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BREAST CANCER Part 03

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Adjuvant Therapy – Chemotherapy

  1. Indications
    • sub-groups of stage I at high risk of recurrence
    • lymphatic invasion
    • high-grade tumours
    • high S-phase fraction
    • aneuploid DNA 
  2. pre-menopausal patients tend to have better response to cytotoxic chemotherapy because of tendency for more aggressive tumours
  3. Treatment
    • postmenopausal patients with positive lymph nodes, negative estrogen receptors
    • CMF (cyclophosphamide, methotrexate and fluorouracil) x 6 months


Adjuvant Therapy – Hormonal

 

  1. estrogen and progesterone receptors
    • helps predict likelihood of regression when treated with hormonal therapy
    • prognostic significance 
  2. most common adjuvant therapy = Tamoxifen (anti-estrogen) 
  3. secondary treatments
    • previous clinical response to one hormonal treatment predicts response to another, thus secondary hormonal therapies therapies are instituted
      • progestins - megestrol acetate (Megace)
      • aromatase inhibitors - induce medical adrenalectomy
      • e.g. amino-glutethamide + hydrocortisone
      • estrogens – diethylstilbestrol
      • androgens – fluoxymesterone
    • oophorectomy - premenopausal patients with metastatic disease no benefit over tamoxifen


Adjuvant Therapy – Radiation

  1. with breast-conserving surgery
  2. those with high-risk of local recurrence
  3. adjuvant radiation to breast decreases local recurrence, increases disease free survival (no change in overall survival)

Post-Surgical Breast Cancer

 

  1. follow-up of post-mastectomy patient
    • history and physical every 4-6 months
    • yearly mammogram of remaining breast 
  2. follow-up of segmental mastectomy patient
    • history and physical every 4-6 months
    • mammograms every 6 months x 2 years,
    • then yearly thereafter
  3. when clinically indicated
    • chest x-ray
    • bone scan
    • LFTs
    • CT of abdomen
    • CT of brain


Metastatic Disease

 

  1. lung 65% bone
  2. 56%
  3. liver 56%


Screening

 

  1. importance of early detection
  2. breast self exam, start age 20
  3. mammography > 50 years every 1-2 years or every year if high risk

 


Prognosis 

 

  1. all patients: 63% 5 year survival, 46% 10 year survival 
  2. most reliably determined by stage
  3. if disease localized to breast: 75-90% clinical cure rate 
  4. if localized and receptor-positive: 90% 5-year survival 
  5. if positive axillary nodes: 40-50% 5-year survival, 25% 10-year survival

 

MALE BREAST LUMPS

 

  1. gynecomastia
  2. breast carcinoma
    • usually > 50 years
    • hard, painless lump +/- nipple retraction, discharge, ulceration
    • often metastatic at time of diagnosis, therefore, poor prognosis
BREAST CANCER Part 03 BREAST CANCER Part 03 Reviewed by Radiology Madeeasy on August 31, 2010 Rating: 5
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