Cancer de Mama. Introduccion

CLINICA MEDICA

ONCOLOGIA

CÁNCER DE MAMA ( 80 %)

DIRECTOR DE ORQUESTACLINICA MEDICA

ESPECIALISTA : SOLISTA

ONCOLOGYONCOLOGYEpidemiologyEpidemiology

Adapted from Greenlee RT, et al. CA Cancer J Clin. 2000:50;22.

Leading causes of deathLeading causes of death

0.7

0.9

1.3

2.7

3.7

4.1

4.7

6.9

23.3

31.4

Percentage of Total Deaths, USPercentage of Total Deaths, US

Heart Diseases

Cancer

Cerebrovascular Diseases

Chronic Obstructive Lung Diseases

Accidents

Pneumonia & Influenza

Diabetes Mellitus

Suicide

Homicide

HIV Infection


1 Lung Breast Lung 1,037,000

2 Stomach Colon/rectum Stomach 798,000

3 Colon/rectum Cervix uteri Breast 796,000

4 Prostate Stomach Colon/rectum 783,000

5 Liver Lung Liver 437,000

6 Mouth/pharynx Ovary Prostate 396,000

7 Esophagus Corpus uteri Cervix uteri 371,000

8 Bladder Liver Mouth/pharynx 363,000

9 Leukemia Mouth/pharynx Esophagus 316,000

10 NHL* Esophagus Bladder 261,000

Total NewTotal NewRankRank MalesMales FemalesFemales Both SexesBoth Sexes CasesCases

*Non-Hodgkin’s lymphoma.

Adapted from Parkin DM, et al. CA Cancer J Clin. 1999;49:39.

Leading cancers worldwideLeading cancers worldwide

ONCOLOGYONCOLOGYEpidemiologyEpidemiologyMale cancer statisticsMale cancer statistics

Adapted from Greenlee RT, et al. CA Cancer J Clin. 2000;50:16.

Estimated incidenceEstimated incidence Estimated deathsEstimated deaths

Melanoma of skin

Oral cavity & pharynx

Lung & bronchus

Pancreas

Kidney & renal pelvis

Colon & rectum

Prostate

Urinary bladder

Leukemia

Non-Hodgkin’s lymphoma

All others

4%

3%

14%

2%

3%

10%

29%

6%

3%

5%

19%

Esophagus

Lung & bronchus

Pancreas

Liver & intrahepatic bile duct

Stomach

Colon & rectum

Prostate

Urinary bladder

Leukemia


All others

3%

31%

5%

3%

3%

10%

11%

3%

4%

5%

22%

ONCOLOGYONCOLOGYEpidemiologyEpidemiologyFemale cancer statisticsFemale cancer statistics

Adapted from Greenlee RT, et al. CA Cancer J Clin. 2000;50:16.

2%

15%

25%

5%

2%

11%

5%

2%

5%

4%

2%

21%

Melanoma of skin

Thyroid

Breast

Lung & bronchus

Pancreas

Colon & rectum

Ovary

Uterine corpus

Urinary bladder


All others

3%

2%

30%

12%

2%

11%

4%

6%

2%

4%

22%

Brain & other nervous system

Breast

Lung & bronchus

Pancreas

Stomach

Colon & rectum

Ovary

Uterine corpus


Leukemia

Multiple myeloma

All others

Estimated incidenceEstimated incidence Estimated deathsEstimated deaths

22,3/100000


Cancer of the esophagus

Head and neck cancer

Cancer of the large bowel

Liver cancer

Pancreatic cancer

Breast cancer

AlcoholAlcohol--related cancersrelated cancers

Trichopoulos D, et al. Cancer: Principles & Practice of Oncology. 5th ed. 1997;231-257.


Major causeMajor cause

Lung

Larynx

Oral cavity

Esophagus

Contributory factorContributory factor Pancreas

Bladder

Kidney

Stomach

Uterine cervix

SmokingSmoking--related cancersrelated cancers

Blum A, et al. Cancer: Principles & Practice of Oncology. 5th ed. 1997;545-557.

Reducing mortalityReducing mortality

Bal DG, et al. American Cancer Society Textbook of Clinical Oncology. 2nd ed. 1995;40-63.

The National Cancer Institute estimates that cancer mortality rates could be significantly reduced, as follows:


8% to 16% by a 15% decrease in tobacco use among adults

8% by dietary measures (ie, reduction of dietary fat to <25% and double dietary fiber)

3% by early screening and early detection

10% to 26% by the wider application of state-of-the art treatments


Site of Site of Relative Relative Attributable Attributable CancerCancer Risk FactorRisk Factor RiskRisk RiskRisk

BreastBreast First full-term pregnancy after age 30 Moderate 7%

Large doses of chest radiation Moderate 2%

Never married Weak -

Never having children Weak 5%

Post-menopausal obesity Weak 12%

Alcohol consumption Weak -

High fat Possible -

Low physical activity Possible -

Use of diethylstilbestrol Possible -

Use of oral contraceptives or ERT Possible -

Modifiable risk factors (contModifiable risk factors (cont’’d)d)

Adapted from Bal DG, et al. American Cancer Society Textbook of Clinical Oncology. 2nd ed. 1995;45.


Test/ProcedureTest/Procedure SexSex AgeAge FrequencyFrequency

Sigmoidoscopy, preferably flexible M&F >50 Every 3-5 yrs, based on advice of physician

Fecal occult blood test M&F >50 Every year

Digital rectal exam M&F >40 Every year

Prostate exam M >50 Every year

Pap test F >18* Every year, if normal >3 times, Pap test may be performed less frequently at discretion of physician

Pelvic exam F 18-40 Every 1-3 years, with Pap test

>40 Every year

Endometrial tissue sample F † At menopause and thereafter at discretion of physician

Breast self-exam F >20 Every month

Breast clinical exam F 20-40 Every 3 years>40 Every year

Mammography F 40-49 Every 1-2 years (1st by age 40)>50 Every year

Health counseling and cancer M&F >20 Every 3 yearscheckups >40 Every year

Early detection guidelinesEarly detection guidelines

Adapted from Fink DJ, Mettlin CJ. American Cancer Society Textbook of Clinical Oncology. 2nd ed. 1995;181.

ACS Screening Recommendations forACS Screening Recommendations for AsymptomaticAsymptomatic People (Average Risk)People (Average Risk)

* Or before if sexually active.† At menopause, for women at high risk for endometrial cancer due to history of infertility, obesity, failure to ovulate, abnormal uterine bleeding, unopposed ERT or tamoxifen use.

ONCOLOGYONCOLOGYPatient managementPatient managementCancer patient management: Solid tumorsCancer patient management: Solid tumors

Therapeutic decisionTherapeutic decision

Clinical findingsClinical findings

Cancer diagnosisCancer diagnosis

Therapeutic intentionTherapeutic intention

BiopsyBiopsy CT scansCT scans

Staging/GradingStaging/Grading

ONCOLOGYONCOLOGYPatient managementPatient managementTNM classificationTNM classification

TTumorumor

NNodesodes

MMetastasisetastasis

ONCOLOGYONCOLOGYPatient managementPatient managementTumor extent/stagingTumor extent/staging

Localized diseaseLocalized disease= limited stage= limited stage

ChemotherapyRadiotherapy

SurgeryImmunotherapy

Hormonal therapyPalliative care

Tumor extent/stagingTumor extent/staging

Metastatic diseaseMetastatic disease

ExtentExtentResectableResectable

tumortumorNonresectableNonresectable

tumortumor

OperableOperablepatientpatient

InoperableInoperablepatientpatient

Surgery+ Radiation therapy+ Chemotherapy+ Hormonal-immunotherapy

Radiation therapyChemotherapyHormonal therapyImmunotherapy

and/or

Cancer de Mama. Introduccion

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