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So you have Breast Cancer: NOW WHAT???

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So you have Breast Cancer: NOW WHAT??? Barbara A. Ward, MD ... Adjuvant Therapy Multidisciplinary Team New Targeted Therapies Survivorship What Can You Do? – PowerPoint PPT presentation

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Title: So you have Breast Cancer: NOW WHAT???


1
So you have Breast CancerNOW WHAT???
  • Barbara A. Ward, MD
  • Medical Director
  • The Breast Center at Greenwich Hospital

2
DO NOT PANIC!
  • Almost everyone survives breast cancer, so why
    not you?
  • Early detection DOES save lives!
  • Why do you think there are so many breast cancer
    survivors at those walks?

3
Educate Yourself
  • Buy a book or go to a reliable website
  • WWW.CANCER.ORG
  • (American Cancer Society)
  • WWW.CANCER.GOV
  • (National Cancer Institute)

4
Find Out The Facts and Get Organized
  • Request a copy of your reports, especially your
    pathology report.
  • The American Cancer Society provides a Patient
    Organization Tool, as do many Breast Centers.
  • Are you at the right hospital and doctor?

5
Quality Indicators
  • National Accreditation Program for Breast Centers
    (NAPBC)
  • Commission on Cancer (CoC)
  • National Cancer Institute Sponsored Site
  • Most University Hospitals
  • Breast or Surgical Oncology Fellowship-Trained
    Surgeon

6
Multi-disciplinary Care
  • Breast Radiologist
  • Breast Surgeon
  • Reconstructive Surgeon
  • Medical Oncologist
  • Radiation Oncologist

7
Other Team Members
  • Nurse Navigator or Educator
  • Pathologist
  • Tumor Registrar
  • Cancer Counselor
  • Nutritionist
  • Social Worker
  • Physical Therapist

8
Keep it Simple
  • First decision typically involves surgery What
    type and Where?
  • Dont feel bad about getting a second opinion,
    especially if a mastectomy is recommended

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12
Evolution of Surgical Practice
  • Halsteds Radical Mastectomy
  • Modified Radical Mastectomy
  • 1985 Lumpectomy plus Radiation same survival
    rates
  • 2006 Poor cosmetics so reassess surgical
    strategies

13
Lumpectomy and Radiation
  • Patient Selection Cancer is localized and can
    be removed with a margin of normal tissue..
    (Clear Margins)
  • Surgeon feels that there is good to excellent
    cosmetic results.
  • Patient willing and able to receive radiation

14
Radiation Therapy
  • Traditional treatment Whole breast radiation
    with boost.
  • _at_ 32 treatments over 6 -7 weeks (minus weekends)
  • Partial breast radiation possible over 1-2
    weeks vs. shortened course of RT to 3 wks
  • May include Mammosite catheter placementrisk of
    infection and fibrosis.

15
??????????????????????????
  • Investigational vs. Cutting Edge
  • Recommended in the context of a clinical trial.

16
Nipple-Sparing Mastectomy
  • Progression of Thought Pre-reconstruction era
    (_at_1960s) there was no attempt, but now there is
    renewed interest.
  • Biologic considerations include
  • SAFETY
  • COSMESIS
  • FUNCTION

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21
Recommendations
  • Garcia-Etienne and Borgen (MSK)
  • Negative lymph nodes
  • Nipple Sparing Mastectomy for breast cancers less
    than 2 cm and more than 2.5 cm from nipple
  • High-risk patients without cancer

22
Recommendations
  • Ward et al (GH) selective patients with low
    risk cancerssmall and away from the nipple, not
    including extensive DCIS.
  • Question including BRCA ½ gene carriers (no
    specific data)
  • High risk patients due to family history,
    anxiety, and LCIS, ADH

23
Perforator Flap Reconstruction
  • New option for reconstructive surgery
  • BIG operation, but right for the right person
  • Could involve the transfer of tissue from the
    abdomen or buttocks
  • Seek a specialist in this technique

24
TRAM
25
Perforator Flaps
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27
DIEP Flap Technique
Skin and fat from the lower abdomen is surgically
transformed to form a new breast mound. This is
the most often performed procedure since excess
fat and skin are usually found in this area - the
end result is a "tummy tuck" - as well as a
reconstructed breast.
28
DIEP Flap Technique
29
DIEP Flap Technique
30
Arterial Anastamosis
Double Opposing Clamps and Background are used
for arterial anastamoses
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32
Immediate DIEP Reconstruction
33
Nipple Sparing Mastectomy
34
Surgical Decisions
  • Identify BRCA1/2 carriers for prophylactic
    surgery
  • Higher rate of second breast cancer in same or
    opposite breast
  • Sentinel lymph node surgery lowers the chance
    for lymphedema (arm swelling)

35
What is my prognosis?
  • Prognosis is based upon multiple facts from the
    pathology report
  • Tumor Size and Grade
  • Lymph Node Involvement
  • Receptor Status
  • Oncotype DX or Mammoprint Score

36
Adjuvant Therapy
  • Prognostic features from surgery, which includes
    removal of the sentinel node, will determine the
    need for chemotherapy
  • Estrogen and Progesterone Receptors, Her-2 neu
    status, and size of tumor
  • Oncotype DX Test, Mammoprint Test also factor
    into decision tree.

37
Multidisciplinary Team
  • Postoperative meeting with a MEDICAL ONCOLOGIST
  • Presentation at Tumor Board
  • Second Opinion always an option
  • Decisions typically follow NCCN guidelines
  • You are the final decision-maker

38
New Targeted Therapies
  • Herceptin is a new IV treatment targeted at a
    marker unique to cancer cells
  • It is given over the course of a yearbut has
    resulted in amazing cures
  • Avastin is also targeted at killing the blood
    vessels that feed cancer growth
  • Results are more preliminary but hopeful

39
Survivorship
  • Buzz word for follow-up post treatment
  • NEXT Step Program
  • Nutrition/EXercise/Therapy
  • Counseling and Support Groups

40
What Can You Do?
  • Lead by example regarding screening
  • Quit smoking
  • Buy the Breast Cancer Stamp
  • Contribute to research efforts such as the
    American Cancer Society
  • Participate in a Clinical Trial as a patient
  • VOLUNTEER AT GILDAS CLUB!

41
What else can you do?
                                                
                                             
                                                  
                                                  
                                                  
                                                  
                                                  
                                          
  • Join the Army of Women

http//www.armyofwomen.org/
42
(Remember why are there so many people walking?
Because so many are survivors!)

                                                                                      
Call for cancer information 1.800.ACS.2345
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