A study of locally advanced breast cancer

Niban, G M (2007) A study of locally advanced breast cancer. Masters thesis, Tirunelveli Medical College, Tirunelveli.


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INTRODUCTION: Carcinoma breast is one of the most common cancers afflicting the females. The presentation of carcinoma breast gives as varied a panorama as the surgical field itself. Locally advanced carcinoma breast is one of the most common modes of presentation of carcinoma breast in the surgical wards. The lack of awareness in the general populace regarding breast lumps in general and the explicit mode of presentation of LABC contribute to the plethora of forms of appearance of this disease. The various modalities of therapy offered to patients with LABC and the synchronized mode of treatment protocol are needed to ensure adequate control of morbidity and mortality of this disease. The fine line between wide-spread metastasis signifying a death sentence and an eminently controllable situation epitomized by LABC is of primal importance in the study and therapy of breast cancer. The slowly increasing incidence of LABC in the general female populace also stresses the need to gain more insight into the behavioral pattern of this dreaded disease. The importance of adjuvant therapy in the form of chemo/radio/endocrine and the modality of administration of the same and the type of surgical remedies offered are also in need of critical evaluation. This study is an attempt to understand the profile of the disease as is epitomized in the presentation of the LABC in Tirunelveli Medical College Hospital and an effort has been made to analyze the disease in its entirety. It also entails a comparison to the picture of LABC in clinical situations in other institutions. AIMS AND OBJECTIVES: The aims of this study are epitomized as follows: a) To study and understand the factors in the pathophysiology of the LABC and evaluate the factors responsible. b) To analyze the variables involved in the causation and etiopathogenesis of locally advanced breast cancer. c) To understand the importance of the various risk factors involved in the interplay of manifestations of this disease. d) To evaluate the efficacy of multimodality treatment as provided in this institution. e) To compare the efficiency of treatment protocols by way of incidence of loco regional recurrences. MATERIALS AND METHODS: This study is based on the follow up of patients with locally advanced breast cancer who were studied during the period between July 2004 and July 2006. A total of one hundred and fourteen patients under went surgery for symptoms and diagnosis of carcinoma breast, of which thirty-nine patients who had locally advanced breast cancer were studied in detail as they presented for regular follow-up at Tirunelveli Medical College Hospital. The selection criteria of patients were based on the TNM classification of breast cancers from stage II B, stage III A and stage III B were selected. The modalities of diagnosis and treatment of breast cancer as is being done in Tirunelveli Medical College Hospital forms the crux of this study. Meticulous history followed by thorough clinical examination and routine biochemical and radiological examinations, invasive procedures for diagnosis like FNAC formed the basis of stratification of patients. The investigative protocols of hormonal receptor assay and sentinel nodal biopsy were not applied due to their non-availability in this institution. Patients were followed up as they underwent various modalities of treatment in the form of surgery, neoadjuvant and adjuvant chemotherapy and radiotherapy supplemented by hormonal therapy. No attempt was made to modify the treatment protocols of the various units under whose care these patients were treated. An effort has been made to study the profile of locally advanced breast cancer as managed in Tirunelveli Medical College Hospital. RESULTS: A total of thirty-nine patients with the disease profile of labc were analyzed for the study. Patients belonged to various socioeconomic and geographical backgrounds. The predominant age group of these patients was in the age group of 40-50 years (31%). The next common age of occurrence being 30-40 years (23%) and 50-60 years (18%) respectively. The most common complaints of these patients included a sensation of lumps of varying sizes in the breast. About 30% of patients had complaints of skin manifestations like peau d’orange, skin ulceration, and retraction of the nipple was found in 5% of patients. The presentation of lymph nodal enlargement was clinically established in 67% of the total no. of patients.the site of occurrence of the carcinoma was found to be predominantly on the right side in 65% of the studied group of patients. The upper outer quadrant was the favoured location of occurrence of cancer in 54% of patients on the right and 29% on the left. CONCLUSION: The following conclusions are drawn from this study: 1. LABC is one of the most common presentations of carcinoma breast in this institution. 2. The epidemiological profile is of the age group of women in the perimenopausal age group of 40-50. 3. The site of occurrence of LABC is predominantly on the right side with the upper outer quadrant being the most common area. 4. Nodal affliction is one of the important prognosticators and histopathologically IDC grade 2 is the most common type. 5. Multimodality therapy administered with meticulous follow-up provides acceptable rates of loco regional failure. 6. The difficult conundrum of LABC still needs further analysis with respect to the efficacy of neo-adjuvant chemotherapy and longer periods of study are essential to validate the same.

Item Type: Thesis (Masters)
Uncontrolled Keywords: locally advanced breast cancer.
Subjects: MEDICAL > General Surgery
Depositing User: Devi S
Date Deposited: 09 Jun 2018 17:03
Last Modified: 13 Jan 2020 13:34
URI: http://repository-tnmgrmu.ac.in/id/eprint/8350

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