Presented by Katarina Bojanić Mentor A Žmegač Horvat

FACTS amp EPIDEMIOLOGYFACTS amp EPIDEMIOLOGY

bull Most common malignancy in women (25-30)

bull 2nd leading cause of cancer deaths (after lung c)

bull gt 570000 new cases worldwide each year

bull 2300 new cases

gt800 deaths in Croatia (2005)

bull One out of eight women will be diagnosed

bull Strikes a small percentage of men

bull asymp1500 new cases expected to be diagnosed in men next year

Every three minutes a woman in the US is diagnosed with BC

Every 12 minutes a woman dies from BC

All women are at risk (rare in women lt40

10 of palpable masses malignant)

5

bull Each breast = 15 to 20 sections (lobes) arranged like petals of daisy

bull Inside lobe = smaller structures (lobules)

bull End of each lobule = tiny sacs (bulbs) produce milk

Female Breast Anatomy

6

bull Lobes lobules bulbs- linked by network of thin tubes (ducts)

bull Carry milk bulbs rarr dark area of skin (areola)

Duct

Areola

Breast profile

A ducts

B lobules

C dilated section of duct to hold milk

D nipple

E fat

F pectoralis major muscle

G chest wallrib cage

Enlargement

A normal duct cells

B basement membrane (duct wall)

C lumen (center of duct)

Risk FactorsRisk Factors

Gender

Age Race

FamilyPersonal history of BC

Genetic factors

Menstrual history

Certain types of breast disease

Radiation

Weight (obesity)

Exercise

Alcohol

Reproductive history

Hormone replacement therapy

Oral contraceptive use

Breastfeeding

Nonmodifiable risks Modifiable risks

Genetic risk factors

rarr10 of BC familial (hereditary)

bull BRCA 1 amp BRCA 2 rarr tumor suppressor genes (breast cancer gene)

rarrrole in cellular DNA repair

rarrmutation increases risk

bull P53 RAS C-MYC RB gene

Types of Breast CancerTypes of Breast Cancer

Invasive Cancers Noninvasive Cancers (in situ)

spread from

ducts or lobes into

fatty tissue

limited to ducts or lobes amp does not spread into

fatty tissue

Detection methodsDetection methods

bull Self breast exam

bull Clinical examination

bull Mammography gt 35

Ultrasound lt 35

bull Biopsy if indicated

MammographyMammography

X-ray picture of the breast to detect breast cancer

Detects a breast lump before it can be felt

Age Frequency of Mammogram

40 1-2 year

50 Every year

lt49 with family hy of breast cancer

Consult health care providers about risks

BIOPSY RESULTS

bull 80 of all breast biopsies turn out to be benign

Clinical Breast ExamClinical Breast Exam

Performed by doctor

Every 3 y for women 20 ndash 39

Yearly for women gt 40 yrs of age

Breast Self-ExamBreast Self-Exam

Monthly starting at the age of 20

bull Still menstruating2-3 days after period ends

bull No longer menstruatingsame day every month

Two parts of BSE

1) Visual

2) Palpatory

bull Examine each breast separately

bull Use pads of middle three fingers feel the texture

bull Examine the armpits

Patterns

Visual

17

Most common Lump or thickening in breastOften painless

Change in color or appearance of areola

Redness or pitting of skin over the breast like the skin of an orange

Discharge or bleeding

Change in size or contours of breast

Abnormal Breast ChangesAbnormal Breast ChangesChanges in breast size of

shape Lump in the breast

Changes in the skin of the breastNipple discharged or tenderness

TREATMENT OPTIONSTREATMENT OPTIONS amp amp PROGNOSISPROGNOSIS

bull Depend on

ndash Size of the tumor

ndash Invasive or in situ

ndash Histologic type - ductal (85) vs lobular

ndash Estrogenprogesterone receptors (60-70positive)ndash Her-2 neu status (receptor for epidermal growth f)

SURVIVAL

tm size increases-

chance decreases

ndash Lymph node status

ndash Spread to other parts of the body (bones liver lung brain)ndash Age (premenopausal = poor prognostic factor)

TREATMENT TREATMENT

bull Surgery

bull Radiation Therapy (local)

bull Chemotherapy (systemic)

bull Hormonal Therapy (systemic)

bull Immunotherapy

1048708 Therapy is individualized

GoalsCure Control Palliation

SURGERY

bull Mastectomy (completeradical)

bull Breast

conservation (partial)

RECONSTRUCTION

RADIATION THERAPY

Local control of disease

Indicationsbull Adjuvant (after partial mastectomy)

bull Young patients with DCIS

bull High risk of local recurrence

bull High energy rays used to kill cancer cells

CHEMOTHERAPYAnticancer drugs = systemic control of disease

Indications

bull After surgery to reduce risk of recurrence

bull Large + locally advanced cancer to reduce the size prior to surgery (neoadjuvant)

bull Metastatic - to reduce cancer that has spread + relieve symptoms amp prolong life

HORMONAL THERAPYbull Hormones (blood stream) rarr attach ca

cells promote their growth

bull Block the receptor or production of hormones

bull Side effects hot flashes depression

uarr risk of uterine cancer induced manopause blood clots

bull Tamoxifen aromatase inhibitors

Monoclonal antibodies

bull TrastuzumabHerceptin

bull Patients whose cancer cells

over-express Her-2-neu oncogene as measured by IHC or FISH (25 to 30 of

patients)

IMMUNOTHERAPY

bull Through early detection and improved treatments more women than ever are surviving breast cancer

Questions

THANK YOU FOR YOUR ATTENTIONTHANK YOU FOR YOUR ATTENTION

References

bull Kusić ZOnkologijaZagreb2008

bull Damjanov I Jukić S Nola MPatologijaMedicinska nakladaZagreb 2008

bull Kumar P Clark MClinical MedicineSaunders ElsevierLondon2007

bull wwwcancerorgbull wwwcancergov

FACTS amp EPIDEMIOLOGYFACTS amp EPIDEMIOLOGY

bull Most common malignancy in women (25-30)

bull 2nd leading cause of cancer deaths (after lung c)

bull gt 570000 new cases worldwide each year

bull 2300 new cases

gt800 deaths in Croatia (2005)

bull One out of eight women will be diagnosed

bull Strikes a small percentage of men

bull asymp1500 new cases expected to be diagnosed in men next year

Every three minutes a woman in the US is diagnosed with BC

Every 12 minutes a woman dies from BC

All women are at risk (rare in women lt40

10 of palpable masses malignant)

5

bull Each breast = 15 to 20 sections (lobes) arranged like petals of daisy

bull Inside lobe = smaller structures (lobules)

bull End of each lobule = tiny sacs (bulbs) produce milk

Female Breast Anatomy

6

bull Lobes lobules bulbs- linked by network of thin tubes (ducts)

bull Carry milk bulbs rarr dark area of skin (areola)

Duct

Areola

Breast profile

A ducts

B lobules

C dilated section of duct to hold milk

D nipple

E fat

F pectoralis major muscle

G chest wallrib cage

Enlargement

A normal duct cells

B basement membrane (duct wall)

C lumen (center of duct)

Risk FactorsRisk Factors

Gender

Age Race

FamilyPersonal history of BC

Genetic factors

Menstrual history

Certain types of breast disease

Radiation

Weight (obesity)

Exercise

Alcohol

Reproductive history

Hormone replacement therapy

Oral contraceptive use

Breastfeeding

Nonmodifiable risks Modifiable risks

Genetic risk factors

rarr10 of BC familial (hereditary)

bull BRCA 1 amp BRCA 2 rarr tumor suppressor genes (breast cancer gene)

rarrrole in cellular DNA repair

rarrmutation increases risk

bull P53 RAS C-MYC RB gene

Types of Breast CancerTypes of Breast Cancer

Invasive Cancers Noninvasive Cancers (in situ)

spread from

ducts or lobes into

fatty tissue

limited to ducts or lobes amp does not spread into

fatty tissue

Detection methodsDetection methods

bull Self breast exam

bull Clinical examination

bull Mammography gt 35

Ultrasound lt 35

bull Biopsy if indicated

MammographyMammography

X-ray picture of the breast to detect breast cancer

Detects a breast lump before it can be felt

Age Frequency of Mammogram

40 1-2 year

50 Every year

lt49 with family hy of breast cancer

Consult health care providers about risks

BIOPSY RESULTS

bull 80 of all breast biopsies turn out to be benign

Clinical Breast ExamClinical Breast Exam

Performed by doctor

Every 3 y for women 20 ndash 39

Yearly for women gt 40 yrs of age

Breast Self-ExamBreast Self-Exam

Monthly starting at the age of 20

bull Still menstruating2-3 days after period ends

bull No longer menstruatingsame day every month

Two parts of BSE

1) Visual

2) Palpatory

bull Examine each breast separately

bull Use pads of middle three fingers feel the texture

bull Examine the armpits

Patterns

Visual

17

Most common Lump or thickening in breastOften painless

Change in color or appearance of areola

Redness or pitting of skin over the breast like the skin of an orange

Discharge or bleeding

Change in size or contours of breast

Abnormal Breast ChangesAbnormal Breast ChangesChanges in breast size of

shape Lump in the breast

Changes in the skin of the breastNipple discharged or tenderness

TREATMENT OPTIONSTREATMENT OPTIONS amp amp PROGNOSISPROGNOSIS

bull Depend on

ndash Size of the tumor

ndash Invasive or in situ

ndash Histologic type - ductal (85) vs lobular

ndash Estrogenprogesterone receptors (60-70positive)ndash Her-2 neu status (receptor for epidermal growth f)

SURVIVAL

tm size increases-

chance decreases

ndash Lymph node status

ndash Spread to other parts of the body (bones liver lung brain)ndash Age (premenopausal = poor prognostic factor)

TREATMENT TREATMENT

bull Surgery

bull Radiation Therapy (local)

bull Chemotherapy (systemic)

bull Hormonal Therapy (systemic)

bull Immunotherapy

1048708 Therapy is individualized

GoalsCure Control Palliation

SURGERY

bull Mastectomy (completeradical)

bull Breast

conservation (partial)

RECONSTRUCTION

RADIATION THERAPY

Local control of disease

Indicationsbull Adjuvant (after partial mastectomy)

bull Young patients with DCIS

bull High risk of local recurrence

bull High energy rays used to kill cancer cells

CHEMOTHERAPYAnticancer drugs = systemic control of disease

Indications

bull After surgery to reduce risk of recurrence

bull Large + locally advanced cancer to reduce the size prior to surgery (neoadjuvant)

bull Metastatic - to reduce cancer that has spread + relieve symptoms amp prolong life

HORMONAL THERAPYbull Hormones (blood stream) rarr attach ca

cells promote their growth

bull Block the receptor or production of hormones

bull Side effects hot flashes depression

uarr risk of uterine cancer induced manopause blood clots

bull Tamoxifen aromatase inhibitors

Monoclonal antibodies

bull TrastuzumabHerceptin

bull Patients whose cancer cells

over-express Her-2-neu oncogene as measured by IHC or FISH (25 to 30 of

patients)

IMMUNOTHERAPY

bull Through early detection and improved treatments more women than ever are surviving breast cancer

Questions

THANK YOU FOR YOUR ATTENTIONTHANK YOU FOR YOUR ATTENTION

References

bull Kusić ZOnkologijaZagreb2008

bull Damjanov I Jukić S Nola MPatologijaMedicinska nakladaZagreb 2008

bull Kumar P Clark MClinical MedicineSaunders ElsevierLondon2007

bull wwwcancerorgbull wwwcancergov

bull One out of eight women will be diagnosed

bull Strikes a small percentage of men

bull asymp1500 new cases expected to be diagnosed in men next year

Every three minutes a woman in the US is diagnosed with BC

Every 12 minutes a woman dies from BC

All women are at risk (rare in women lt40

10 of palpable masses malignant)

5

bull Each breast = 15 to 20 sections (lobes) arranged like petals of daisy

bull Inside lobe = smaller structures (lobules)

bull End of each lobule = tiny sacs (bulbs) produce milk

Female Breast Anatomy

6

bull Lobes lobules bulbs- linked by network of thin tubes (ducts)

bull Carry milk bulbs rarr dark area of skin (areola)

Duct

Areola

Breast profile

A ducts

B lobules

C dilated section of duct to hold milk

D nipple

E fat

F pectoralis major muscle

G chest wallrib cage

Enlargement

A normal duct cells

B basement membrane (duct wall)

C lumen (center of duct)

Risk FactorsRisk Factors

Gender

Age Race

FamilyPersonal history of BC

Genetic factors

Menstrual history

Certain types of breast disease

Radiation

Weight (obesity)

Exercise

Alcohol

Reproductive history

Hormone replacement therapy

Oral contraceptive use

Breastfeeding

Nonmodifiable risks Modifiable risks

Genetic risk factors

rarr10 of BC familial (hereditary)

bull BRCA 1 amp BRCA 2 rarr tumor suppressor genes (breast cancer gene)

rarrrole in cellular DNA repair

rarrmutation increases risk

bull P53 RAS C-MYC RB gene

Types of Breast CancerTypes of Breast Cancer

Invasive Cancers Noninvasive Cancers (in situ)

spread from

ducts or lobes into

fatty tissue

limited to ducts or lobes amp does not spread into

fatty tissue

Detection methodsDetection methods

bull Self breast exam

bull Clinical examination

bull Mammography gt 35

Ultrasound lt 35

bull Biopsy if indicated

MammographyMammography

X-ray picture of the breast to detect breast cancer

Detects a breast lump before it can be felt

Age Frequency of Mammogram

40 1-2 year

50 Every year

lt49 with family hy of breast cancer

Consult health care providers about risks

BIOPSY RESULTS

bull 80 of all breast biopsies turn out to be benign

Clinical Breast ExamClinical Breast Exam

Performed by doctor

Every 3 y for women 20 ndash 39

Yearly for women gt 40 yrs of age

Breast Self-ExamBreast Self-Exam

Monthly starting at the age of 20

bull Still menstruating2-3 days after period ends

bull No longer menstruatingsame day every month

Two parts of BSE

1) Visual

2) Palpatory

bull Examine each breast separately

bull Use pads of middle three fingers feel the texture

bull Examine the armpits

Patterns

Visual

17

Most common Lump or thickening in breastOften painless

Change in color or appearance of areola

Redness or pitting of skin over the breast like the skin of an orange

Discharge or bleeding

Change in size or contours of breast

Abnormal Breast ChangesAbnormal Breast ChangesChanges in breast size of

shape Lump in the breast

Changes in the skin of the breastNipple discharged or tenderness

TREATMENT OPTIONSTREATMENT OPTIONS amp amp PROGNOSISPROGNOSIS

bull Depend on

ndash Size of the tumor

ndash Invasive or in situ

ndash Histologic type - ductal (85) vs lobular

ndash Estrogenprogesterone receptors (60-70positive)ndash Her-2 neu status (receptor for epidermal growth f)

SURVIVAL

tm size increases-

chance decreases

ndash Lymph node status

ndash Spread to other parts of the body (bones liver lung brain)ndash Age (premenopausal = poor prognostic factor)

TREATMENT TREATMENT

bull Surgery

bull Radiation Therapy (local)

bull Chemotherapy (systemic)

bull Hormonal Therapy (systemic)

bull Immunotherapy

1048708 Therapy is individualized

GoalsCure Control Palliation

SURGERY

bull Mastectomy (completeradical)

bull Breast

conservation (partial)

RECONSTRUCTION

RADIATION THERAPY

Local control of disease

Indicationsbull Adjuvant (after partial mastectomy)

bull Young patients with DCIS

bull High risk of local recurrence

bull High energy rays used to kill cancer cells

CHEMOTHERAPYAnticancer drugs = systemic control of disease

Indications

bull After surgery to reduce risk of recurrence

bull Large + locally advanced cancer to reduce the size prior to surgery (neoadjuvant)

bull Metastatic - to reduce cancer that has spread + relieve symptoms amp prolong life

HORMONAL THERAPYbull Hormones (blood stream) rarr attach ca

cells promote their growth

bull Block the receptor or production of hormones

bull Side effects hot flashes depression

uarr risk of uterine cancer induced manopause blood clots

bull Tamoxifen aromatase inhibitors

Monoclonal antibodies

bull TrastuzumabHerceptin

bull Patients whose cancer cells

over-express Her-2-neu oncogene as measured by IHC or FISH (25 to 30 of

patients)

IMMUNOTHERAPY

bull Through early detection and improved treatments more women than ever are surviving breast cancer

Questions

THANK YOU FOR YOUR ATTENTIONTHANK YOU FOR YOUR ATTENTION

References

bull Kusić ZOnkologijaZagreb2008

bull Damjanov I Jukić S Nola MPatologijaMedicinska nakladaZagreb 2008

bull Kumar P Clark MClinical MedicineSaunders ElsevierLondon2007

bull wwwcancerorgbull wwwcancergov

Every three minutes a woman in the US is diagnosed with BC

Every 12 minutes a woman dies from BC

All women are at risk (rare in women lt40

10 of palpable masses malignant)

5

bull Each breast = 15 to 20 sections (lobes) arranged like petals of daisy

bull Inside lobe = smaller structures (lobules)

bull End of each lobule = tiny sacs (bulbs) produce milk

Female Breast Anatomy

6

bull Lobes lobules bulbs- linked by network of thin tubes (ducts)

bull Carry milk bulbs rarr dark area of skin (areola)

Duct

Areola

Breast profile

A ducts

B lobules

C dilated section of duct to hold milk

D nipple

E fat

F pectoralis major muscle

G chest wallrib cage

Enlargement

A normal duct cells

B basement membrane (duct wall)

C lumen (center of duct)

Risk FactorsRisk Factors

Gender

Age Race

FamilyPersonal history of BC

Genetic factors

Menstrual history

Certain types of breast disease

Radiation

Weight (obesity)

Exercise

Alcohol

Reproductive history

Hormone replacement therapy

Oral contraceptive use

Breastfeeding

Nonmodifiable risks Modifiable risks

Genetic risk factors

rarr10 of BC familial (hereditary)

bull BRCA 1 amp BRCA 2 rarr tumor suppressor genes (breast cancer gene)

rarrrole in cellular DNA repair

rarrmutation increases risk

bull P53 RAS C-MYC RB gene

Types of Breast CancerTypes of Breast Cancer

Invasive Cancers Noninvasive Cancers (in situ)

spread from

ducts or lobes into

fatty tissue

limited to ducts or lobes amp does not spread into

fatty tissue

Detection methodsDetection methods

bull Self breast exam

bull Clinical examination

bull Mammography gt 35

Ultrasound lt 35

bull Biopsy if indicated

MammographyMammography

X-ray picture of the breast to detect breast cancer

Detects a breast lump before it can be felt

Age Frequency of Mammogram

40 1-2 year

50 Every year

lt49 with family hy of breast cancer

Consult health care providers about risks

BIOPSY RESULTS

bull 80 of all breast biopsies turn out to be benign

Clinical Breast ExamClinical Breast Exam

Performed by doctor

Every 3 y for women 20 ndash 39

Yearly for women gt 40 yrs of age

Breast Self-ExamBreast Self-Exam

Monthly starting at the age of 20

bull Still menstruating2-3 days after period ends

bull No longer menstruatingsame day every month

Two parts of BSE

1) Visual

2) Palpatory

bull Examine each breast separately

bull Use pads of middle three fingers feel the texture

bull Examine the armpits

Patterns

Visual

17

Most common Lump or thickening in breastOften painless

Change in color or appearance of areola

Redness or pitting of skin over the breast like the skin of an orange

Discharge or bleeding

Change in size or contours of breast

Abnormal Breast ChangesAbnormal Breast ChangesChanges in breast size of

shape Lump in the breast

Changes in the skin of the breastNipple discharged or tenderness

TREATMENT OPTIONSTREATMENT OPTIONS amp amp PROGNOSISPROGNOSIS

bull Depend on

ndash Size of the tumor

ndash Invasive or in situ

ndash Histologic type - ductal (85) vs lobular

ndash Estrogenprogesterone receptors (60-70positive)ndash Her-2 neu status (receptor for epidermal growth f)

SURVIVAL

tm size increases-

chance decreases

ndash Lymph node status

ndash Spread to other parts of the body (bones liver lung brain)ndash Age (premenopausal = poor prognostic factor)

TREATMENT TREATMENT

bull Surgery

bull Radiation Therapy (local)

bull Chemotherapy (systemic)

bull Hormonal Therapy (systemic)

bull Immunotherapy

1048708 Therapy is individualized

GoalsCure Control Palliation

SURGERY

bull Mastectomy (completeradical)

bull Breast

conservation (partial)

RECONSTRUCTION

RADIATION THERAPY

Local control of disease

Indicationsbull Adjuvant (after partial mastectomy)

bull Young patients with DCIS

bull High risk of local recurrence

bull High energy rays used to kill cancer cells

CHEMOTHERAPYAnticancer drugs = systemic control of disease

Indications

bull After surgery to reduce risk of recurrence

bull Large + locally advanced cancer to reduce the size prior to surgery (neoadjuvant)

bull Metastatic - to reduce cancer that has spread + relieve symptoms amp prolong life

HORMONAL THERAPYbull Hormones (blood stream) rarr attach ca

cells promote their growth

bull Block the receptor or production of hormones

bull Side effects hot flashes depression

uarr risk of uterine cancer induced manopause blood clots

bull Tamoxifen aromatase inhibitors

Monoclonal antibodies

bull TrastuzumabHerceptin

bull Patients whose cancer cells

over-express Her-2-neu oncogene as measured by IHC or FISH (25 to 30 of

patients)

IMMUNOTHERAPY

bull Through early detection and improved treatments more women than ever are surviving breast cancer

Questions

THANK YOU FOR YOUR ATTENTIONTHANK YOU FOR YOUR ATTENTION

References

bull Kusić ZOnkologijaZagreb2008

bull Damjanov I Jukić S Nola MPatologijaMedicinska nakladaZagreb 2008

bull Kumar P Clark MClinical MedicineSaunders ElsevierLondon2007

bull wwwcancerorgbull wwwcancergov

5

bull Each breast = 15 to 20 sections (lobes) arranged like petals of daisy

bull Inside lobe = smaller structures (lobules)

bull End of each lobule = tiny sacs (bulbs) produce milk

Female Breast Anatomy

6

bull Lobes lobules bulbs- linked by network of thin tubes (ducts)

bull Carry milk bulbs rarr dark area of skin (areola)

Duct

Areola

Breast profile

A ducts

B lobules

C dilated section of duct to hold milk

D nipple

E fat

F pectoralis major muscle

G chest wallrib cage

Enlargement

A normal duct cells

B basement membrane (duct wall)

C lumen (center of duct)

Risk FactorsRisk Factors

Gender

Age Race

FamilyPersonal history of BC

Genetic factors

Menstrual history

Certain types of breast disease

Radiation

Weight (obesity)

Exercise

Alcohol

Reproductive history

Hormone replacement therapy

Oral contraceptive use

Breastfeeding

Nonmodifiable risks Modifiable risks

Genetic risk factors

rarr10 of BC familial (hereditary)

bull BRCA 1 amp BRCA 2 rarr tumor suppressor genes (breast cancer gene)

rarrrole in cellular DNA repair

rarrmutation increases risk

bull P53 RAS C-MYC RB gene

Types of Breast CancerTypes of Breast Cancer

Invasive Cancers Noninvasive Cancers (in situ)

spread from

ducts or lobes into

fatty tissue

limited to ducts or lobes amp does not spread into

fatty tissue

Detection methodsDetection methods

bull Self breast exam

bull Clinical examination

bull Mammography gt 35

Ultrasound lt 35

bull Biopsy if indicated

MammographyMammography

X-ray picture of the breast to detect breast cancer

Detects a breast lump before it can be felt

Age Frequency of Mammogram

40 1-2 year

50 Every year

lt49 with family hy of breast cancer

Consult health care providers about risks

BIOPSY RESULTS

bull 80 of all breast biopsies turn out to be benign

Clinical Breast ExamClinical Breast Exam

Performed by doctor

Every 3 y for women 20 ndash 39

Yearly for women gt 40 yrs of age

Breast Self-ExamBreast Self-Exam

Monthly starting at the age of 20

bull Still menstruating2-3 days after period ends

bull No longer menstruatingsame day every month

Two parts of BSE

1) Visual

2) Palpatory

bull Examine each breast separately

bull Use pads of middle three fingers feel the texture

bull Examine the armpits

Patterns

Visual

17

Most common Lump or thickening in breastOften painless

Change in color or appearance of areola

Redness or pitting of skin over the breast like the skin of an orange

Discharge or bleeding

Change in size or contours of breast

Abnormal Breast ChangesAbnormal Breast ChangesChanges in breast size of

shape Lump in the breast

Changes in the skin of the breastNipple discharged or tenderness

TREATMENT OPTIONSTREATMENT OPTIONS amp amp PROGNOSISPROGNOSIS

bull Depend on

ndash Size of the tumor

ndash Invasive or in situ

ndash Histologic type - ductal (85) vs lobular

ndash Estrogenprogesterone receptors (60-70positive)ndash Her-2 neu status (receptor for epidermal growth f)

SURVIVAL

tm size increases-

chance decreases

ndash Lymph node status

ndash Spread to other parts of the body (bones liver lung brain)ndash Age (premenopausal = poor prognostic factor)

TREATMENT TREATMENT

bull Surgery

bull Radiation Therapy (local)

bull Chemotherapy (systemic)

bull Hormonal Therapy (systemic)

bull Immunotherapy

1048708 Therapy is individualized

GoalsCure Control Palliation

SURGERY

bull Mastectomy (completeradical)

bull Breast

conservation (partial)

RECONSTRUCTION

RADIATION THERAPY

Local control of disease

Indicationsbull Adjuvant (after partial mastectomy)

bull Young patients with DCIS

bull High risk of local recurrence

bull High energy rays used to kill cancer cells

CHEMOTHERAPYAnticancer drugs = systemic control of disease

Indications

bull After surgery to reduce risk of recurrence

bull Large + locally advanced cancer to reduce the size prior to surgery (neoadjuvant)

bull Metastatic - to reduce cancer that has spread + relieve symptoms amp prolong life

HORMONAL THERAPYbull Hormones (blood stream) rarr attach ca

cells promote their growth

bull Block the receptor or production of hormones

bull Side effects hot flashes depression

uarr risk of uterine cancer induced manopause blood clots

bull Tamoxifen aromatase inhibitors

Monoclonal antibodies

bull TrastuzumabHerceptin

bull Patients whose cancer cells

over-express Her-2-neu oncogene as measured by IHC or FISH (25 to 30 of

patients)

IMMUNOTHERAPY

bull Through early detection and improved treatments more women than ever are surviving breast cancer

Questions

THANK YOU FOR YOUR ATTENTIONTHANK YOU FOR YOUR ATTENTION

References

bull Kusić ZOnkologijaZagreb2008

bull Damjanov I Jukić S Nola MPatologijaMedicinska nakladaZagreb 2008

bull Kumar P Clark MClinical MedicineSaunders ElsevierLondon2007

bull wwwcancerorgbull wwwcancergov

6

bull Lobes lobules bulbs- linked by network of thin tubes (ducts)

bull Carry milk bulbs rarr dark area of skin (areola)

Duct

Areola

Breast profile

A ducts

B lobules

C dilated section of duct to hold milk

D nipple

E fat

F pectoralis major muscle

G chest wallrib cage

Enlargement

A normal duct cells

B basement membrane (duct wall)

C lumen (center of duct)

Risk FactorsRisk Factors

Gender

Age Race

FamilyPersonal history of BC

Genetic factors

Menstrual history

Certain types of breast disease

Radiation

Weight (obesity)

Exercise

Alcohol

Reproductive history

Hormone replacement therapy

Oral contraceptive use

Breastfeeding

Nonmodifiable risks Modifiable risks

Genetic risk factors

rarr10 of BC familial (hereditary)

bull BRCA 1 amp BRCA 2 rarr tumor suppressor genes (breast cancer gene)

rarrrole in cellular DNA repair

rarrmutation increases risk

bull P53 RAS C-MYC RB gene

Types of Breast CancerTypes of Breast Cancer

Invasive Cancers Noninvasive Cancers (in situ)

spread from

ducts or lobes into

fatty tissue

limited to ducts or lobes amp does not spread into

fatty tissue

Detection methodsDetection methods

bull Self breast exam

bull Clinical examination

bull Mammography gt 35

Ultrasound lt 35

bull Biopsy if indicated

MammographyMammography

X-ray picture of the breast to detect breast cancer

Detects a breast lump before it can be felt

Age Frequency of Mammogram

40 1-2 year

50 Every year

lt49 with family hy of breast cancer

Consult health care providers about risks

BIOPSY RESULTS

bull 80 of all breast biopsies turn out to be benign

Clinical Breast ExamClinical Breast Exam

Performed by doctor

Every 3 y for women 20 ndash 39

Yearly for women gt 40 yrs of age

Breast Self-ExamBreast Self-Exam

Monthly starting at the age of 20

bull Still menstruating2-3 days after period ends

bull No longer menstruatingsame day every month

Two parts of BSE

1) Visual

2) Palpatory

bull Examine each breast separately

bull Use pads of middle three fingers feel the texture

bull Examine the armpits

Patterns

Visual

17

Most common Lump or thickening in breastOften painless

Change in color or appearance of areola

Redness or pitting of skin over the breast like the skin of an orange

Discharge or bleeding

Change in size or contours of breast

Abnormal Breast ChangesAbnormal Breast ChangesChanges in breast size of

shape Lump in the breast

Changes in the skin of the breastNipple discharged or tenderness

TREATMENT OPTIONSTREATMENT OPTIONS amp amp PROGNOSISPROGNOSIS

bull Depend on

ndash Size of the tumor

ndash Invasive or in situ

ndash Histologic type - ductal (85) vs lobular

ndash Estrogenprogesterone receptors (60-70positive)ndash Her-2 neu status (receptor for epidermal growth f)

SURVIVAL

tm size increases-

chance decreases

ndash Lymph node status

ndash Spread to other parts of the body (bones liver lung brain)ndash Age (premenopausal = poor prognostic factor)

TREATMENT TREATMENT

bull Surgery

bull Radiation Therapy (local)

bull Chemotherapy (systemic)

bull Hormonal Therapy (systemic)

bull Immunotherapy

1048708 Therapy is individualized

GoalsCure Control Palliation

SURGERY

bull Mastectomy (completeradical)

bull Breast

conservation (partial)

RECONSTRUCTION

RADIATION THERAPY

Local control of disease

Indicationsbull Adjuvant (after partial mastectomy)

bull Young patients with DCIS

bull High risk of local recurrence

bull High energy rays used to kill cancer cells

CHEMOTHERAPYAnticancer drugs = systemic control of disease

Indications

bull After surgery to reduce risk of recurrence

bull Large + locally advanced cancer to reduce the size prior to surgery (neoadjuvant)

bull Metastatic - to reduce cancer that has spread + relieve symptoms amp prolong life

HORMONAL THERAPYbull Hormones (blood stream) rarr attach ca

cells promote their growth

bull Block the receptor or production of hormones

bull Side effects hot flashes depression

uarr risk of uterine cancer induced manopause blood clots

bull Tamoxifen aromatase inhibitors

Monoclonal antibodies

bull TrastuzumabHerceptin

bull Patients whose cancer cells

over-express Her-2-neu oncogene as measured by IHC or FISH (25 to 30 of

patients)

IMMUNOTHERAPY

bull Through early detection and improved treatments more women than ever are surviving breast cancer

Questions

THANK YOU FOR YOUR ATTENTIONTHANK YOU FOR YOUR ATTENTION

References

bull Kusić ZOnkologijaZagreb2008

bull Damjanov I Jukić S Nola MPatologijaMedicinska nakladaZagreb 2008

bull Kumar P Clark MClinical MedicineSaunders ElsevierLondon2007

bull wwwcancerorgbull wwwcancergov

Risk FactorsRisk Factors

Gender

Age Race

FamilyPersonal history of BC

Genetic factors

Menstrual history

Certain types of breast disease

Radiation

Weight (obesity)

Exercise

Alcohol

Reproductive history

Hormone replacement therapy

Oral contraceptive use

Breastfeeding

Nonmodifiable risks Modifiable risks

Genetic risk factors

rarr10 of BC familial (hereditary)

bull BRCA 1 amp BRCA 2 rarr tumor suppressor genes (breast cancer gene)

rarrrole in cellular DNA repair

rarrmutation increases risk

bull P53 RAS C-MYC RB gene

Types of Breast CancerTypes of Breast Cancer

Invasive Cancers Noninvasive Cancers (in situ)

spread from

ducts or lobes into

fatty tissue

limited to ducts or lobes amp does not spread into

fatty tissue

Detection methodsDetection methods

bull Self breast exam

bull Clinical examination

bull Mammography gt 35

Ultrasound lt 35

bull Biopsy if indicated

MammographyMammography

X-ray picture of the breast to detect breast cancer

Detects a breast lump before it can be felt

Age Frequency of Mammogram

40 1-2 year

50 Every year

lt49 with family hy of breast cancer

Consult health care providers about risks

BIOPSY RESULTS

bull 80 of all breast biopsies turn out to be benign

Clinical Breast ExamClinical Breast Exam

Performed by doctor

Every 3 y for women 20 ndash 39

Yearly for women gt 40 yrs of age

Breast Self-ExamBreast Self-Exam

Monthly starting at the age of 20

bull Still menstruating2-3 days after period ends

bull No longer menstruatingsame day every month

Two parts of BSE

1) Visual

2) Palpatory

bull Examine each breast separately

bull Use pads of middle three fingers feel the texture

bull Examine the armpits

Patterns

Visual

17

Most common Lump or thickening in breastOften painless

Change in color or appearance of areola

Redness or pitting of skin over the breast like the skin of an orange

Discharge or bleeding

Change in size or contours of breast

Abnormal Breast ChangesAbnormal Breast ChangesChanges in breast size of

shape Lump in the breast

Changes in the skin of the breastNipple discharged or tenderness

TREATMENT OPTIONSTREATMENT OPTIONS amp amp PROGNOSISPROGNOSIS

bull Depend on

ndash Size of the tumor

ndash Invasive or in situ

ndash Histologic type - ductal (85) vs lobular

ndash Estrogenprogesterone receptors (60-70positive)ndash Her-2 neu status (receptor for epidermal growth f)

SURVIVAL

tm size increases-

chance decreases

ndash Lymph node status

ndash Spread to other parts of the body (bones liver lung brain)ndash Age (premenopausal = poor prognostic factor)

TREATMENT TREATMENT

bull Surgery

bull Radiation Therapy (local)

bull Chemotherapy (systemic)

bull Hormonal Therapy (systemic)

bull Immunotherapy

1048708 Therapy is individualized

GoalsCure Control Palliation

SURGERY

bull Mastectomy (completeradical)

bull Breast

conservation (partial)

RECONSTRUCTION

RADIATION THERAPY

Local control of disease

Indicationsbull Adjuvant (after partial mastectomy)

bull Young patients with DCIS

bull High risk of local recurrence

bull High energy rays used to kill cancer cells

CHEMOTHERAPYAnticancer drugs = systemic control of disease

Indications

bull After surgery to reduce risk of recurrence

bull Large + locally advanced cancer to reduce the size prior to surgery (neoadjuvant)

bull Metastatic - to reduce cancer that has spread + relieve symptoms amp prolong life

HORMONAL THERAPYbull Hormones (blood stream) rarr attach ca

cells promote their growth

bull Block the receptor or production of hormones

bull Side effects hot flashes depression

uarr risk of uterine cancer induced manopause blood clots

bull Tamoxifen aromatase inhibitors

Monoclonal antibodies

bull TrastuzumabHerceptin

bull Patients whose cancer cells

over-express Her-2-neu oncogene as measured by IHC or FISH (25 to 30 of

patients)

IMMUNOTHERAPY

bull Through early detection and improved treatments more women than ever are surviving breast cancer

Questions

THANK YOU FOR YOUR ATTENTIONTHANK YOU FOR YOUR ATTENTION

References

bull Kusić ZOnkologijaZagreb2008

bull Damjanov I Jukić S Nola MPatologijaMedicinska nakladaZagreb 2008

bull Kumar P Clark MClinical MedicineSaunders ElsevierLondon2007

bull wwwcancerorgbull wwwcancergov

Genetic risk factors

rarr10 of BC familial (hereditary)

bull BRCA 1 amp BRCA 2 rarr tumor suppressor genes (breast cancer gene)

rarrrole in cellular DNA repair

rarrmutation increases risk

bull P53 RAS C-MYC RB gene

Types of Breast CancerTypes of Breast Cancer

Invasive Cancers Noninvasive Cancers (in situ)

spread from

ducts or lobes into

fatty tissue

limited to ducts or lobes amp does not spread into

fatty tissue

Detection methodsDetection methods

bull Self breast exam

bull Clinical examination

bull Mammography gt 35

Ultrasound lt 35

bull Biopsy if indicated

MammographyMammography

X-ray picture of the breast to detect breast cancer

Detects a breast lump before it can be felt

Age Frequency of Mammogram

40 1-2 year

50 Every year

lt49 with family hy of breast cancer

Consult health care providers about risks

BIOPSY RESULTS

bull 80 of all breast biopsies turn out to be benign

Clinical Breast ExamClinical Breast Exam

Performed by doctor

Every 3 y for women 20 ndash 39

Yearly for women gt 40 yrs of age

Breast Self-ExamBreast Self-Exam

Monthly starting at the age of 20

bull Still menstruating2-3 days after period ends

bull No longer menstruatingsame day every month

Two parts of BSE

1) Visual

2) Palpatory

bull Examine each breast separately

bull Use pads of middle three fingers feel the texture

bull Examine the armpits

Patterns

Visual

17

Most common Lump or thickening in breastOften painless

Change in color or appearance of areola

Redness or pitting of skin over the breast like the skin of an orange

Discharge or bleeding

Change in size or contours of breast

Abnormal Breast ChangesAbnormal Breast ChangesChanges in breast size of

shape Lump in the breast

Changes in the skin of the breastNipple discharged or tenderness

TREATMENT OPTIONSTREATMENT OPTIONS amp amp PROGNOSISPROGNOSIS

bull Depend on

ndash Size of the tumor

ndash Invasive or in situ

ndash Histologic type - ductal (85) vs lobular

ndash Estrogenprogesterone receptors (60-70positive)ndash Her-2 neu status (receptor for epidermal growth f)

SURVIVAL

tm size increases-

chance decreases

ndash Lymph node status

ndash Spread to other parts of the body (bones liver lung brain)ndash Age (premenopausal = poor prognostic factor)

TREATMENT TREATMENT

bull Surgery

bull Radiation Therapy (local)

bull Chemotherapy (systemic)

bull Hormonal Therapy (systemic)

bull Immunotherapy

1048708 Therapy is individualized

GoalsCure Control Palliation

SURGERY

bull Mastectomy (completeradical)

bull Breast

conservation (partial)

RECONSTRUCTION

RADIATION THERAPY

Local control of disease

Indicationsbull Adjuvant (after partial mastectomy)

bull Young patients with DCIS

bull High risk of local recurrence

bull High energy rays used to kill cancer cells

CHEMOTHERAPYAnticancer drugs = systemic control of disease

Indications

bull After surgery to reduce risk of recurrence

bull Large + locally advanced cancer to reduce the size prior to surgery (neoadjuvant)

bull Metastatic - to reduce cancer that has spread + relieve symptoms amp prolong life

HORMONAL THERAPYbull Hormones (blood stream) rarr attach ca

cells promote their growth

bull Block the receptor or production of hormones

bull Side effects hot flashes depression

uarr risk of uterine cancer induced manopause blood clots

bull Tamoxifen aromatase inhibitors

Monoclonal antibodies

bull TrastuzumabHerceptin

bull Patients whose cancer cells

over-express Her-2-neu oncogene as measured by IHC or FISH (25 to 30 of

patients)

IMMUNOTHERAPY

bull Through early detection and improved treatments more women than ever are surviving breast cancer

Questions

THANK YOU FOR YOUR ATTENTIONTHANK YOU FOR YOUR ATTENTION

References

bull Kusić ZOnkologijaZagreb2008

bull Damjanov I Jukić S Nola MPatologijaMedicinska nakladaZagreb 2008

bull Kumar P Clark MClinical MedicineSaunders ElsevierLondon2007

bull wwwcancerorgbull wwwcancergov

Types of Breast CancerTypes of Breast Cancer

Invasive Cancers Noninvasive Cancers (in situ)

spread from

ducts or lobes into

fatty tissue

limited to ducts or lobes amp does not spread into

fatty tissue

Detection methodsDetection methods

bull Self breast exam

bull Clinical examination

bull Mammography gt 35

Ultrasound lt 35

bull Biopsy if indicated

MammographyMammography

X-ray picture of the breast to detect breast cancer

Detects a breast lump before it can be felt

Age Frequency of Mammogram

40 1-2 year

50 Every year

lt49 with family hy of breast cancer

Consult health care providers about risks

BIOPSY RESULTS

bull 80 of all breast biopsies turn out to be benign

Clinical Breast ExamClinical Breast Exam

Performed by doctor

Every 3 y for women 20 ndash 39

Yearly for women gt 40 yrs of age

Breast Self-ExamBreast Self-Exam

Monthly starting at the age of 20

bull Still menstruating2-3 days after period ends

bull No longer menstruatingsame day every month

Two parts of BSE

1) Visual

2) Palpatory

bull Examine each breast separately

bull Use pads of middle three fingers feel the texture

bull Examine the armpits

Patterns

Visual

17

Most common Lump or thickening in breastOften painless

Change in color or appearance of areola

Redness or pitting of skin over the breast like the skin of an orange

Discharge or bleeding

Change in size or contours of breast

Abnormal Breast ChangesAbnormal Breast ChangesChanges in breast size of

shape Lump in the breast

Changes in the skin of the breastNipple discharged or tenderness

TREATMENT OPTIONSTREATMENT OPTIONS amp amp PROGNOSISPROGNOSIS

bull Depend on

ndash Size of the tumor

ndash Invasive or in situ

ndash Histologic type - ductal (85) vs lobular

ndash Estrogenprogesterone receptors (60-70positive)ndash Her-2 neu status (receptor for epidermal growth f)

SURVIVAL

tm size increases-

chance decreases

ndash Lymph node status

ndash Spread to other parts of the body (bones liver lung brain)ndash Age (premenopausal = poor prognostic factor)

TREATMENT TREATMENT

bull Surgery

bull Radiation Therapy (local)

bull Chemotherapy (systemic)

bull Hormonal Therapy (systemic)

bull Immunotherapy

1048708 Therapy is individualized

GoalsCure Control Palliation

SURGERY

bull Mastectomy (completeradical)

bull Breast

conservation (partial)

RECONSTRUCTION

RADIATION THERAPY

Local control of disease

Indicationsbull Adjuvant (after partial mastectomy)

bull Young patients with DCIS

bull High risk of local recurrence

bull High energy rays used to kill cancer cells

CHEMOTHERAPYAnticancer drugs = systemic control of disease

Indications

bull After surgery to reduce risk of recurrence

bull Large + locally advanced cancer to reduce the size prior to surgery (neoadjuvant)

bull Metastatic - to reduce cancer that has spread + relieve symptoms amp prolong life

HORMONAL THERAPYbull Hormones (blood stream) rarr attach ca

cells promote their growth

bull Block the receptor or production of hormones

bull Side effects hot flashes depression

uarr risk of uterine cancer induced manopause blood clots

bull Tamoxifen aromatase inhibitors

Monoclonal antibodies

bull TrastuzumabHerceptin

bull Patients whose cancer cells

over-express Her-2-neu oncogene as measured by IHC or FISH (25 to 30 of

patients)

IMMUNOTHERAPY

bull Through early detection and improved treatments more women than ever are surviving breast cancer

Questions

THANK YOU FOR YOUR ATTENTIONTHANK YOU FOR YOUR ATTENTION

References

bull Kusić ZOnkologijaZagreb2008

bull Damjanov I Jukić S Nola MPatologijaMedicinska nakladaZagreb 2008

bull Kumar P Clark MClinical MedicineSaunders ElsevierLondon2007

bull wwwcancerorgbull wwwcancergov

Detection methodsDetection methods

bull Self breast exam

bull Clinical examination

bull Mammography gt 35

Ultrasound lt 35

bull Biopsy if indicated

MammographyMammography

X-ray picture of the breast to detect breast cancer

Detects a breast lump before it can be felt

Age Frequency of Mammogram

40 1-2 year

50 Every year

lt49 with family hy of breast cancer

Consult health care providers about risks

BIOPSY RESULTS

bull 80 of all breast biopsies turn out to be benign

Clinical Breast ExamClinical Breast Exam

Performed by doctor

Every 3 y for women 20 ndash 39

Yearly for women gt 40 yrs of age

Breast Self-ExamBreast Self-Exam

Monthly starting at the age of 20

bull Still menstruating2-3 days after period ends

bull No longer menstruatingsame day every month

Two parts of BSE

1) Visual

2) Palpatory

bull Examine each breast separately

bull Use pads of middle three fingers feel the texture

bull Examine the armpits

Patterns

Visual

17

Most common Lump or thickening in breastOften painless

Change in color or appearance of areola

Redness or pitting of skin over the breast like the skin of an orange

Discharge or bleeding

Change in size or contours of breast

Abnormal Breast ChangesAbnormal Breast ChangesChanges in breast size of

shape Lump in the breast

Changes in the skin of the breastNipple discharged or tenderness

TREATMENT OPTIONSTREATMENT OPTIONS amp amp PROGNOSISPROGNOSIS

bull Depend on

ndash Size of the tumor

ndash Invasive or in situ

ndash Histologic type - ductal (85) vs lobular

ndash Estrogenprogesterone receptors (60-70positive)ndash Her-2 neu status (receptor for epidermal growth f)

SURVIVAL

tm size increases-

chance decreases

ndash Lymph node status

ndash Spread to other parts of the body (bones liver lung brain)ndash Age (premenopausal = poor prognostic factor)

TREATMENT TREATMENT

bull Surgery

bull Radiation Therapy (local)

bull Chemotherapy (systemic)

bull Hormonal Therapy (systemic)

bull Immunotherapy

1048708 Therapy is individualized

GoalsCure Control Palliation

SURGERY

bull Mastectomy (completeradical)

bull Breast

conservation (partial)

RECONSTRUCTION

RADIATION THERAPY

Local control of disease

Indicationsbull Adjuvant (after partial mastectomy)

bull Young patients with DCIS

bull High risk of local recurrence

bull High energy rays used to kill cancer cells

CHEMOTHERAPYAnticancer drugs = systemic control of disease

Indications

bull After surgery to reduce risk of recurrence

bull Large + locally advanced cancer to reduce the size prior to surgery (neoadjuvant)

bull Metastatic - to reduce cancer that has spread + relieve symptoms amp prolong life

HORMONAL THERAPYbull Hormones (blood stream) rarr attach ca

cells promote their growth

bull Block the receptor or production of hormones

bull Side effects hot flashes depression

uarr risk of uterine cancer induced manopause blood clots

bull Tamoxifen aromatase inhibitors

Monoclonal antibodies

bull TrastuzumabHerceptin

bull Patients whose cancer cells

over-express Her-2-neu oncogene as measured by IHC or FISH (25 to 30 of

patients)

IMMUNOTHERAPY

bull Through early detection and improved treatments more women than ever are surviving breast cancer

Questions

THANK YOU FOR YOUR ATTENTIONTHANK YOU FOR YOUR ATTENTION

References

bull Kusić ZOnkologijaZagreb2008

bull Damjanov I Jukić S Nola MPatologijaMedicinska nakladaZagreb 2008

bull Kumar P Clark MClinical MedicineSaunders ElsevierLondon2007

bull wwwcancerorgbull wwwcancergov

MammographyMammography

X-ray picture of the breast to detect breast cancer

Detects a breast lump before it can be felt

Age Frequency of Mammogram

40 1-2 year

50 Every year

lt49 with family hy of breast cancer

Consult health care providers about risks

BIOPSY RESULTS

bull 80 of all breast biopsies turn out to be benign

Clinical Breast ExamClinical Breast Exam

Performed by doctor

Every 3 y for women 20 ndash 39

Yearly for women gt 40 yrs of age

Breast Self-ExamBreast Self-Exam

Monthly starting at the age of 20

bull Still menstruating2-3 days after period ends

bull No longer menstruatingsame day every month

Two parts of BSE

1) Visual

2) Palpatory

bull Examine each breast separately

bull Use pads of middle three fingers feel the texture

bull Examine the armpits

Patterns

Visual

17

Most common Lump or thickening in breastOften painless

Change in color or appearance of areola

Redness or pitting of skin over the breast like the skin of an orange

Discharge or bleeding

Change in size or contours of breast

Abnormal Breast ChangesAbnormal Breast ChangesChanges in breast size of

shape Lump in the breast

Changes in the skin of the breastNipple discharged or tenderness

TREATMENT OPTIONSTREATMENT OPTIONS amp amp PROGNOSISPROGNOSIS

bull Depend on

ndash Size of the tumor

ndash Invasive or in situ

ndash Histologic type - ductal (85) vs lobular

ndash Estrogenprogesterone receptors (60-70positive)ndash Her-2 neu status (receptor for epidermal growth f)

SURVIVAL

tm size increases-

chance decreases

ndash Lymph node status

ndash Spread to other parts of the body (bones liver lung brain)ndash Age (premenopausal = poor prognostic factor)

TREATMENT TREATMENT

bull Surgery

bull Radiation Therapy (local)

bull Chemotherapy (systemic)

bull Hormonal Therapy (systemic)

bull Immunotherapy

1048708 Therapy is individualized

GoalsCure Control Palliation

SURGERY

bull Mastectomy (completeradical)

bull Breast

conservation (partial)

RECONSTRUCTION

RADIATION THERAPY

Local control of disease

Indicationsbull Adjuvant (after partial mastectomy)

bull Young patients with DCIS

bull High risk of local recurrence

bull High energy rays used to kill cancer cells

CHEMOTHERAPYAnticancer drugs = systemic control of disease

Indications

bull After surgery to reduce risk of recurrence

bull Large + locally advanced cancer to reduce the size prior to surgery (neoadjuvant)

bull Metastatic - to reduce cancer that has spread + relieve symptoms amp prolong life

HORMONAL THERAPYbull Hormones (blood stream) rarr attach ca

cells promote their growth

bull Block the receptor or production of hormones

bull Side effects hot flashes depression

uarr risk of uterine cancer induced manopause blood clots

bull Tamoxifen aromatase inhibitors

Monoclonal antibodies

bull TrastuzumabHerceptin

bull Patients whose cancer cells

over-express Her-2-neu oncogene as measured by IHC or FISH (25 to 30 of

patients)

IMMUNOTHERAPY

bull Through early detection and improved treatments more women than ever are surviving breast cancer

Questions

THANK YOU FOR YOUR ATTENTIONTHANK YOU FOR YOUR ATTENTION

References

bull Kusić ZOnkologijaZagreb2008

bull Damjanov I Jukić S Nola MPatologijaMedicinska nakladaZagreb 2008

bull Kumar P Clark MClinical MedicineSaunders ElsevierLondon2007

bull wwwcancerorgbull wwwcancergov

BIOPSY RESULTS

bull 80 of all breast biopsies turn out to be benign

Clinical Breast ExamClinical Breast Exam

Performed by doctor

Every 3 y for women 20 ndash 39

Yearly for women gt 40 yrs of age

Breast Self-ExamBreast Self-Exam

Monthly starting at the age of 20

bull Still menstruating2-3 days after period ends

bull No longer menstruatingsame day every month

Two parts of BSE

1) Visual

2) Palpatory

bull Examine each breast separately

bull Use pads of middle three fingers feel the texture

bull Examine the armpits

Patterns

Visual

17

Most common Lump or thickening in breastOften painless

Change in color or appearance of areola

Redness or pitting of skin over the breast like the skin of an orange

Discharge or bleeding

Change in size or contours of breast

Abnormal Breast ChangesAbnormal Breast ChangesChanges in breast size of

shape Lump in the breast

Changes in the skin of the breastNipple discharged or tenderness

TREATMENT OPTIONSTREATMENT OPTIONS amp amp PROGNOSISPROGNOSIS

bull Depend on

ndash Size of the tumor

ndash Invasive or in situ

ndash Histologic type - ductal (85) vs lobular

ndash Estrogenprogesterone receptors (60-70positive)ndash Her-2 neu status (receptor for epidermal growth f)

SURVIVAL

tm size increases-

chance decreases

ndash Lymph node status

ndash Spread to other parts of the body (bones liver lung brain)ndash Age (premenopausal = poor prognostic factor)

TREATMENT TREATMENT

bull Surgery

bull Radiation Therapy (local)

bull Chemotherapy (systemic)

bull Hormonal Therapy (systemic)

bull Immunotherapy

1048708 Therapy is individualized

GoalsCure Control Palliation

SURGERY

bull Mastectomy (completeradical)

bull Breast

conservation (partial)

RECONSTRUCTION

RADIATION THERAPY

Local control of disease

Indicationsbull Adjuvant (after partial mastectomy)

bull Young patients with DCIS

bull High risk of local recurrence

bull High energy rays used to kill cancer cells

CHEMOTHERAPYAnticancer drugs = systemic control of disease

Indications

bull After surgery to reduce risk of recurrence

bull Large + locally advanced cancer to reduce the size prior to surgery (neoadjuvant)

bull Metastatic - to reduce cancer that has spread + relieve symptoms amp prolong life

HORMONAL THERAPYbull Hormones (blood stream) rarr attach ca

cells promote their growth

bull Block the receptor or production of hormones

bull Side effects hot flashes depression

uarr risk of uterine cancer induced manopause blood clots

bull Tamoxifen aromatase inhibitors

Monoclonal antibodies

bull TrastuzumabHerceptin

bull Patients whose cancer cells

over-express Her-2-neu oncogene as measured by IHC or FISH (25 to 30 of

patients)

IMMUNOTHERAPY

bull Through early detection and improved treatments more women than ever are surviving breast cancer

Questions

THANK YOU FOR YOUR ATTENTIONTHANK YOU FOR YOUR ATTENTION

References

bull Kusić ZOnkologijaZagreb2008

bull Damjanov I Jukić S Nola MPatologijaMedicinska nakladaZagreb 2008

bull Kumar P Clark MClinical MedicineSaunders ElsevierLondon2007

bull wwwcancerorgbull wwwcancergov

Clinical Breast ExamClinical Breast Exam

Performed by doctor

Every 3 y for women 20 ndash 39

Yearly for women gt 40 yrs of age

Breast Self-ExamBreast Self-Exam

Monthly starting at the age of 20

bull Still menstruating2-3 days after period ends

bull No longer menstruatingsame day every month

Two parts of BSE

1) Visual

2) Palpatory

bull Examine each breast separately

bull Use pads of middle three fingers feel the texture

bull Examine the armpits

Patterns

Visual

17

Most common Lump or thickening in breastOften painless

Change in color or appearance of areola

Redness or pitting of skin over the breast like the skin of an orange

Discharge or bleeding

Change in size or contours of breast

Abnormal Breast ChangesAbnormal Breast ChangesChanges in breast size of

shape Lump in the breast

Changes in the skin of the breastNipple discharged or tenderness

TREATMENT OPTIONSTREATMENT OPTIONS amp amp PROGNOSISPROGNOSIS

bull Depend on

ndash Size of the tumor

ndash Invasive or in situ

ndash Histologic type - ductal (85) vs lobular

ndash Estrogenprogesterone receptors (60-70positive)ndash Her-2 neu status (receptor for epidermal growth f)

SURVIVAL

tm size increases-

chance decreases

ndash Lymph node status

ndash Spread to other parts of the body (bones liver lung brain)ndash Age (premenopausal = poor prognostic factor)

TREATMENT TREATMENT

bull Surgery

bull Radiation Therapy (local)

bull Chemotherapy (systemic)

bull Hormonal Therapy (systemic)

bull Immunotherapy

1048708 Therapy is individualized

GoalsCure Control Palliation

SURGERY

bull Mastectomy (completeradical)

bull Breast

conservation (partial)

RECONSTRUCTION

RADIATION THERAPY

Local control of disease

Indicationsbull Adjuvant (after partial mastectomy)

bull Young patients with DCIS

bull High risk of local recurrence

bull High energy rays used to kill cancer cells

CHEMOTHERAPYAnticancer drugs = systemic control of disease

Indications

bull After surgery to reduce risk of recurrence

bull Large + locally advanced cancer to reduce the size prior to surgery (neoadjuvant)

bull Metastatic - to reduce cancer that has spread + relieve symptoms amp prolong life

HORMONAL THERAPYbull Hormones (blood stream) rarr attach ca

cells promote their growth

bull Block the receptor or production of hormones

bull Side effects hot flashes depression

uarr risk of uterine cancer induced manopause blood clots

bull Tamoxifen aromatase inhibitors

Monoclonal antibodies

bull TrastuzumabHerceptin

bull Patients whose cancer cells

over-express Her-2-neu oncogene as measured by IHC or FISH (25 to 30 of

patients)

IMMUNOTHERAPY

bull Through early detection and improved treatments more women than ever are surviving breast cancer

Questions

THANK YOU FOR YOUR ATTENTIONTHANK YOU FOR YOUR ATTENTION

References

bull Kusić ZOnkologijaZagreb2008

bull Damjanov I Jukić S Nola MPatologijaMedicinska nakladaZagreb 2008

bull Kumar P Clark MClinical MedicineSaunders ElsevierLondon2007

bull wwwcancerorgbull wwwcancergov

Breast Self-ExamBreast Self-Exam

Monthly starting at the age of 20

bull Still menstruating2-3 days after period ends

bull No longer menstruatingsame day every month

Two parts of BSE

1) Visual

2) Palpatory

bull Examine each breast separately

bull Use pads of middle three fingers feel the texture

bull Examine the armpits

Patterns

Visual

17

Most common Lump or thickening in breastOften painless

Change in color or appearance of areola

Redness or pitting of skin over the breast like the skin of an orange

Discharge or bleeding

Change in size or contours of breast

Abnormal Breast ChangesAbnormal Breast ChangesChanges in breast size of

shape Lump in the breast

Changes in the skin of the breastNipple discharged or tenderness

TREATMENT OPTIONSTREATMENT OPTIONS amp amp PROGNOSISPROGNOSIS

bull Depend on

ndash Size of the tumor

ndash Invasive or in situ

ndash Histologic type - ductal (85) vs lobular

ndash Estrogenprogesterone receptors (60-70positive)ndash Her-2 neu status (receptor for epidermal growth f)

SURVIVAL

tm size increases-

chance decreases

ndash Lymph node status

ndash Spread to other parts of the body (bones liver lung brain)ndash Age (premenopausal = poor prognostic factor)

TREATMENT TREATMENT

bull Surgery

bull Radiation Therapy (local)

bull Chemotherapy (systemic)

bull Hormonal Therapy (systemic)

bull Immunotherapy

1048708 Therapy is individualized

GoalsCure Control Palliation

SURGERY

bull Mastectomy (completeradical)

bull Breast

conservation (partial)

RECONSTRUCTION

RADIATION THERAPY

Local control of disease

Indicationsbull Adjuvant (after partial mastectomy)

bull Young patients with DCIS

bull High risk of local recurrence

bull High energy rays used to kill cancer cells

CHEMOTHERAPYAnticancer drugs = systemic control of disease

Indications

bull After surgery to reduce risk of recurrence

bull Large + locally advanced cancer to reduce the size prior to surgery (neoadjuvant)

bull Metastatic - to reduce cancer that has spread + relieve symptoms amp prolong life

HORMONAL THERAPYbull Hormones (blood stream) rarr attach ca

cells promote their growth

bull Block the receptor or production of hormones

bull Side effects hot flashes depression

uarr risk of uterine cancer induced manopause blood clots

bull Tamoxifen aromatase inhibitors

Monoclonal antibodies

bull TrastuzumabHerceptin

bull Patients whose cancer cells

over-express Her-2-neu oncogene as measured by IHC or FISH (25 to 30 of

patients)

IMMUNOTHERAPY

bull Through early detection and improved treatments more women than ever are surviving breast cancer

Questions

THANK YOU FOR YOUR ATTENTIONTHANK YOU FOR YOUR ATTENTION

References

bull Kusić ZOnkologijaZagreb2008

bull Damjanov I Jukić S Nola MPatologijaMedicinska nakladaZagreb 2008

bull Kumar P Clark MClinical MedicineSaunders ElsevierLondon2007

bull wwwcancerorgbull wwwcancergov

Two parts of BSE

1) Visual

2) Palpatory

bull Examine each breast separately

bull Use pads of middle three fingers feel the texture

bull Examine the armpits

Patterns

Visual

17

Most common Lump or thickening in breastOften painless

Change in color or appearance of areola

Redness or pitting of skin over the breast like the skin of an orange

Discharge or bleeding

Change in size or contours of breast

Abnormal Breast ChangesAbnormal Breast ChangesChanges in breast size of

shape Lump in the breast

Changes in the skin of the breastNipple discharged or tenderness

TREATMENT OPTIONSTREATMENT OPTIONS amp amp PROGNOSISPROGNOSIS

bull Depend on

ndash Size of the tumor

ndash Invasive or in situ

ndash Histologic type - ductal (85) vs lobular

ndash Estrogenprogesterone receptors (60-70positive)ndash Her-2 neu status (receptor for epidermal growth f)

SURVIVAL

tm size increases-

chance decreases

ndash Lymph node status

ndash Spread to other parts of the body (bones liver lung brain)ndash Age (premenopausal = poor prognostic factor)

TREATMENT TREATMENT

bull Surgery

bull Radiation Therapy (local)

bull Chemotherapy (systemic)

bull Hormonal Therapy (systemic)

bull Immunotherapy

1048708 Therapy is individualized

GoalsCure Control Palliation

SURGERY

bull Mastectomy (completeradical)

bull Breast

conservation (partial)

RECONSTRUCTION

RADIATION THERAPY

Local control of disease

Indicationsbull Adjuvant (after partial mastectomy)

bull Young patients with DCIS

bull High risk of local recurrence

bull High energy rays used to kill cancer cells

CHEMOTHERAPYAnticancer drugs = systemic control of disease

Indications

bull After surgery to reduce risk of recurrence

bull Large + locally advanced cancer to reduce the size prior to surgery (neoadjuvant)

bull Metastatic - to reduce cancer that has spread + relieve symptoms amp prolong life

HORMONAL THERAPYbull Hormones (blood stream) rarr attach ca

cells promote their growth

bull Block the receptor or production of hormones

bull Side effects hot flashes depression

uarr risk of uterine cancer induced manopause blood clots

bull Tamoxifen aromatase inhibitors

Monoclonal antibodies

bull TrastuzumabHerceptin

bull Patients whose cancer cells

over-express Her-2-neu oncogene as measured by IHC or FISH (25 to 30 of

patients)

IMMUNOTHERAPY

bull Through early detection and improved treatments more women than ever are surviving breast cancer

Questions

THANK YOU FOR YOUR ATTENTIONTHANK YOU FOR YOUR ATTENTION

References

bull Kusić ZOnkologijaZagreb2008

bull Damjanov I Jukić S Nola MPatologijaMedicinska nakladaZagreb 2008

bull Kumar P Clark MClinical MedicineSaunders ElsevierLondon2007

bull wwwcancerorgbull wwwcancergov

Patterns

Visual

17

Most common Lump or thickening in breastOften painless

Change in color or appearance of areola

Redness or pitting of skin over the breast like the skin of an orange

Discharge or bleeding

Change in size or contours of breast

Abnormal Breast ChangesAbnormal Breast ChangesChanges in breast size of

shape Lump in the breast

Changes in the skin of the breastNipple discharged or tenderness

TREATMENT OPTIONSTREATMENT OPTIONS amp amp PROGNOSISPROGNOSIS

bull Depend on

ndash Size of the tumor

ndash Invasive or in situ

ndash Histologic type - ductal (85) vs lobular

ndash Estrogenprogesterone receptors (60-70positive)ndash Her-2 neu status (receptor for epidermal growth f)

SURVIVAL

tm size increases-

chance decreases

ndash Lymph node status

ndash Spread to other parts of the body (bones liver lung brain)ndash Age (premenopausal = poor prognostic factor)

TREATMENT TREATMENT

bull Surgery

bull Radiation Therapy (local)

bull Chemotherapy (systemic)

bull Hormonal Therapy (systemic)

bull Immunotherapy

1048708 Therapy is individualized

GoalsCure Control Palliation

SURGERY

bull Mastectomy (completeradical)

bull Breast

conservation (partial)

RECONSTRUCTION

RADIATION THERAPY

Local control of disease

Indicationsbull Adjuvant (after partial mastectomy)

bull Young patients with DCIS

bull High risk of local recurrence

bull High energy rays used to kill cancer cells

CHEMOTHERAPYAnticancer drugs = systemic control of disease

Indications

bull After surgery to reduce risk of recurrence

bull Large + locally advanced cancer to reduce the size prior to surgery (neoadjuvant)

bull Metastatic - to reduce cancer that has spread + relieve symptoms amp prolong life

HORMONAL THERAPYbull Hormones (blood stream) rarr attach ca

cells promote their growth

bull Block the receptor or production of hormones

bull Side effects hot flashes depression

uarr risk of uterine cancer induced manopause blood clots

bull Tamoxifen aromatase inhibitors

Monoclonal antibodies

bull TrastuzumabHerceptin

bull Patients whose cancer cells

over-express Her-2-neu oncogene as measured by IHC or FISH (25 to 30 of

patients)

IMMUNOTHERAPY

bull Through early detection and improved treatments more women than ever are surviving breast cancer

Questions

THANK YOU FOR YOUR ATTENTIONTHANK YOU FOR YOUR ATTENTION

References

bull Kusić ZOnkologijaZagreb2008

bull Damjanov I Jukić S Nola MPatologijaMedicinska nakladaZagreb 2008

bull Kumar P Clark MClinical MedicineSaunders ElsevierLondon2007

bull wwwcancerorgbull wwwcancergov

Visual

17

Most common Lump or thickening in breastOften painless

Change in color or appearance of areola

Redness or pitting of skin over the breast like the skin of an orange

Discharge or bleeding

Change in size or contours of breast

Abnormal Breast ChangesAbnormal Breast ChangesChanges in breast size of

shape Lump in the breast

Changes in the skin of the breastNipple discharged or tenderness

TREATMENT OPTIONSTREATMENT OPTIONS amp amp PROGNOSISPROGNOSIS

bull Depend on

ndash Size of the tumor

ndash Invasive or in situ

ndash Histologic type - ductal (85) vs lobular

ndash Estrogenprogesterone receptors (60-70positive)ndash Her-2 neu status (receptor for epidermal growth f)

SURVIVAL

tm size increases-

chance decreases

ndash Lymph node status

ndash Spread to other parts of the body (bones liver lung brain)ndash Age (premenopausal = poor prognostic factor)

TREATMENT TREATMENT

bull Surgery

bull Radiation Therapy (local)

bull Chemotherapy (systemic)

bull Hormonal Therapy (systemic)

bull Immunotherapy

1048708 Therapy is individualized

GoalsCure Control Palliation

SURGERY

bull Mastectomy (completeradical)

bull Breast

conservation (partial)

RECONSTRUCTION

RADIATION THERAPY

Local control of disease

Indicationsbull Adjuvant (after partial mastectomy)

bull Young patients with DCIS

bull High risk of local recurrence

bull High energy rays used to kill cancer cells

CHEMOTHERAPYAnticancer drugs = systemic control of disease

Indications

bull After surgery to reduce risk of recurrence

bull Large + locally advanced cancer to reduce the size prior to surgery (neoadjuvant)

bull Metastatic - to reduce cancer that has spread + relieve symptoms amp prolong life

HORMONAL THERAPYbull Hormones (blood stream) rarr attach ca

cells promote their growth

bull Block the receptor or production of hormones

bull Side effects hot flashes depression

uarr risk of uterine cancer induced manopause blood clots

bull Tamoxifen aromatase inhibitors

Monoclonal antibodies

bull TrastuzumabHerceptin

bull Patients whose cancer cells

over-express Her-2-neu oncogene as measured by IHC or FISH (25 to 30 of

patients)

IMMUNOTHERAPY

bull Through early detection and improved treatments more women than ever are surviving breast cancer

Questions

THANK YOU FOR YOUR ATTENTIONTHANK YOU FOR YOUR ATTENTION

References

bull Kusić ZOnkologijaZagreb2008

bull Damjanov I Jukić S Nola MPatologijaMedicinska nakladaZagreb 2008

bull Kumar P Clark MClinical MedicineSaunders ElsevierLondon2007

bull wwwcancerorgbull wwwcancergov

Abnormal Breast ChangesAbnormal Breast ChangesChanges in breast size of

shape Lump in the breast

Changes in the skin of the breastNipple discharged or tenderness

TREATMENT OPTIONSTREATMENT OPTIONS amp amp PROGNOSISPROGNOSIS

bull Depend on

ndash Size of the tumor

ndash Invasive or in situ

ndash Histologic type - ductal (85) vs lobular

ndash Estrogenprogesterone receptors (60-70positive)ndash Her-2 neu status (receptor for epidermal growth f)

SURVIVAL

tm size increases-

chance decreases

ndash Lymph node status

ndash Spread to other parts of the body (bones liver lung brain)ndash Age (premenopausal = poor prognostic factor)

TREATMENT TREATMENT

bull Surgery

bull Radiation Therapy (local)

bull Chemotherapy (systemic)

bull Hormonal Therapy (systemic)

bull Immunotherapy

1048708 Therapy is individualized

GoalsCure Control Palliation

SURGERY

bull Mastectomy (completeradical)

bull Breast

conservation (partial)

RECONSTRUCTION

RADIATION THERAPY

Local control of disease

Indicationsbull Adjuvant (after partial mastectomy)

bull Young patients with DCIS

bull High risk of local recurrence

bull High energy rays used to kill cancer cells

CHEMOTHERAPYAnticancer drugs = systemic control of disease

Indications

bull After surgery to reduce risk of recurrence

bull Large + locally advanced cancer to reduce the size prior to surgery (neoadjuvant)

bull Metastatic - to reduce cancer that has spread + relieve symptoms amp prolong life

HORMONAL THERAPYbull Hormones (blood stream) rarr attach ca

cells promote their growth

bull Block the receptor or production of hormones

bull Side effects hot flashes depression

uarr risk of uterine cancer induced manopause blood clots

bull Tamoxifen aromatase inhibitors

Monoclonal antibodies

bull TrastuzumabHerceptin

bull Patients whose cancer cells

over-express Her-2-neu oncogene as measured by IHC or FISH (25 to 30 of

patients)

IMMUNOTHERAPY

bull Through early detection and improved treatments more women than ever are surviving breast cancer

Questions

THANK YOU FOR YOUR ATTENTIONTHANK YOU FOR YOUR ATTENTION

References

bull Kusić ZOnkologijaZagreb2008

bull Damjanov I Jukić S Nola MPatologijaMedicinska nakladaZagreb 2008

bull Kumar P Clark MClinical MedicineSaunders ElsevierLondon2007

bull wwwcancerorgbull wwwcancergov

TREATMENT OPTIONSTREATMENT OPTIONS amp amp PROGNOSISPROGNOSIS

bull Depend on

ndash Size of the tumor

ndash Invasive or in situ

ndash Histologic type - ductal (85) vs lobular

ndash Estrogenprogesterone receptors (60-70positive)ndash Her-2 neu status (receptor for epidermal growth f)

SURVIVAL

tm size increases-

chance decreases

ndash Lymph node status

ndash Spread to other parts of the body (bones liver lung brain)ndash Age (premenopausal = poor prognostic factor)

TREATMENT TREATMENT

bull Surgery

bull Radiation Therapy (local)

bull Chemotherapy (systemic)

bull Hormonal Therapy (systemic)

bull Immunotherapy

1048708 Therapy is individualized

GoalsCure Control Palliation

SURGERY

bull Mastectomy (completeradical)

bull Breast

conservation (partial)

RECONSTRUCTION

RADIATION THERAPY

Local control of disease

Indicationsbull Adjuvant (after partial mastectomy)

bull Young patients with DCIS

bull High risk of local recurrence

bull High energy rays used to kill cancer cells

CHEMOTHERAPYAnticancer drugs = systemic control of disease

Indications

bull After surgery to reduce risk of recurrence

bull Large + locally advanced cancer to reduce the size prior to surgery (neoadjuvant)

bull Metastatic - to reduce cancer that has spread + relieve symptoms amp prolong life

HORMONAL THERAPYbull Hormones (blood stream) rarr attach ca

cells promote their growth

bull Block the receptor or production of hormones

bull Side effects hot flashes depression

uarr risk of uterine cancer induced manopause blood clots

bull Tamoxifen aromatase inhibitors

Monoclonal antibodies

bull TrastuzumabHerceptin

bull Patients whose cancer cells

over-express Her-2-neu oncogene as measured by IHC or FISH (25 to 30 of

patients)

IMMUNOTHERAPY

bull Through early detection and improved treatments more women than ever are surviving breast cancer

Questions

THANK YOU FOR YOUR ATTENTIONTHANK YOU FOR YOUR ATTENTION

References

bull Kusić ZOnkologijaZagreb2008

bull Damjanov I Jukić S Nola MPatologijaMedicinska nakladaZagreb 2008

bull Kumar P Clark MClinical MedicineSaunders ElsevierLondon2007

bull wwwcancerorgbull wwwcancergov

ndash Lymph node status

ndash Spread to other parts of the body (bones liver lung brain)ndash Age (premenopausal = poor prognostic factor)

TREATMENT TREATMENT

bull Surgery

bull Radiation Therapy (local)

bull Chemotherapy (systemic)

bull Hormonal Therapy (systemic)

bull Immunotherapy

1048708 Therapy is individualized

GoalsCure Control Palliation

SURGERY

bull Mastectomy (completeradical)

bull Breast

conservation (partial)

RECONSTRUCTION

RADIATION THERAPY

Local control of disease

Indicationsbull Adjuvant (after partial mastectomy)

bull Young patients with DCIS

bull High risk of local recurrence

bull High energy rays used to kill cancer cells

CHEMOTHERAPYAnticancer drugs = systemic control of disease

Indications

bull After surgery to reduce risk of recurrence

bull Large + locally advanced cancer to reduce the size prior to surgery (neoadjuvant)

bull Metastatic - to reduce cancer that has spread + relieve symptoms amp prolong life

HORMONAL THERAPYbull Hormones (blood stream) rarr attach ca

cells promote their growth

bull Block the receptor or production of hormones

bull Side effects hot flashes depression

uarr risk of uterine cancer induced manopause blood clots

bull Tamoxifen aromatase inhibitors

Monoclonal antibodies

bull TrastuzumabHerceptin

bull Patients whose cancer cells

over-express Her-2-neu oncogene as measured by IHC or FISH (25 to 30 of

patients)

IMMUNOTHERAPY

bull Through early detection and improved treatments more women than ever are surviving breast cancer

Questions

THANK YOU FOR YOUR ATTENTIONTHANK YOU FOR YOUR ATTENTION

References

bull Kusić ZOnkologijaZagreb2008

bull Damjanov I Jukić S Nola MPatologijaMedicinska nakladaZagreb 2008

bull Kumar P Clark MClinical MedicineSaunders ElsevierLondon2007

bull wwwcancerorgbull wwwcancergov

TREATMENT TREATMENT

bull Surgery

bull Radiation Therapy (local)

bull Chemotherapy (systemic)

bull Hormonal Therapy (systemic)

bull Immunotherapy

1048708 Therapy is individualized

GoalsCure Control Palliation

SURGERY

bull Mastectomy (completeradical)

bull Breast

conservation (partial)

RECONSTRUCTION

RADIATION THERAPY

Local control of disease

Indicationsbull Adjuvant (after partial mastectomy)

bull Young patients with DCIS

bull High risk of local recurrence

bull High energy rays used to kill cancer cells

CHEMOTHERAPYAnticancer drugs = systemic control of disease

Indications

bull After surgery to reduce risk of recurrence

bull Large + locally advanced cancer to reduce the size prior to surgery (neoadjuvant)

bull Metastatic - to reduce cancer that has spread + relieve symptoms amp prolong life

HORMONAL THERAPYbull Hormones (blood stream) rarr attach ca

cells promote their growth

bull Block the receptor or production of hormones

bull Side effects hot flashes depression

uarr risk of uterine cancer induced manopause blood clots

bull Tamoxifen aromatase inhibitors

Monoclonal antibodies

bull TrastuzumabHerceptin

bull Patients whose cancer cells

over-express Her-2-neu oncogene as measured by IHC or FISH (25 to 30 of

patients)

IMMUNOTHERAPY

bull Through early detection and improved treatments more women than ever are surviving breast cancer

Questions

THANK YOU FOR YOUR ATTENTIONTHANK YOU FOR YOUR ATTENTION

References

bull Kusić ZOnkologijaZagreb2008

bull Damjanov I Jukić S Nola MPatologijaMedicinska nakladaZagreb 2008

bull Kumar P Clark MClinical MedicineSaunders ElsevierLondon2007

bull wwwcancerorgbull wwwcancergov

SURGERY

bull Mastectomy (completeradical)

bull Breast

conservation (partial)

RECONSTRUCTION

RADIATION THERAPY

Local control of disease

Indicationsbull Adjuvant (after partial mastectomy)

bull Young patients with DCIS

bull High risk of local recurrence

bull High energy rays used to kill cancer cells

CHEMOTHERAPYAnticancer drugs = systemic control of disease

Indications

bull After surgery to reduce risk of recurrence

bull Large + locally advanced cancer to reduce the size prior to surgery (neoadjuvant)

bull Metastatic - to reduce cancer that has spread + relieve symptoms amp prolong life

HORMONAL THERAPYbull Hormones (blood stream) rarr attach ca

cells promote their growth

bull Block the receptor or production of hormones

bull Side effects hot flashes depression

uarr risk of uterine cancer induced manopause blood clots

bull Tamoxifen aromatase inhibitors

Monoclonal antibodies

bull TrastuzumabHerceptin

bull Patients whose cancer cells

over-express Her-2-neu oncogene as measured by IHC or FISH (25 to 30 of

patients)

IMMUNOTHERAPY

bull Through early detection and improved treatments more women than ever are surviving breast cancer

Questions

THANK YOU FOR YOUR ATTENTIONTHANK YOU FOR YOUR ATTENTION

References

bull Kusić ZOnkologijaZagreb2008

bull Damjanov I Jukić S Nola MPatologijaMedicinska nakladaZagreb 2008

bull Kumar P Clark MClinical MedicineSaunders ElsevierLondon2007

bull wwwcancerorgbull wwwcancergov

RECONSTRUCTION

RADIATION THERAPY

Local control of disease

Indicationsbull Adjuvant (after partial mastectomy)

bull Young patients with DCIS

bull High risk of local recurrence

bull High energy rays used to kill cancer cells

CHEMOTHERAPYAnticancer drugs = systemic control of disease

Indications

bull After surgery to reduce risk of recurrence

bull Large + locally advanced cancer to reduce the size prior to surgery (neoadjuvant)

bull Metastatic - to reduce cancer that has spread + relieve symptoms amp prolong life

HORMONAL THERAPYbull Hormones (blood stream) rarr attach ca

cells promote their growth

bull Block the receptor or production of hormones

bull Side effects hot flashes depression

uarr risk of uterine cancer induced manopause blood clots

bull Tamoxifen aromatase inhibitors

Monoclonal antibodies

bull TrastuzumabHerceptin

bull Patients whose cancer cells

over-express Her-2-neu oncogene as measured by IHC or FISH (25 to 30 of

patients)

IMMUNOTHERAPY

bull Through early detection and improved treatments more women than ever are surviving breast cancer

Questions

THANK YOU FOR YOUR ATTENTIONTHANK YOU FOR YOUR ATTENTION

References

bull Kusić ZOnkologijaZagreb2008

bull Damjanov I Jukić S Nola MPatologijaMedicinska nakladaZagreb 2008

bull Kumar P Clark MClinical MedicineSaunders ElsevierLondon2007

bull wwwcancerorgbull wwwcancergov

RADIATION THERAPY

Local control of disease

Indicationsbull Adjuvant (after partial mastectomy)

bull Young patients with DCIS

bull High risk of local recurrence

bull High energy rays used to kill cancer cells

CHEMOTHERAPYAnticancer drugs = systemic control of disease

Indications

bull After surgery to reduce risk of recurrence

bull Large + locally advanced cancer to reduce the size prior to surgery (neoadjuvant)

bull Metastatic - to reduce cancer that has spread + relieve symptoms amp prolong life

HORMONAL THERAPYbull Hormones (blood stream) rarr attach ca

cells promote their growth

bull Block the receptor or production of hormones

bull Side effects hot flashes depression

uarr risk of uterine cancer induced manopause blood clots

bull Tamoxifen aromatase inhibitors

Monoclonal antibodies

bull TrastuzumabHerceptin

bull Patients whose cancer cells

over-express Her-2-neu oncogene as measured by IHC or FISH (25 to 30 of

patients)

IMMUNOTHERAPY

bull Through early detection and improved treatments more women than ever are surviving breast cancer

Questions

THANK YOU FOR YOUR ATTENTIONTHANK YOU FOR YOUR ATTENTION

References

bull Kusić ZOnkologijaZagreb2008

bull Damjanov I Jukić S Nola MPatologijaMedicinska nakladaZagreb 2008

bull Kumar P Clark MClinical MedicineSaunders ElsevierLondon2007

bull wwwcancerorgbull wwwcancergov

CHEMOTHERAPYAnticancer drugs = systemic control of disease

Indications

bull After surgery to reduce risk of recurrence

bull Large + locally advanced cancer to reduce the size prior to surgery (neoadjuvant)

bull Metastatic - to reduce cancer that has spread + relieve symptoms amp prolong life

HORMONAL THERAPYbull Hormones (blood stream) rarr attach ca

cells promote their growth

bull Block the receptor or production of hormones

bull Side effects hot flashes depression

uarr risk of uterine cancer induced manopause blood clots

bull Tamoxifen aromatase inhibitors

Monoclonal antibodies

bull TrastuzumabHerceptin

bull Patients whose cancer cells

over-express Her-2-neu oncogene as measured by IHC or FISH (25 to 30 of

patients)

IMMUNOTHERAPY

bull Through early detection and improved treatments more women than ever are surviving breast cancer

Questions

THANK YOU FOR YOUR ATTENTIONTHANK YOU FOR YOUR ATTENTION

References

bull Kusić ZOnkologijaZagreb2008

bull Damjanov I Jukić S Nola MPatologijaMedicinska nakladaZagreb 2008

bull Kumar P Clark MClinical MedicineSaunders ElsevierLondon2007

bull wwwcancerorgbull wwwcancergov

HORMONAL THERAPYbull Hormones (blood stream) rarr attach ca

cells promote their growth

bull Block the receptor or production of hormones

bull Side effects hot flashes depression

uarr risk of uterine cancer induced manopause blood clots

bull Tamoxifen aromatase inhibitors

Monoclonal antibodies

bull TrastuzumabHerceptin

bull Patients whose cancer cells

over-express Her-2-neu oncogene as measured by IHC or FISH (25 to 30 of

patients)

IMMUNOTHERAPY

bull Through early detection and improved treatments more women than ever are surviving breast cancer

Questions

THANK YOU FOR YOUR ATTENTIONTHANK YOU FOR YOUR ATTENTION

References

bull Kusić ZOnkologijaZagreb2008

bull Damjanov I Jukić S Nola MPatologijaMedicinska nakladaZagreb 2008

bull Kumar P Clark MClinical MedicineSaunders ElsevierLondon2007

bull wwwcancerorgbull wwwcancergov

Monoclonal antibodies

bull TrastuzumabHerceptin

bull Patients whose cancer cells

over-express Her-2-neu oncogene as measured by IHC or FISH (25 to 30 of

patients)

IMMUNOTHERAPY

bull Through early detection and improved treatments more women than ever are surviving breast cancer

Questions

THANK YOU FOR YOUR ATTENTIONTHANK YOU FOR YOUR ATTENTION

References

bull Kusić ZOnkologijaZagreb2008

bull Damjanov I Jukić S Nola MPatologijaMedicinska nakladaZagreb 2008

bull Kumar P Clark MClinical MedicineSaunders ElsevierLondon2007

bull wwwcancerorgbull wwwcancergov

bull Through early detection and improved treatments more women than ever are surviving breast cancer

Questions

THANK YOU FOR YOUR ATTENTIONTHANK YOU FOR YOUR ATTENTION

References

bull Kusić ZOnkologijaZagreb2008

bull Damjanov I Jukić S Nola MPatologijaMedicinska nakladaZagreb 2008

bull Kumar P Clark MClinical MedicineSaunders ElsevierLondon2007

bull wwwcancerorgbull wwwcancergov

Questions

THANK YOU FOR YOUR ATTENTIONTHANK YOU FOR YOUR ATTENTION

References

bull Kusić ZOnkologijaZagreb2008

bull Damjanov I Jukić S Nola MPatologijaMedicinska nakladaZagreb 2008

bull Kumar P Clark MClinical MedicineSaunders ElsevierLondon2007

bull wwwcancerorgbull wwwcancergov

References

bull Kusić ZOnkologijaZagreb2008

bull Damjanov I Jukić S Nola MPatologijaMedicinska nakladaZagreb 2008

bull Kumar P Clark MClinical MedicineSaunders ElsevierLondon2007

bull wwwcancerorgbull wwwcancergov