You are on page 1of 12

BREAST DISORDERS PART II  Trends since 1950 in age-standardized death rates comparing breast and

BREAST CANCER AND RECONSTRUCTION selected other types of cancer, among women in the USA
IWAN IRAWAN K
Early detection

 Health history can affect the risk of developing breast cancer.
 Anything that increases your chance of getting a disease is called a risk
factor. Having a risk factor does not mean that you will get cancer; not
having risk factors doesn't mean that you will not get cancer. Talk with your
doctor if you think you may be at risk. Risk factors for breast cancer include BREAST CANCER IN THE WORLD
the following:  1.15 million new cases
 A family history (first-degree relative, such as mother, daughter, or sister) of  Incidence increasing in most countries
breast cancer.  470 000 deaths
 Inherited changes in the BRCA1 and BRCA2 genes or in other genes that  Half of the global burden in low- and medium-resourced countries
increase the risk of breast cancer.  Indonesia : 1. Cervix Ca. 2. Breast Ca
 Drinking alcoholic beverages.
 Breast tissue that is dense on a mammogram.
 Estrogen (made in the body) Menstruating at an early age.
 Older age at first birth or never having given birth.
 Taking hormones such as estrogen combined with progestin for symptoms
of menopause.
 Taking oral contraceptives ("the pill").
 Obesity.
 Not getting enough exercise.
 A personal history of invasive breast cancer, ductal carcinoma in situ (DCIS),
or lobular carcinoma in situ (LCIS).
 A personal history of benign (noncancer) breast disease.
 Being white.
 Treatment with radiation therapy to the breast/chest.
How breast cancer is:
 Detected
 Diagnosed
 Treated
Breast Cancer
 Breast cancer is second only to lung cancer as a cause of cancer deaths in
American women Noncancerous Conditions

 One out of every eight women will be diagnosed with breast cancer in 2011  Fibrocystic changes: Lumpiness, thickening and swelling, often associated

 Fortunately, radical mastectomy (surgical removal) is rarely needed today with a woman’s period

with better treatment options  Cysts: Fluid-filled lumps can range from very tiny to about the size of an
egg
 Fibroadenomas: A solid, round, rubbery lump that moves under skin when
touched, occuring most in young women
 Infections: The breast will likely be red, warm, tender and lumpy
 Trauma: a blow to the breast or a bruise can cause a lump
 Microcalcifications: Tiny deposits of calcium can appear anywhere in a
breast and often show up on a mammogram
o Most women have one or more areas of microcalcifications of
various sizes
o Majority of calcium deposits are harmless
o A small percentage may be precancerous or cancer (biopsy is
sometimes recommended)

but cancer may also occur in the lobules or in other breast tissue  (often early age at onset. to the lymph or to other parts of the body  Male breast cancer (metastasize) BRCA1-Associated Cancers:Lifetime Risk  The most common type of breast cancer begins in the milk-production  Breast cancer 50%-85% ducts. and adrenocortical adenomas  Identify early detection marker  *Cowden’s Syndrome.C aus e s  Breast and ovarian cancer in the same woman  Some of the cells begin growing abnormally  Bilateral breast cancer  These cells divide more rapidly than healthy cells do and may spread  Ashkenazi Jewish heritage through the breast. abnormal TP53 gene on chromosome 17p. prostate. gastrointestinal malignancies. childhood sarcomas.g. abnormal PTEN tumor suppressor gene on Molecular Portrait of Breast Cancers chromosome 10 associated with premenopausal breast cancers. colon) Potential Applications forBreast Cancer Biology  Predict risk of cancer development  Estimate prognosis for established cancer  Predict response to therapy  Identify therapeutic targets  Identify early detection markers Family history as a risk factor-Hereditary Breast and Ovarian Cancer Established Prognostic Markers for Breast Cancer  Axillary lymph nodes Causes of Hereditary Susceptibility to Breast Cancer  Tumor size  Histological grade  Histological tumor type  Steroid receptor status  Age Potential Applications forBreast Cancer Biology  Predict risk of cancer development  Estimate prognosis for established cancer  Li-Fraumeni Syndrome. brain  Identify therapeutic targets tumors.  Predict response to therapy associated with premenopausal breast cancer. and benign and malignant Features That Indicate Increased Likelihood of Having BRCA Mutations  Multiple cases of early onset breast cancer  Ovarian cancer (with family history of breast or ovarian cancer) . leukemia. less than 40 years) Factors determining risk of developing Breast Cancer’  Second primary breast cancer 40%-60%  Ovarian cancer 15%-45%  Possible increased risk of other cancers (e.

insertions. frame shifts-25-30%  p53. HOXs.  Overexpression of oncogenes. NEJM 2004. SABCS The Estrogen Receptors 2004) Candidate Gene Selection From ~40.000 genes Activation of Estrogen Receptor Three Breast Cancer Studies Used to Select 16 Cancer and 5 Reference Genes  Her-2 overexpression in breast cancer. Nature 2002) of promoter sequences  Subset outcomes for women with node-negative  microRNAs and long noncoding RNAs. or methylation (van’t Veer. syk.by deletion.emerging players  ER-positive breast cancer treated with tamoxifen (Paik.1985-1998 Three Breast Cancer Studies Used to Develop Recurrence Score (RS) Algorithm  About 20-30% of breast cancers overexpress HER-2 protein (usually because of gene amplification)  Monotherapy with anti-HER-2 monoclonal antibody (trastuzumab or Herceptin) has a 30% response rate in HER-2-positive metastatic breast cancer .  PI3KCA single point mutations. 50% inclusive of intronic mutations Applications of Expression Microarrays in Predicting Response to Therapy  Other genes with less than 5% incidence of mutations  Different profile of sporadic vs hereditary breast cancer (Heldenfalk.  Combination of trastuzumab plus chemotherapy improves time to progression and overall survival in advanced HER-2 positive breast cancer  Trastuzumab plus anthracycline results in a 20% incidence of cardiotoxicity Potential Applications for Breast Cancer Biology  Predict risk of cancer development  Estimate prognosis for established cancer  Predict response to therapy  Identify therapeutic targets  Identify early detection markers The EGFR (ErbB) family and ligands Subtypes and Prognosis Potential Applications for Breast Cancer Biology  Predict risk of cancer development  Estimate prognosis for established cancer  Predict response to therapy  Identify therapeutic targets  Identify early detection markers Common molecular alterations in breast cancer  Mutations. TKs  Identify subset of young women with poor prognosis early breast cancer  Loss of expression of tumor suppressor genes.by amplification or transcriptional NEJM 2001) deregulation ex. Myc.Around 15-25%.Very rare compared to colon ca.

Intermediate recurrence score means: Clear benefit from tamoxifen Uncertain benefit from chemotherapy Detection of Malignant Masses  Malignant masses have a more spiculated appearance High recurrence score means:No benefit from tamoxifen Clear benefit from chemotherapy Malignant benign Difficult case  Heterogeneously dense breast  Cancer can be difficult to detect with this type of breast tissue  The fibroglandular tissue (white areas) may hide the tumor  The breasts of younger women contain more glands and ligaments resulting in dense breast tissue Potential Applications forBreast Cancer Biology  Predict risk of cancer development  Estimate prognosis for establishecancer  Predict response to therapy  Identify therapeutic targets How is breast cancer:  Detected  Diagnosed  Treated Mammography .  Use a low-dose x-ray system to examine breasts  Digital mammography replaces x-ray film by solid-state detectors that convert x-rays into electrical signals. These signals are used to produce images that can be displayed on a computer screen (similar to digital cameras)  Mammography can show changes in the breast up to two years before a physician can feel them Low recurrence score means:Clear benefit from tamoxifen No benefit from chemotherapy What Mammograms Show Two of the most important mammographic indicators of breat cancers o Masses o Microcalcifications: Tiny flecks of calcium – like grains of salt – in the soft tissue of the breast that can sometimes indicate an early cancer.

and brightness is injected near the tumor.Mammogram – Easier Case*  With age.  Estrogen/ Progesterone Receptor (2/3 positive) . tests are done to find out if cancer cells have spread within the breast or to other parts of the body. If cancer cells are not found. it may not be necessary to Diagnosis and Treatment remove more lymph nodes. An x-ray is  Surgical biopsy or aspiration a type of energy beam that can go through the body and onto film.  There are three ways that cancer spreads in the body. the lymph system. The information gathered from the staging process determines the stage of the disease. A very small amount of radioactive material is  Margins . A small amount of radioactive glucose (sugar) is injected into a vein.  The process used to find out whether the cancer has spread within the breast or to other parts of the body is called staging. Non-invasive . lumpectomy or mastectomy making a picture of areas inside the body. e. A radioactive substance and/or blue dye  The morphology of individual calcification. The pictures are made therapies by a computer linked to an x-ray machine. shape. dye is removed. The radioactive  Lymph Nodes . It is the first lymph node the cancer is Calcification Features likely to spread to from the tumor. The following tests and procedures may be used in the staging process:  Sentinel lymph node biopsy : The removal of the sentinel lymph node during surgery. Lobular . area. It is important to know the stage in order to plan treatment. A pathologist views the tissue under a microscope to look  Cluster features such as total area. material collects in the bones and is detected by a scanner. cancer cells. breast tissue becomes fattier and has fewer glands TESTS  Cancer is relatively easy to detect in this type of breast tissue  After breast cancer has been diagnosed. computerized  Histologic Type-Ductal (85%) vs. The sentinel lymph node is the first lymph node to receive lymphatic drainage from a tumor.  PET scan (positron emission tomography scan): A procedure to find  Her-2/ neu malignant tumor cells in the body.  Staging  CT scan (CAT scan): A procedure that makes a series of detailed pictures of  Delivery of adjuvant therapies—radiation and/or chemotherapy.  Observation (LCIS).hormonal areas inside the body. or computerized axial tomography.  Grade (estimate of the aggressiveness under microscope) . procedure is also called computed tomography. injected into a vein and travels through the bloodstream.. and the blood:  Tissue. the ducts to the lymph nodes. tomography. and the maximum value for each feature.  Bone scan : A procedure to check if there are rapidly dividing cells. taken from different angles. The substance or dye flows through the lymph  The heterogeneity of individual features characterized by the mean. The PET scanner rotates around the body and makes a picture of where glucose is being used in the body.g. such as  Size . This  Invasive vs. The first lymph node to receive the substance or standard deviation. A dye may be injected into a Tumor characteristics vein or swallowed to help the organs or tissues show up more clearly.  Patient feels a breast mass or has an abnormal radiologic screening exam  Chest x-ray : An x-ray of the organs and bones inside the chest. compactness for cancer cells. .  Cancer can spread through tissue. Malignant tumor cells show up brighter in the picture because they are more active and take up more glucose than normal cells do. The cancer spreads from where it began by growing into nearby areas. in the bone.

cancer.2 millimeter but  Stage 0 (carcinoma in situ) not larger than 2 millimeters) are found in the lymph nodes.  In stage IIB. For example. found in the lobules of the breast. No tumor is found in the breast and cancer is found in 1 to 3 axillary lymph nodes or lymph nodes near the breastbone (left panel). the tumor is 2 centimeters or smaller. cancer has formed. no tumor is found in the breast or the tumor is nodes removed during surgery and other tests. The tumor is larger than 2 centimeters but not larger than 5 centimeters and small clusters of cancer cells (larger than 0. the cancer cells in the bone are actually breast cancer cells. or  Lobular carcinoma in situ (LCIS) is a condition in which abnormal cells are  the tumor is larger than 2 centimeters but not larger than 5 centimeters. Information about LCIS is not included in this summary. abnormal cells are found in the lining of a breast duct. Stage I is divided into stages IA and IB. Lymph system.  In stage IB. The cancer spreads from where it began by getting into the blood. The metastatic tumor is the same type of cancer as the primary tumor. Cancer has not spread to the lymph nodes.2 millimeter but not larger than 2 millimeters) are found in the lymph nodes . Cancer has spread to 1 to 3 axillary lymph nodes or to the lymph nodes near the breastbone (found during a sentinel lymph node biopsy). or  larger than 5 centimeters. The abnormal cells  In stage IIA: no tumor is found in the breast or the tumor is 2 centimeters have not spread outside the duct to other tissues in the breast.  In stage IA. At lymph nodes or in the lymph nodes near the breastbone (found during a this time. small clusters of breast cancer cells (larger than 0. The cancer travels through the blood vessels to other parts of the body. the tumor is: larger than 2 centimeters but not larger than 5 centimeters.  Blood. sentinel lymph node biopsy). OR the tumor is 2 centimeters or smaller and cancer is found in 1 to 3 axillary lymph nodes or lymph nodes near the breastbone (middle panel).  Paget disease of the nipple is a condition in which abnormal cells are found in the nipple only  In stage I. Cancer (larger than 2 millimeters) is found in 1 to 3 axillary cases.2 millimeter but not larger than 2 millimeters) are found in the lymph nodes. The breast cancer stage Stage I breast cancer.2 millimeter but not larger than 2 millimeters) are found in the lymph nodes and either: no tumor is found in the breast.  The following stages are used for breast cancer:  This section describes the stages of breast cancer. In some or smaller. Small clusters of cancer cells (larger than 0.  Stage IIA breast cancer. The cancer spreads from where it began by getting into the lymph system. Small clusters of breast cancer cells (larger than 0. there is no way to know which lesions could become invasive.  There are 3 types of breast carcinoma in situ: Stage II  Ductal carcinoma in situ (DCIS) is a noninvasive condition in which  Stage II is divided into stages IIA and IIB. DCIS may become invasive cancer and spread to other tissues. OR the tumor is larger than 2 centimeters but not larger than 5 centimeters and has not spread to the lymph nodes (right panel). The disease is metastatic breast cancer. if breast cancer spreads to the bone. In stage IA. not bone cancer. This condition seldom becomes invasive Cancer has not spread to the lymph nodes. Cancer has not spread outside the breast.  Stage IIB breast cancer. or  larger than 2 centimeters but not larger than 5 centimeters. The cancer travels through the lymph vessels to other parts of the body. the tumor is 2 centimeters or smaller and has not is based on the results of testing that is done on the tumor and lymph spread outside the breast. 2 centimeters or smaller. In stage IB. or  the tumor is 2 centimeters or smaller.

Also. The redness and breast cancer.2 millimeter but not larger than 2 millimeters) are found in the lymph nodes (middle panel). Also. or o axillary lymph nodes and lymph nodes near the breastbone. Also.  stage IIIB. Cancer is o 10 or more axillary lymph nodes. cancer has spread to the skin of the breast  Cancer that has spread to the skin of the breast may also be inflammatory and the breast looks red and swollen and feels warm. lungs. See the section on Inflammatory Breast Cancer for more the lymph nodes. cancer may have spread to: most often the bones.  the tumor is larger than 5 centimeters. liver. Cancer that has spread to the skin of centimeters and cancer is found in 1 to 3 axillary lymph nodes or lymph the breast may be inflammatory breast cancer. Inflammatory breast cancer may be stage IIIB. stage IIIC. Cancer has spread to 1 to 3 axillary  For treatment. the tumor may be any size and cancer has spread to the chest wall and/or to the skin of the breast and caused swelling or an ulcer. or brain. Cancer that has spread to the skin of the breast may be inflammatory breast cancer.  the tumor is larger than 5 centimeters. or found in 4 to 9 axillary lymph nodes or in the lymph nodes near the o lymph nodes above or below the collarbone. information. nodes near the breastbone (middle panel). lungs. OR the tumor is larger than 5 centimeters and cancer is found in 1 to 3 axillary lymph nodes or lymph nodes near the breastbone (right panel).  In inflammatory breast cancer. Small clusters of breast cancer cells  Cancer that has spread to the skin of the breast may also be inflammatory (larger than 0. The tumor may be any size and cancer has spread to the chest wall and/or to the skin of the breast and caused swelling or an ulcer.  Stage IIIC breast cancer. OR to axillary lymph nodes and lymph nodes near the breastbone (right panel). Cancer may have spread to up to 9 axillary lymph nodes or the . The cancer has spread to other parts of the body. There may not be any lumps in the breast that can be felt. cancer has spread to:  no tumor is found in the breast or the tumor may be any size. stage IIIC breast cancer is divided into operable and lymph nodes or to the lymph nodes near the breastbone (found during a inoperable stage IIIC.  In stage IV. Recurrent Breast Cancer  Stage IIIB breast cancer. liver. OR the tumor is larger than 2 centimeters but not larger than 5 lymph nodes near the breastbone. cancer has spread to 10 or more axillary lymph nodes (left panel). OR the tumor is larger than 5  stage IIIC. or information.  up to 9 axillary lymph nodes. or breastbone (found during imaging tests or a physical exam). centimeters and has not spread to the lymph nodes (right panel) Cancer may have spread to the skin of the breast and caused swelling or  stage IIIA: an ulcer and/or has spread to the chest wall. cancer has spread to other organs of the body. OR to lymph nodes above or below the collarbone (middle panel). No tumor is found in the breast or the tumor may be any size and cancer is found in 4 to 9 axillary lymph nodes or lymph nodes near the breastbone (left panel). The skin of the breast may also show the dimpled appearance called peau d’orange (like the skin of an orange). most often the bones. No tumor is found in the breast or the tumor may be any size and may have spread to the chest wall and/or to the skin of the breast and caused swelling or an ulcer. (left panel). sentinel lymph node biopsy). or Inflammatory Breast Cancer  the lymph nodes near the breastbone.2 millimeter but not larger than 2 millimeters) are found in breast cancer. See the section on Inflammatory Breast Cancer for more warmth occur because the cancer cells block the lymph vessels in the skin. or brain  Stage IIIA breast cancer. OR the tumor is larger than 5 centimeters and small clusters of cancer cells (larger than 0. no tumor is found in the breast or the tumor may be any size.  Stage IV breast cancer. or stage IV.  Inflammatory breast cancer of the left breast showing peau d’orange and inverted nipple.

2. It may also be used as the drugs enter the bloodstream and can reach cancer cells throughout the neoadjuvant therapy in certain patients with early-stage HER2-positive body (systemic chemotherapy). is made mainly by the ovaries. may be treated with trastuzumab combined with chemotherapy. toxins. or a body cavity such as the abdomen. anticancer drug. PARP inhibitors are a type of targeted therapy being studied for the treatment of triple- negative breast cancer. The cancer may come back in the breast. from a single type of immune system cell.  Monoclonal antibody therapy is a cancer treatment that uses antibodies made in the laboratory. Sentinel lymph node biopsy followed by surgery Hormone-dependent breast cancer needs the hormone estrogen to grow. The antibodies attach to the substances and kill the cancer cells. A radioactive substance and/or blue dye may be used as adjuvant therapy instead of tamoxifen or after 2 or more is injected near the tumor. They may be used alone or to  Radiation therapy is a cancer treatment that uses high-energy x-rays or carry drugs. to identify and attack specific cancer cells without harming normal cells. 5. either by killing the cells or by stopping them from dividing. 3. Monoclonal antibodies may be used in combination with chemotherapy as There are two types of radiation therapy. Radiation therapy Monoclonal antibodies are given by infusion. Women taking tamoxifen normal tissue around it. should be reported to a cancer and some normal tissue around it. drugs. other types of radiation to kill cancer cells or keep them from growing. radiation therapy is used to reduce the production of hormones or block Six types of standard treatment are used: them from working. The substance or dye flows through the lymph years of tamoxifen. Hormone therapy with breast itself. The lining over the chest muscles doctor as soon as possible. After the sentinel lymph node biopsy. It may be used to cancer cells. an operation to remove the cancer but not the that has spread to other parts of the body). External radiation therapy uses a adjuvant therapy. or keep them from spreading. If tests show that the cancer been treated. machine outside the body to send radiation toward the cancer. should have a pelvic exam every year to look for any signs of cancer. or radioactive material directly to cancer cells. Some . lymphatic drainage from a tumor. 4.  Ado-trastuzumab emtansine is a monoclonal antibody linked to an the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way growth factor protein HER2. Some of the lymph nodes under the arm are usually taken out  Hormone therapy with tamoxifen is often given to patients with early and looked at under a microscope to see if they contain cancer cells. Any  Partial mastectomy: Surgery to remove the part of the breast that has vaginal bleeding. surgery.  Sentinel lymph node biopsy is the removal of the sentinel lymph node Aromatase inhibitors decrease the body's estrogen by blocking an enzyme during surgery.  Recurrent breast cancer is cancer that has recurred (come back) after it has hormones can cause certain cancers to grow. treat certain patients with HER2-positive breast cancer that has When chemotherapy is taken by mouth or injected into a vein or muscle. seeds. This procedure is also called a  Hormone therapy with an aromatase inhibitor is given to some segmental mastectomy. the cerebrospinal fluid. The first lymph node to receive the substance or aromatase inhibitors are being tested in clinical trials to compare them to dye is removed. or cells have places where hormones can attach (receptors). These antibodies can identify substances on cancer cells or normal substances that may help cancer cells grow. below the cancer may also be removed. includes the following: tamoxifen or estrogens can act on cells all over the body and may increase  Lumpectomy: Surgery to remove a tumor (lump) and a small amount of the chance of developing endometrial cancer. Internal Targeted therapy radiation therapy uses a radioactive substance sealed in needles. in the chest wall. This is called an antibody-drug conjugate. it may not be necessary to 6. an organ. which makes some breast 1. the  Targeted therapy is a type of treatment that uses drugs or other substances surgeon removes the tumor (breast-conserving surgery or mastectomy). other than menstrual bleeding. or in other parts of the body. Surgery cancers grow. It is the first lymph node the cancer is  For the treatment of early stage breast cancer. For the treatment of metastatic breast cancer. Tyrosine kinase inhibitors may be used with their action and stops cancer cells from growing. If cancer cells are not found. certain aromatase inhibitors likely to spread to from the tumor. the breast. When chemotherapy is placed directly into breast cancer. Chemotherapy  Pertuzumab is a monoclonal antibody that may be combined with  Chemotherapy is a cancer treatment that uses drugs to stop the growth of trastuzumab and chemotherapy to treat breast cancer. Monoclonal antibodies and tyrosine kinase inhibitors are two types of targeted therapies used in the treatment of breast cancer. The sentinel lymph node is the first lymph node to receive called aromatase from turning androgen into estrogen. ducts to the lymph nodes. block their growth. for cancer cells. made by glands in the body and circulated in the bloodstream. Hormones are substances other anticancer drugs as adjuvant therapy. About one-fourth of patients with breast cancer have tumors that being treated. or catheters that are placed directly into or near the cancer.  Trastuzumab is a monoclonal antibody that blocks the effects of the wires. metastasized (spread to other parts of the body). Treatment to stop the ovaries  Most patients with breast cancer have surgery to remove the cancer from from making estrogen is called ovarian ablation. It is used to The way the chemotherapy is given depends on the type and stage of the treat HER2-positive breast cancer that has spread to other parts of the cancer being treated body or recurred (come back). stages of breast cancer and those with metastatic breast cancer (cancer  Breast-conserving surgery. The hormone estrogen. Targeted therapy remove more lymph nodes. which sends growth signals to breast cancer the radiation therapy is given depends on the type and stage of the cancer cells. postmenopausal women who have hormone-dependent breast cancer. Hormone therapy  Tyrosine kinase inhibitors are targeted therapy drugs that block signals  Hormone therapy is a cancer treatment that removes hormones or blocks needed for tumors to grow. A pathologist views the tissue under a microscope to look hormone therapy with tamoxifen.

and without radiation therapy new ways of giving treatment.  A clinical trial of new targeted therapies. and Operable Stage IIIC Breast Cancer Treatment Options for Triple-Negative Breast Cancer  Treatment of stage I.  Clinical trials testing new chemotherapy and/or hormone therapy. with lymph node dissection followed by radiation therapy. including high-dose chemotherapy with stem cell transplant. including targeted therapy. the stored stem cells are  Monoclonal antibody therapy with trastuzumab combined with thawed and given back to the patient through an infusion. given. hormone therapy. Doctors have decided that. and chemotherapy. Additional therapy (chemotherapy. women should talk with their doctors about the serious side  Chemotherapy.  Clinical trials testing new anticancer drugs. and Metastatic Breast Cancer transplant does not work better than standard chemotherapy in the  Stage IIIB and inoperable stage IIIC breast cancer treatment of breast cancer. Before taking part in the following: such a trial. and new ways of giving treatment Stage IV and metastatic breast cancer  Treatment of stage IV or metastatic breast cancer may include the following:  Hormone therapy and/or chemotherapy with or without trastuzumab. effects.  Lapatinib is a tyrosine kinase inhibitor that blocks the effects of the HER2  Breast-conserving surgery to remove only the cancer and some protein and other proteins inside tumor cells. stage IIIA.  Studies have shown that high-dose chemotherapy followed by stem cell Stage IIIB. These reinfused chemotherapy. After the chemotherapy is completed. Additional therapy (chemotherapy. including death. or both) may be  Breast-conserving surgery without radiation therapy. It may be used with other surrounding breast tissue. surgery). mastectomy). and operable stage IIIC breast  Treatment of triple-negative breast cancer may include the following: cancer may include the following:  Chemotherapy followed by surgery (breast-conserving surgery.  Clinical trials of new combinations of treatments. or modified radical mastectomy) and lymph node dissection. Stage IIIA. followed by lymph node dissection and radiation drugs to treat patients with HER2-positive breast cancer that has therapy. that may be caused by high-dose chemotherapy  Chemotherapy followed by surgery (breast-conserving surgery or total mastectomy). total mastectomy. New types of treatment are being tested in clinical trials. high-dose  Treatment of stage IIIB and inoperable stage IIIC breast cancer may include chemotherapy should be tested only in clinical trials. Stem cells (immature blood cells) are removed from  Chemotherapy with or without hormone therapy. stored. the blood or bone marrow of the patient or a donor and are frozen and  Hormone therapy. . for now. progressed after treatment with trastuzumab.  Clinical trials testing breast-conserving surgery and tamoxifen with or  Clinical trials testing new anticancer drugs.  Clinical trials testing other treatments. hormone therapy. new drug combinations.  Monoclonal antibody therapy with trastuzumab and pertuzumab combined with chemotherapy. PARP inhibitor therapy is being studied for  Targeted therapy as neoadjuvant therapy (to shrink the tumor before the treatment of triple-negative breast cancer.  Antibody-drug conjugate therapy with ado-trastuzumab emtansine. Stage II. Treatment Options for Inflammatory Breast Cancer  Treatment of inflammatory breast cancer may include the following: Treatment Options for Ductal Carcinoma In Situ (DCIS)  Chemotherapy. Stage IV. hormone therapy.  Combined treatment with trastuzumab and lapatinib. with lymph node dissection followed by radiation therapy. stage II. stem cells grow into (and restore) the body’s blood cells.  Total mastectomy with or without tamoxifen.  Modified radical mastectomy with or without breast reconstruction surgery. Inoperable Stage IIIC. may cause cancer cells to die. new drug combinations. Stage I.  Radiation therapy and/or surgery for relief of pain and other symptoms.  Treatment of ductal carcinoma in situ (DCIS) may include the following:  Chemotherapy followed by surgery (breast-conserving surgery or total  Breast-conserving surgery and radiation therapy with or without tamoxifen.  Tyrosine kinase inhibitor therapy with lapatinib combined with capecitabine. or both) may be given.  Bisphosphonate drugs to reduce bone disease and pain when cancer has spread to the bone. the cancer treatment.  Adjuvant therapy (treatment given after surgery to lower the risk that  High-dose chemotherapy with stem cell transplant cancer will come back) may include the following:  High-dose chemotherapy with stem cell transplant is a way of giving high  Radiation therapy to the lymph nodes near the breast and to the chest wall doses of chemotherapy and replacing blood -forming cells destroyed by after a modified radical mastectomy.  PARP inhibitors are a type of targeted therapy that block DNA repair and  Sentinel lymph node biopsy followed by surgery.

 Antibody-drug conjugate therapy with ado-trastuzumab emtansine.  A clinical trial of PARP inhibitor therapy. radiation therapy. BREAST RECONSTRUCTION AND WOMEN’S HEALTH  Congress guaranteed universal coverage for breast reconstruction after cancer surgery in 1998. BREAST RECONSTRUCTION AND WOMEN’S HEALTH  Concerns about masking recurrence overrated. or both.  A clinical trial of trastuzumab combined with chemotherapy.  A clinical trial of combination chemotherapy with drugs that are often used to treat breast cancer and drugs that are not usually used to treat breast cancer.  Chemotherapy or hormone therapy.  Delaying reconstruction is not supported BREAST RECONSTRUCTION AND WOMEN’S HEALTH  Well proven psychological benefits of breast reconstruction for recovering mastectomy patients -Defining the “right” rate of breast reconstruction has clear policy implications for women’s health . Treatment Options for Recurrent Breast Cancer  Treatment of recurrent breast cancer (cancer that has come back after treatment) in the breast or chest wall may include the following:  Surgery (modified radical mastectomy). local recurrence mostly superficial and not hidden by reconstruction. Br Ca is mostly a systemic disease.

with large breasts  What about the elderly 2. o For wide local excision o For mastectomy  Flaps o Lat dorsi o Rectus abdominis o Free flaps Who will do it?  Breast & Cancer Surgeon AUTOGENOUS RECONSTRUCTION o Issues with timing  Pedicled TRAM flap o Numbers  Free TRAM flap o Training  DIEP Flap  Plastic Surgeon  Latissimus flap  Cosmetic Surgeon  Latissimus sparing flap  SGAP flap  IGAP flap How?  Lets have the mound  Develop the ptosis  Nipple areola reconstruction  Getting symmetry  Contralateral procedures Breast Reconstruction  The prosthesis  Who should have it  Needs expansion  When  Overinflation  How  Correct size  Who will do it  Remove the valve  What can we hope to achieve Subpectoral implant Who should have it?  It is unsuitable for women:  Everyone? 1. because the skin is unlikely to stretch o Systemic disease enough to take an implant of the correct size. o Time of operation Subpectoral implant o Pathology results  Gradual expansion o Subsequent treatments  May take 6 months When?  Operation to remove port  Primary reconstruction o One operation o Patient goes home with a breast o Full details of treatment not known  Delayed reconstruction o Can get a good comparison with an extrnal prosthesis How? Methods of reconstruction  Volume displacement  Volume replacement . who have had a radical mastectomy with the removal of the chest  Are there any disadvantages wall muscles o Costs 3. who have had radiotherapy.