METASTATIC BREAST CANCER & RECENT ADVANCES.pptx

Breast ca

1. METASTATIC BREAST CANCER & RECENT ADVANCES HOD & UNIT CHIEF : DR.R.BANUREKHA  M.S, D.G.O PRESENTOR : HEMALATHA L 

2. METASTATIC  BREAST CANCER STAGE IV: ANY T, ANY N, M1 SPREAD OF BREAST CANCER TO ANOTHER PART OF THE BODY M1- DISTANT DETECTABLE METASTASES AS DETERMINED BY CLASSIC CLINICAL RADIOGRAPHIC MEANS AND/OR HISTOLOGICALLY PROVEN LARGER THAN 0.2MM

3. TREATMENT FOR STAGE IV BREAST CANCER IS AIMED AT                             PALLIATING SYMPTOMS                            IMPROVING QUALITY OF LIFE                            ATTEMPTING TO PROLONG LIFE BUT NOT CURATIVE     

4. MODE OF SPREAD LYMPHATIC SPREAD  HEMATOGENOUS SPREAD 

5. SITES OF METASTASIS BONE              MOST COMMON SITE(70%).             LUMBAR VERTEBRAE > FEMUR > THORACIC VERTEBRAE  > RIBS > SKULL             TO VERTEBRA – THROUGH   BATSON'S  VENOUS PLEXUS

6. LIVER METASTASES                 1) LYMPHATIC SPREAD                            LOWER INNER QUADRANT                                               PLEXUS OF RECTUS SHEATH                             SUBPERITONEAL PLEXUS                               FALCIFORM LIGAMENT                    2) HEMATOGENOUS SPREAD

7. LUNGS AND PLEURA                   CAUSES CANNON BALL SECONDARIES , PLEURAL EFFUSION, CONSOLIDATION, CHEST WALL SECONDARIES.,  BRAIN   SOFT TISSUE SECONDARIES – GOOD PROGNOSIS VISCERAL SECONDARIES – WORST PROGNOSIS            

8. KRUKENBERG'S TUMOUR                             SUBPERITONEAL PLEXUS                             TRANSCOELOMIC SPREAD                             FUNCTIONING OVARY

9. SYMPTOMS OF METASTATIC BREAST CANCER GENERAL SYMPTOMS               UNEXPLAINED WEIGHT LOSS               POOR APPETITE               FATIGUE METASTATIC SYMPTOMS OF               BONE - BONE PAIN, SWELLING,  FRACTURE MORE EASILY                            

10.                      BRAIN - HEADACHES, SEIZURES, NAUSEA, VOMITING, VISUAL DISTURBANCES          LIVER – JAUNDICE, ITCHY SKIN, LOSS OF APPETITE           LUNG –  DYSPNOEA, CHEST PAIN, COUGH       

11. INVESTIGATIONS COMPUTED TOMOGRAPHY (CT) SCAN OF CHEST, ABDOMEN, PELVIS OR BRAIN MAGNETIC RESONANCE IMAGING  (MRI)  OF SPINE OR BRAIN POSITRON EMISSION TOMOGRAPHY (PET) - SCAN WITH F-FDG TRACER  BRONCHOSCOPY  BIOPSY FLUID TAPPING – PLEURAL TAP, SPINAL TAP, PARACENTESIS

12. MULTIMODALITY TREAMENT        H- HORMONE THERAPY        E-  ENDOCRINE MANIPULATION        R- RADIOTHERAPY       O- OESTROGEN BLOCKERS        I- IMMUNE THERAPY       C-  CHEMOTHERAPY              

13.                                     TREATMENT FOR MBC          HORMONE RECEPTOR +VE                    HORMONE RECEPTOR -VE          BONY METASATSIS                              HORMONE REFRACTORY METASATSIS          LIMITED VISCERAL METASTASIS                     VISCERAL CRISIS            ENDOCRINE THERAPY               1st LINE  CHEMOTHERAPY                                                                                                                          RESPONSE           NO RESPONSE/PROGRESSES           RESPONSE/          NO RESPONSE         PROGRESSES                                                                                                                                          2nd LINE CHEMOTHERAPY                     

14. ENDOCRINE THERAPY FOR POSTMENOPAUSAL WOMEN AROMATASE INHIBITOR (AI) –  LETROZOLE, ANASTRAZOLE, EXEMESTANE SERM (SELECTIVE ESTROGEN RECEPTOR MODULATOR) - TAMOXIFEN, TOREMIFENE ESTROGEN RECEPTOR DOWN REGULATOR – FULVESTRANT-ER ANTAGONIST PROGESTIN ANDROGEN HIGH DOSE ESTROGEN

15. ENDOCRINE THERAPY FOR PREMENOPAUSAL WOMEN SERM – TAMOXIFEN LHRH AGONIST – GOSERELIN, LEUPROLIDE SURGICAL/RADIOTHERAPEUTIC OOPHORECTOMY HIGH DOSE ESTROGEN

16. CHEMOTHERAPY 1ST LINE – ANTHRACYCLINES 2ND LINE - TAXANES 3RD LINE  ANTIMETABOLITES - GEMCITABINE, CAPECITABINE, COMMONLY USED REGIMENS ARE CMF, CAF

17. TARGET THERAPY ​                                 HER2 POSITIVE METASTATIC CA BREAST  – 1ST LINE TREATMENT IS PERTUZUMAB + TRASTUZUMAB WITH TAXANES + ANTHRACYCLINE​

18. SUPPORTIVE THERAPY FOR METASTASES BONE – BISPHOSPHONATES LIKE ZOLIDRONATE, PAMIDRONATE WITH ORAL CALCIUM  AND VITAMIN D CNS – ANTIEPILEPTICS, CORTICOSTROIDS, WHOLE BRAIN RADIOTHERAPY PLEURAL EFFUSION – ICD AND PLUERODESIS

19. SURGERY IN STAGE IV CA BREAST TOTAL/TOILET MASTECTOMY FOR PALLIATON OF SYMPTOMS AND TO PREVENT COMPLICATIONS LIKE                    SKIN ULCERATION           FUNGATION           PAIN               

20. RADIOTHERAPY NOT MAINSTAY OF TREATMENT, ONLY SUPPORTIVE CARE – TO HELP EASE PAIN OR DISCOMFORT TYPES          WHOLE BREAST RADIATION THERAPY (WBRT)          ACCELERATED PARTIAL BREAST IRRADIATION (APBI)    RADIATION – 45-50Gy IN 1.8-2Gy PER FRACTION OR 42.5Gy AT 2.66Gy PER RFACTION

21. RECENT ADVANCES 3D MAMMOGRAPHY STEREOTACTIC RADIOTHERAPY QUADRUPLE NEGATIVE BREAST CANCER ADVANCEMENT IN TREATMENT OF BREAST CANCER

22.               BREAST TOMOSYNTHESIS

23.  LIMITATIONS OF 2D MAMMOGRAPHY

24. STEREOTACTIC RADIOTHERAPY NON INVASIVE APPROACH FOR DELIVERING A SINGLE OR VERY LIMITED NUMBER OF RELATIVELY LAGRE DOSES OF RADIATION TO A SMALL PRECISELY DEFINED TARGET WITH STEEP DOSE FALL OFF  USED IN SELECTED CASES LIKE OLIGOMETASTATIC PHENOTYPE i.e. LOW DISEASE BURDEN WITH INDOLENT BIOLOGY OFTEN ≤ 5   ESPECIALLY USED IN METASTASIC DISEASE OF BRAIN AND EXTRACRANIUM

25.          INCLUSION CRITERIA                 METASTATIC BREAST CANCER            UPTO 5 METASTATIC LESIONS            FEASIBILITY OF LOCAL RADIOTHERAPY TO ALL METASTATIC SITES            AGE ≥ 18 YEARS EXCLUSION CRITERIA           MORE THAN 5 METASTATIC  LESIONS            PREVIOUS RADIOTHERAPY            PREGNANCY            LACTATION

26. QUADRUPLE NEGATIVE BREAST CANCER(QNBC)               ER               PR               HER2         - VE               AR QNBC - WORST PROGNOSIS, INSENTIVE TO CONVENTIONAL CHEMOTHERAPY QNBC EXPRESS UNIQUE PROTIENS THAT SERVE AS EFFECTIVE TARGET FOR ITS TREATMENT SUCH AS ACLS4, SKP2, EGFR, IMMUNE CHECKPOINT INHIBITORS, microRNA SIGNATURES .,

27. ADVANCEMENT IN TEARTMENT OF BREAST CANCER HR-POSITIVE BREAST CANCER – PALBOCICLIB, RIBOCICLIB METASTATIS HR-POSITIVE, HER2-NEGATIVE BREAST CANCER – ABEMACICLIB WITH HORMONE THERAPY METASTATIC HR-POSITIVE, HER2-NEGATIVE BREAST CANCER THAT HAVE MUTATION IN PIK3CA GENE – ALPELISIB HER2-POSITIVE, METASTATIC BREAST CANCER – TUCATINIB/LAPATINIB  WITH TRASTUZUMAB AND CAPECITABINE ADO TRASTUZUMAB EMTANSINE – METASTATIC HER2 POSITIVE BREAST CANCER WHO PREVIOUSLY RECEIVED TRASTUZUMAB AND A TAXANE

28.     THANK YOU