cervix 8.9 % Ovary 5.9 % Thyroid 5.6 %
1985 5012 new Cancer patients
1990 6063 new Cancer patients
1995 7300 new Cancer patients
2000 10925 new Cancer patients
2004 12632 new Cancer patients
2005 13372 new Cancer Patients
Breast Cancer Epidemic! Asian-young,ER-,PR-,High grade Europian->50 years,ER+,PR+Awareness of Breast CA at all agesPresentationMammographic detectionBlood stained nipple dischargeSelf detected lumpClinical breast examination detectedLocally advanced-ulcer,Peud’orangeMetastatic-Pleural effusion,Back ache
6 5
Diagnosis
Triple assesment Clinical Examination-site,size for staging Mammogram/US scan in < 40-45 years FNAC/Core(trucut) biopsy
Metastatic Survey General and systemic examination Xray chest US scan Abdomen and Pelvis LFT FBC,SC Bone Scan,CT scan–depending on the symptom
Histology Preinvasive CA Duct Carcinoma in Situ (DCIS) Lobuler Carcinoma in Situ (LCIS)
Invasive CADuct CA Mucinous Ca Medullary CA Papillary CALobuler CA
Receptor status is mandatory General Concept ER-,PR- Poor prognosis Her2- Good prognosis Change in Concepts due to Complicated cross talk between
Receptors Concept of Triple negative Disease
– ER (-)– PR (-)– Her-2/neu (-)
Treatment Early Stage –Surgery Breast Conserving Surgery+RT to the
breast Wide local Excission Qadrantectomy Lumpectomy Mastectomy+immediate or delayed
reconstructionAxilla- US scan axilla (-) LN –Sentinal Lymph node biopsy US scan axilla (+) LN- Axillary clearance
Place for Radiotherapy Mandatory in Breast conservation Lymph nodes in Axilla+ Large tumours (>5 cm) Poorly Differentiated CA To relieve pain locally-spine
• Place of Chemotherapy Post operative(Adjuvant) Lymph nodes in Axilla+ Poorly Differentiated CA Large tumours (>5 cm) ER-,PR-,Her2 + Metastatic Disease
Preoperative(Neoajuvant) Locally advanced disease(T3,T4) InoperableChemothrapy-Anthracyclin based Paclitaxel based
Place of hormonal TherapyER+,PR+ Premenapausal-TamoxifenER+,PR+ Postmenapausal- Aromatase inhibitors Anastrazole Letrazole Exemestane
The occurrence of relapse and survival (Prognosis) are influenced by
1.Stage at presentation (Size,Pathology,Grade,Metastasis)
2.Lymph node status 3.Hormone receptor status 4.Measures of proliferation of the cancer
cell 5.Genetics of the cancer and the host 6.Age at diagnosis
St Galens Recommendations Low risk
T1 N0 G1 ER+ and /or PR+ Her2 – >35 years No lymphovasculer invasion
Intermediate risk
ER and/or PR + Her2 – N0 No lymphovasculer
invasion pT>1 or G2-3 or <35 years or (1-3) LN
High risk
ER- and PR- LN >3 Her2+
or LN 1-3 with lymphovasculer
invasion
Stage 5 year survival Stage I T1 NO M0 85% Stage II T0-1 N1 M0 T2 N0-1 M0 65% T3 N0 M0 Stage III T0-2 N2 M0 T3 N1-2 M0 T4 any N M0 45% Any T N3 M0 Stage IV Any T any N M1 10%
Prevention All females should do self breast
examination monthly Women over 40 years old should
have Clinical breast examination every 3 years
Bilateral Mammogram at perimenapausal age of 45-50 years
If Clinical Breast examination detects a suspicious lesion under the age of 45 years-US scan breasts and ideally MRI of Breast
Thank you