Anda di halaman 1dari 33

BREAST CANCER TREATMENT

DEDY YULIDAR
konsultan bedah onkologi RSUD Prof WZ Johannes,Kupang,NTT
MAH MUD
Historical Overview
The earliest reference known as the Edwin Smith
Surgical Papyrus, a series of medical case
presentations written in Egypt. (3000 and 2500 b.c.)
Hippocrates:
breast cancer was a systemic disease,
extirpation of the primary tumor made matters worse it is
better not to excise hidden cancer, for those who are
excised quickly perish; while they who are not excised live
longer.( 400 b.c.)
Galen:
breast cancer was a systemic disease, and
humoral theory for its pathogenesis.
advocated surgery for the treatment of breast
cancer.
Early instruments
by Louis-Jacques Goussier,17221792
surgeons with aggressive surgical approach (16-19th cent.)

Jean Louis Petit (16741750),


Director of the French Surgical Academy,
first unified concept for the surgical treatment of breast
cancer.
In his writings, the roots of cancer were the enlarged
lymphatic glands; that the glands should be looked for and
removed and that the pectoral fascia and even some fibers
of the muscle itself should be dissected away rather than
leave any doubtful tissue. The mammary gland too should
not be cut into during the operation.
John Hunter
English surgeon
advocated the removal of enlarged lymph nodes in
patients with primary breast cancer.
How to get Breast Cancer

Familial

P53
BRCA 1
BRCA 2

Normal Cell INITIATED PROMOTION Progretion


INITIATION Cancer Cell
CELL

INISIATOR PROMOTOR

RADIATION ESTROGEN
CHEMICAL
outline
How to treat breast cancer patient
Breast cancer classification
BREAST CANCER TREATMENT
MULTI MODALITY
Surgery
HORMON Therapy
Chemotherapy
RADIOTERAPI
Targetting therapy
Immunotherapy
Ultimate goal ( curative vs palliative )
Approve the patient need
imaging

pathologic Clinician
PE examinati n decision

Needle
biopsy

surgery NAC

CLINICAL PRACTICE
10 20 YEARS AGO
imaging

Pathologic
PE examination

Needle
biopsy

Strong family history


Gene study
Molecular Concerning to risk of
study recurrence

TREATMENT OPTION
CLINICAL PRACTICE
NOWDAYS
1 2 3 4
The complexity of treating cancers
Efficacy vs Toxicity

The treatment of systemic recurrence of


breast cancer prolongs survival and
enhances quality of life, but is not
curative.

Therefore treatments associated with


minimal toxicity are preferred
.
outline
How to treat breast cancer patient
Breast cancer classification
BREAST CANCER CLASSIFICATION
Prognostic factor and implication of treatment
Classification occording :
Histopathological type
The grade of the tumor
The stage of the disease
The expression of protein and gene
combined
INTRINSICT SUBTYPE CLINICO-PATHOLOGIC DEFINITION NOTES
Surrogate definitions of intrinsict

Luminal A ER and/or PgR positive(76) The cut point for Ki-67 labelling
subtype of breast cancer

HER2 negative (77) index was established by


Ki-67 low (<14%)* comparison with PAM50

Luminal B** Luminal B (HER2 negative) If reliable of Ki-67 measurement


ER and/or PgR positive is not available, some alternative
HER2 negative assessment of tumor proliferation
Ki-67 high such as grade may be used to
distinguish between A and B
Luminal B (HER2 positive) Both endocrine and HER2 therapy
ER and/or PgR positive may be indicated.
Any Ki-67
HER2 over-expressed or amplified

HER2 over expression HER2 Positive ( non luminal )


HER2 over-expressed or amplified
ER and PgR negative

Basal-like Triple Negatve ( ductal )


ER and PgR absent
HER2 Negative
Gonadotrophins
Ovarian Ablation
(FSH + LH) Oestrogens

Ovary

SERMs

Pituitary gland Adrenal Tamoxifen


LHRH glands 1970s
(hypothalamus) Androgens Oestrogens
ACTH Aromatase inhibitor

ACTH, adrenocorticotrophic hormone Peripheral conversion


FSH, follicle-stimulating hormone (aromatase enzyme)
LH, luteinising hormone
LHRH, LH-releasing hormone
SC Fat, Muscle, Liver, Breast
EARLY DETECTION

Secondary prevention (WHO priorities)


Decrease incidence and increase survival
Non palpable breast cancer
Stereotactic biopsy (sono/mammography)
Conservative surgery (BCT)
Terima kasih