http://cancer-treatment-madurai.com Breast cancer is a type of cancer that starts in the tissues of the breast. Dr.S.G.Balamurugan is one of the best cancer doctor in India, offers low cost breast cancer diagnosis, breast cancer treatments and breast cancer care at Guru Cancer Hospital, Madurai.

1. DR.S.G.BALAMURUGAN M.CH.,
SURGICAL ONCOLOGIST
GURU CANCER HOSPITAL
. MADURAI
BREAST CANCER
- CURRENT
CONCEPT

2. GURU CANCER HOSPITAL

3.  World: Commonest in female,
30% of Total body cancer in female
 India: upto 2010
2nd
most commonest in women,
2011 - Commonest
BREAST CANCER

4. TODAYS AGENDA
 To discuss about BREAST CANCER
 How to approach pt with Oncological norms
 Recent updates in cancer management
 Mismanagement –QUALITY
 BREAST CANCER AWARENESS

5. APPROACH

6. PALPABLE BREAST MASSES
fibrocystic changes (40%)fibrocystic changes (40%)
no disease (30%)no disease (30%)
benign NOS (13%)benign NOS (13%)
fibroadenoma (7%)fibroadenoma (7%)
CANCER (10%)CANCER (10%)

7. DIAGNOSIS
Triple assessment
Clinical examination + imaging
+FNAC/Corebiopsy

8. MALIGNANT LESION
o Lump in breast – usually painless
o Bloody nipple discharge
o Recent inversion of nipple
o Destruction of nipple
o Thickening of skin – orange peel like
o Node in the Axilla

9. Peaude’orange
Axillary vein thrombosis

10. Mammographic appearance of Ca
 A mass
 Associated calcification
 Architectural distortion
 Irregular border
 Skin or nipple change

11. WHAT TO DO?
SUSPECTED MALIGNANT LESION
FNAC - if inconclusive
Trucut biopsy - if inconclusive
Small lesion – excision biopsy
Large lesion – incision biopsy

13.  CONFIRMATION OF DIAGNOSIS
 trucut biopsy open biopsy
IDEAL - BIOPSY

14. BIOPSY INCISIONS
 Incision must be transverse or curvilinear
 Scars should be included in the future definitive incision
 . NO VERTICAL INCISION Adversely affects the plan of
treatment both in definitive surgery & RT planning

15. ORDER OF INVESTIGATION IN
BREAST
 CONFIRMATION OF DIAGNOSIS
 fnac trucut biopsy incision biopsy
 METASTATIC WORKUP
 X-ray chest
 US abdomen
 Bone scan

16. THE NEED OF THIS ERA
Multidisciplinary Tumor Board
Finalize Tumor staging
Formulates treatment plan

17. MANAGEMENT

18. MULTIMODAL
 Pt to be treated by all three weapons
(surgery,RT,chemotherapy) by appropriate
sequence that results in high success rate
and less complications

19. MANAGEMENT
CLASSIFICATION
 EARLY CANCER (INTENT – CURE)
SURGERY
 LOCALLY ADVANCED CANCER (INTENT –
CURE) NEOADJUVANT CHEMO
 METASTATIC CANCER (INTENT –PALLIATION)
PALLIATIVE

20. MANAGEMENT
CLASSIFICATION
 EARLY CANCER
 Size < 5cm
 Mobile axillary node
 NO skin involment
 LOCALLY ADVANCED CANCER
 Size > 5 cm
 Fixed Axillary node / SCLN involvement
 Skin involvement
 METASTATIC CANCER

21. CHANGING TRENDS

22. CHANGING TRENDS

23. EARLY CASES - OPTIONS OF SURGERY
Modified radical mastectomy
OR
Breast Conservative surgery

24. EARLY CASES - OPTIONS OF
SURGERY
 Whether Modified radical Mastectomy
or Breast conservative surgery
Axillary dissection is mandatory

25. 20TH CENTURY 21 CENTURY

26. BREAST CONSERVATIVE SURGERY

27. Brachytherapy

28. 

30. Alternative…………
BCT is not possible

31. Breast
Reconstruction

33. Breast reconstruction

34. BREAST RECONSTRUCTION
TRAM FLAP

35. BREAST RECONSTRUCTION
LD FLAP

36. LOCALY ADVANCED BREAST CANCER

37. WHAT TO DO LABC?
3 cycles of Neo adjuvant Chemo
Review
Responds well No Response
Surgery RT & Review for Surgery

38. MRI-before treatment After treatment

39. Early Nipple retraction
Orange peel like skin
Ulcer
LABC- POOR SURGICAL SELECTION

40. HOW TO MANAGE METASTATIC
DISEASE?
 Palliative treatment
 Chemotherapy
 Commonest metastasic site – BONE

41. MASTECTOMY
 NO ROLE IN METASTATIC
DISEASE WITH OUT
BLEEDING , FUNGATION
 Toilet mastectomy indicated only
for bleeding and fungating tumor

42. MICRO METASTASIS
 IMAGE OCCULT MATASTASIS
 risk of recurrence and death from breast
cancer with local therapy alone
 30% with node-negative disease
 75% with node-positive disease
Principles of Adjuvant Therapy

43. FOR WHOM ADJUVANT CHEMOTHERAPY
TO BE GIVEN?
For all cases except
1. Node negative status
2. Tumor size <1cm
3. Grade 1 – Well differentiated cancer
 Preferable regimen FAC

44. FOR WHOM ADJUVANT
RADIOTHERAPY TO BE GIVEN?
Node positive status
Incomplete axillary dissection
Tumor size more than 5cm

45. FOR WHOM ADJUVANT HORMONAL
THERAPY TO BE GIVEN?
ER and / or PR positive tumors
PREMENOPAUSAL – TAMOXIFEN
POSTMENOPAUSAL – A.I(LETROZOLE)
5 years

46. QUALITY GUIDELINE

47. HOW TO ASSESS WHETHER THE
SURGERY IS COMPLETE?
Specimen should contains atleast 10
axillary node

48. MISMANAGEMENT
 Incomplete Mastectomy
 Inadequate or no axillary dissection
 Direct surgery in locally advanced
cancers
 Lumpectomy without FNAC or Trucut
 Improperly placed incision
 Incomplete data while referring

49. Residual Breast mass

50. Residual Breast with recurrence

51. Residual Breast with Tumor - Pre operative RT

52. LOCAL RECURRENCE DUE TO INADEQUATE
SURGERY

53. IS OPERATING SURGEON REALLY A
PROGNOSTIC FACTOR?
Fact, always known but scientifically
and statistically accepted only

54. BREAST CANCER
Treatment by surgical oncologists
resulted in a 33% reduction in the risk
of death at 5 years.
An analysis of 43,411 cases, cancer
surveillance program data base
- Los Angeles
Annals of surgical oncology 10:606-615(2012)
Annals of surgical oncology

55. POSITIVE ATTITUDE

56. Prognosis: Lymph Nodes
0
10
20
30
40
50
60
70
80
0 1 2 3 4 5 6-10 11-15 16-20 >20
Number of Involved Lymph NodesNumber of Involved Lymph Nodes
%Five-YearSurvival%Five-YearSurvival
(adapted from Harris et al. Cancer: Principles and Practice of Oncology. 5th
ed.)

57. Future treatment
20th century
Cytotoxic therapy
Radiotherapy
Hormonal therapy
Surgery
21st century
Oncogene-based diagnosis
Targeted therapy
Patient-specific therapy
Today

58. Paclitaxel & Docetaxel
1971
1986
OH
European Yew: Taxus baccata
Pacific Yew: Taxus brevifolia

59. GENETIC

60. PROGNOSIS
disease state 5 year survival
noninvasive 97%
invasive, local 78%
invasive, metastatic 22%

61. TODAY
 50% of cancer is curable
 25% it is possible to achieve long term
survival

62. Breast Cancer Awareness

63. Breast cancer screening in
women: the problem
N= 1000
4 malignant
Cancer
Normal
N= 980
16 Benign
lesions

64. 9 Million Cancer Survivors
“Progress with a Purpose: Eliminating the
Death and Suffering from Cancer by 2015”

66. Breast Cancer Awareness:

67. THE CANCER
TO CURE OR NOT TO CURE
IS IN YOUR HANDS

68. Cancer is a word not a sentenceCancer is a word not a sentence

69. THANK YOU
DR.S.G.BALAMURUGAN M.Ch