Living Beyond Breast Cancer Liver and Lung Metastases Workshop April 29, 2012 Paul B. Gilman,...
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Transcript of Living Beyond Breast Cancer Liver and Lung Metastases Workshop April 29, 2012 Paul B. Gilman,...
Living Beyond Breast CancerLiver and Lung Metastases Workshop
April 29, 2012
Paul B. Gilman, MD Lankenau Medical Center
Presentation of Liver/Lung Presentation of Liver/Lung MetastasesMetastases
SymptomaticSymptomatic Incidental finding on physical examIncidental finding on physical exam Incidental finding on imagingIncidental finding on imagingLaboratory studiesLaboratory studies
LBBC/04.29.2012
Liver MetastasisLiver MetastasisSymptomsSymptoms
Nausea, anorexia, weight lossNausea, anorexia, weight lossPainPainJaundiceJaundiceFeverFever
LBBC/04.29.2012
Liver Metastasis Liver Metastasis Laboratory EvaluationLaboratory Evaluation
Liver function testsLiver function testsBlood countsBlood countsCoagulation testsCoagulation testsTumor markersTumor markers
LBBC/04.29.2012
Liver Metastasis Liver Metastasis Imaging EvaluationImaging Evaluation
UltrasoundUltrasoundCT ScanCT ScanMRIMRIPET-CTPET-CT
LBBC/04.29.2012
Lung MetastasisLung MetastasisSymptomsSymptoms
DyspneaDyspneaCough, hemoptysisCough, hemoptysisPainPain
LBBC/04.29.2012
Lung MetastasisLung MetastasisLaboratory EvaluationsLaboratory Evaluations
Sputum analysisSputum analysisTumor markersTumor markersPulmonary Function TestingPulmonary Function Testing
LBBC/04.29.2012
Lung MetastasisLung MetastasisImaging EvaluationsImaging Evaluations
Chest x-rayChest x-rayCT ScanCT ScanPET-CTPET-CT
LBBC/04.29.2012
DiagnosisDiagnosis
ClinicalClinicalLaboratoryLaboratoryRadiologicRadiologicPathologicPathologic
LBBC/04.29.2012
BiopsyBiopsyTissue DiagnosisTissue Diagnosis
Needle BiopsyNeedle Biopsy• FNAFNA• CoreCore
Surgical BiopsySurgical Biopsy Endoscopic (ultrasound)Endoscopic (ultrasound) US-guidedUS-guided CT-guidedCT-guided
LBBC/04.29.2012
Biopsy AnalysisBiopsy Analysis
Tissue of originTissue of originHormone receptorsHormone receptorsHER-2HER-2Biomarkers (investigational)Biomarkers (investigational)
LBBC/04.29.2012
Treatment GoalsTreatment Goals
Palliation (Symptoms, QOL)Palliation (Symptoms, QOL) Organ FunctionOrgan Function Improved Survival (chronic disease)Improved Survival (chronic disease)
LBBC/04.29.2012
Treatment ObjectivesTreatment Objectives
Response vs. Stable (clinical benefits)Response vs. Stable (clinical benefits) Disease Free Survival vs. Overall SurvivalDisease Free Survival vs. Overall Survival ToxicityToxicity
LBBC/04.29.2012
Treatment ApproachesTreatment Approaches
Lines of Therapy (First-line, etc.)Lines of Therapy (First-line, etc.) SequentialSequential CombinationCombination ““Maintenance”Maintenance” InvestigationalInvestigational
LBBC/04.29.2012
TreatmentTreatment LocalLocal
• Ablation (cryo, radiofrequency)Ablation (cryo, radiofrequency)• Radiation (external beam, brachytherapy)Radiation (external beam, brachytherapy)• Surgery Surgery
SystemicSystemic• Hormonal therapyHormonal therapy• ChemotherapyChemotherapy• Targeted TherapiesTargeted Therapies
LBBC/04.29.2012