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CANCER
Options available :
Surgery
Radiotherapy
Hormone Therapy
Chemotherapy
SURGICAL APPROACHES
Total (Simple)
Mastectomy
Total Mastectomy with
Axillary Clearance
Modified Radical
Mastectomy [MRM]
1. Pateys Operation
2. Scanlons Operation
3. Auchincloss MRM
Radical Mastectomy of
Halsted
Conservative Breast
Surgeries
1. Wide Local Excision
[WLE]
2. Lumpectomy
3. Quadrantectomy
4. Toilet Mastectomy
5. Skin-Sparing/Keyhole
Mastectomy [SSM]
1. Total (Simple)
Mastectomy
Tissues removed:
Tumor, entire breast,
areola, nipple, skin
over
breast, Axillary tail of
Spence, Pectoral fascia
Tissues retained:
NO axillary dissection
Subjected to
radiotherapy later
3. Modified Radical
Mastectomy
1) Pateys Operation
) Tissues removed:
TM + Clearance of Level
I,
II & III Axillary LN +
Pectoralis minor
) Tissues preserved:
Nerve to Serratus
anterior,
Nerve to Latissimus
dorsi,
Intercostobrachial nerve,
4. Radical Mastectomy of
Halsted
Tissues removed:
Tumor, entire breast, areola, nipple, skin over
tumour,
Pectoralis major & minor muscles, fat, fascia,
Level I, II, III
Axillary LN, few digitations of Serratus anterior
muscle
Tissues retained:
Axillary vein
Bells nerve (N.to Serr.ant)
Cephalic vein
Complications:
5. Breast Conservative
Surgeries
Wide Local Excision (WLE)/ Partial Mastectom
Removal of unicentric tumour with 1cm clearance
margin.
Incision : Over tumour + Axillary
Dissection + RT
Quadrantectomy
Removal of entire quadrant with ductal system with
2-3cm normal
breast tissue clearance.
Part of QUART Therapy (Quadrantectomy + Axillary
dissection + RT)
Not advocated now.
RADIOTHERAPY APPROACH
Indications :
1. Conservative Breast Surgery adjuvant [Breast]
2. Total Mastectomy [Axilla]
3. High-risk of relapse patients
1) Invasive Carcinoma
2) Extensive in-situ Carcinoma
3) Age < 35 years
4) Multifocal disease
HORMONE THERAPY
APPROACH
Principles :
Used in ER/PR +ve patients only
All age groups included now
Relatively safe
Easy to administer
Adequate prophylaxis against Ca of opposite
breast
Useful in Metastatic Carcinoma
Reduces recurrence improves quality of life
and longevity
iv.
Aminoglutethimide
[Medical Adrenalectomy]
Androgens
inj.Testosterone
propionate 100mg IM three
times a week,
Fluoxymestrone 30 mg
daily
Surgical
i.
Ovarian Ablation by
a. Surgery (Bilateral
Oophorectomy)
b. Radiation
ii. Adrenalectomy
iii. Pituitary ablation
CHEMOTHERAPY APPROACH
Types :
A.Adjuvant Chemotherapy
Administration of Cytotoxics after surgery
Eliminate clinically undetectable distant spread
B. Neoadjuvant Chemotherapy
Administration of Cytotoxics in large operable tumours
before surgery
Reduce loco-regional tumour burden downstage
Amenable to surgical resection after 3 doses
C. Palliative Chemotherapy
Advanced Ca Breast
Metastatic Ca Breast
CHEMOTHERAPY APPROACH
(1)
Indications :
All node +ve patients
Primary tumour >1cm in size
Poor prognostic factors
Advanced Ca Breast
Inflammatory Ca Breast
Metastatic Ca Breast
Drugs :
CMF Regime
CAF Regime
MMM Regime
Cyclophosphamide
Cyclophosphamide
Methotrexate
Methotrexate
Adriamycin
Mitomycin-C
5-Fluorouracil
5-Fluorouracil
Mitozantrone
THANK YOU