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Breast Cancer: The Profile Ma. Belen E. Tamayo,M.D. Medical Oncologist Makati Medical Center The Medical City Breast Cancer • leading cause of cancer and cancer death among females worldwide • estimated to affect 1 in 10 females during her lifetime Risk Factors: 1. Female gender 2. Hormonal factors 3. Family history particularly 1st degree relatives (mother, sisters) 4. Previous breast cancer 5. (+)BRCA-1, BRCA-2 gene Clinical Presentation: • lump in the breast • skin dimpling • skin retraction • nipple discharge • ulcerating breast mass • pain in the breast Diagnosis: • tissue biopsy (excision or FNA) • mammography • scintimammography • MRI Management Depends on Several Factors: 1. Stage of the disease 2. Age 3. Menopausal status 4. Estrogen/Progesterone Receptors 5. Concomitant illness Management : I. Local Treatment A. Surgery 1.Breast-conservation surg + ALND + RT 2.Modified radical mastectomy B. Radiation Therapy Cobalt Linear Accelerator Indications: 1. Node positive tumors (II,III) 2. (+) margins of resection 3. As part of breast conservation treatment Indications of Radiation Therapy: 4. Local recurrence 5. Ulcerating lesions 6. Brain metastasis 7. Bone metastasis II. Systemic Treatment A. Cytotoxic chemotherapy B. Hormonal therapy Early Breast Cancer Trialist Collaborative Group (EBCTCG) confirmed that Tamoxifen and polychemotherapy reduced both recurrence and 10-year mortality Lancet 1992 IS BREAST CANCER CURABLE? Yes No Prognostic Factors For Recurrence: 1. Age 2. Cancer Stage at the time of initial diagnosis (Stage III > II > I ) 3. Treatment given after surgery (adjuvant therapy) •Chance for Cure rises after 5 to 10 years of no recurrence. •Cure cannot be absolutely guaranteed. For Advanced or Metastatic Breast Cancer: • Cure is not possible • Disease control may be achieved with the use of chemotherapy or hormonal therapy Risk Factors of Dying from Breast Cancer: 1. Extent of metastasis 2. Co-morbid illnesses Surveillance • Critical period is the 1st 3 years • Requires follow-up every 3 months Symptoms warranting further investigation: • chronic cough • difficulty in breathing • bone pains • persistent headache • abdominal enlargement &/or pain