Management of Locally Advanced Breast Cancer Fifty cases

Jaya Sai Sekhar, B (2007) Management of Locally Advanced Breast Cancer Fifty cases. Masters thesis, Kilpauk Medical College, Chennai.


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INTRODUCTION: Breast cancer is a major and important malignant disease in the Western World. In North America it was the most common malignancy among women, accounting for 27 per cent of all female cancers. One in 14 women can expect to develop breast cancer. Breast cancer is one of the more slowly growing tumours which therefore renders it suitable for screening programmes. The evolution of breast cancer, especially in its preclinical phases, can be measured in years or even decades, although there are exceptions to this rule in which the disease takes on a more aggressive form. The disease progresses from normality to hyperplasia, atypia, carcinoma in situ, and finally to invasive cancer. This progression is by no means inevitable and, in theory, stages may be missed out. It is also possible that a given stage may be permanent or may even regress to a more normal state. Serial mammography has indirectly indicated that the doubling time for human breast cancer is usually of the order of 100 to 300 days, although exceptions to this are frequently seen. AIMS AND OBJECTIVES: This study was conducted on patients who were treated at the Government Royapettah Hospital, Royapettah, Chennai 14 and Government Kilpauk Medical college Hospital, Kilpauk, Chennai 10 during the period 2004 – 2006. This is a prospective study the aims of which are: 1. To find the Age incidence of Locally Advanced Breast Cancer (LABC). 2. To study the various presentations of LABC. 3. To study the management protocol used its rational and relevance to our system of medical care. 4. To study the awareness of the present management protocol of surgeons through the cases referred to the institution. 5. To analyze the Disease free survival of patients with LABC. MATERIALS AND METHODS: This study was conducted on patients with locally advanced breast cancer who were admitted and treated at both Government Royapettah Hospital, Chennai – 14, And Government Kilpauk Medical College and Hospital, Chennai -10. Pathological diagnosis was by FNAC for all cases, TRUCUT and OPEN BIOPSY as appropriate for each case. Case Selection Criteria: All cases with breast cancer with T stage of T3 and above and /or nodal stage of N2 and above were chosen. Metastatic breast cancer was ruled out from each system by appropriate investigations such as: (A) Abdomen and Pelvis: Ultrasound, CT scan for doubtful lesions, (B) Respiratory : X ray chest, CT scan for doubtful lesions, (C) Skeletal : X ray of part, Bone scan if normal X ray, (D) Brain And Spinal Cord: CT/ MRI as per affordability. No case of Inflammatory breast cancer was encountered in this study. In cases that had particular symptoms the same investigations as those done to rule out metastases were performed. Cases were reviewed monthly for the first year and two monthly for the second year. Clinical examination at every visit, Liver function tests every 3 months, and an ultrasound abdomen every 3 months were routinely performed in cases where there were no specific complaints. An Echo cardiogram was done in patients to evaluate cardiac status before and during the course of chemotherapy with cardiotoxic agents such as adriamycin and taxanes. SUMMARY: Locally advanced breast cancer commonly: 1. Presents in the fifth to sixth decade of life. 2. Presents as a painless lump in un-intervened cases. 3. Presents in the post menopausal group and with a higher stage. 4. Has a good disease control if treated first by neoadjuvant therapy followed by surgery. 5. Has early loco-regional and distant recurrences if managed by non standard protocols. CONCLUSIONS: Age: The most common age for presentation of LABC was from 40 to 60 years of age. Sex: It is most common in female sex. Male breast cancer most commonly presents as LABC. Menopausal status: Post menopausal cases comprised the largest group of patients presenting with LABC. Mode of presentation: Post mastectomy status was the most common presentation with a painless lump being the next most common presentation. Stage of presentation: Majority of the LABC cases belonged to the TNM stage IIIA. Treatment modalities: Surgery with or without adjuvant chemotherapy was the most common treatment (66 %) given to patients outside our hospital as per this study Neo adjuvant therapy (26 %) followed by surgery was the treatment offered to patients treated primarily in this institute. Margins: Positive Surgical margins led to high rate of loco-regional recurrences. Pathology: Almost all cases were Infiltrating ductal carcinoma (NOS) type. Recurrence: Recurrence rate was found to be 88% in the arm with surgery with adjuvant therapy of which 66% (10/ 15) recurred in the first six months and remaining 34% in the subsequent 6 months. A recurrence rate of 12 % (2/17) in the arm with neo-adjuvant therapy followed by surgery of which 50% recurred in first six months and 50% in next six months. Recurrence interval: The time interval for recurrence to occur was on an average 6 months.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Locally Advanced Breast Cancer ; Management ; Fifty cases.
Subjects: MEDICAL > General Surgery
Depositing User: Devi S
Date Deposited: 05 Jun 2018 17:33
Last Modified: 06 Jun 2018 01:12

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