C11 Breast cancer Treatments

Breast cancer treatments Surgical Mastectomy Lumpectomy Reconstruction Adjuvant therapy Radiation Chemo SERMs

Mastectomy Removal of the whole breast 5 different types “Simple” or “total” Modified radical Radical Partial Subcutaneous (Nipple- sparing)

“Simple or “total” mastectomy Removal of the entire breast No axillary lymph node dissection- occasional No muscle is removed from beneath the breast Who usually gets simple or total mastectomy? Women with multiple or large areas of ductal carcinoma in situ AND women seeking prophylactic mastectomies (prevention mastectomy)

Modified radical Mastectomy Removal of both breast tissue and lymph nodes Axillary lymph node dissection is- underarm lymph nodes are removed No muscle are removed from beneath the breast Who usually get a modified radical mastectomy? People with invasive breast cancer and need lymph nodes examined to see if cancer cells spread beyond the breast

Radical mastectomy Removal of the entire breast Levels 1, 2, 3 of the underarm lymph nodes are removed Removal of chest wall muscles under the breast Who usually gets a radical mastectomy? Recommended when breast cancer has spread to the chest muscles under the breast.

Partial mastectomy Removal of the cancerous part of the breast tissue and some normal tissue around it. Lumpectomy is technically a form of partial mastectomy, but more tissue is removed in a partial mastectomy.

Skin- Sparing and Nipple-sparing mastectomy Resection of the nipple-areola complex Removal of any existing surgical or biopsy scar Removal of all Breast tissue Nipple-Sparing All of the breast tissues is removed, but the nipple-nipple- areola complex remains

Lumpectomy Removal of breast tumor and some normal tissue that surrounds it “Breast-conserving” Preformed on patient with DCIS Quadrantectomy quarter of your breast is removed

Lymphatic Biopsy and Drainage Sentinel lymph node Biopsy Early stages of Breast cancer 1-3 axially lymph nodes are removed Radioactive substance or blue dye injected Axillary lymph node dissection Most lymph nodes under arm, are removed and examined

Reconstruction Implants Autologous Reconstruction FLAPS

Adjuvant therapy Additional cancer treatment given after the primary treatment to lower the risk that the cancer will come back. Chemo Radiation Hormone therapy Targeted therapy Biologic therapy Neo Adjuvant treatment before surgery to shrink tumor, see treatment response

Radiation Therapy Patients with hx of mastectomy or lumpectomy Daily treatments 5 days a week for 5-7 weeks Reduces recurrence by more than 70% External Internal

Radiation Therapy External One month after surgery Combination with chemotherapy Similar, but stronger than an xray Focused on the spot cancer was removed

Radiation Therapy Internal “brachytherapy” Places the radioactive source into a ballon or catheter inserted directly in the lumpectomy cavity Can be used along with external beam radiation for an extra boost Interstitial brachytherapy Intracavity brachytherapy

Chemotherapy Systemic drug therapy Distributed through the body through the bloodstream Affects all tissues and organs in the body More than 90 chemotherapy drugs Destroys fast growing cells Cycles , IVs, Pills Tailored to the individual patient Causes most damage to the bone marrow blood and cells of the hair follicles, the reproductive system and digestive tract

Serms: Tamoxifen Block estrogen and can lower the risk for breast cancer recurrence in postmenopausal women. Prevents estrogen from latching onto tumor cell receptors and stops them from multiplying Prevents new cancers from developing Shrink large tumors before surgery

Serms: Raloxifene Replacement of tamoxifen Fewer side effects Originally marketed to treat osteoporosis Decrease the risk for breast cancer by blocking the effect of estrogen and thereby stopping the growth of cancer

The future in breast cancer treatments When are we going to cure cancer? - we do cure cancer, but the problem is we don’t cure enough of them and we are not curing them fast enough. Over the past 30 years breast cancer has decrease by 1/3 More than 3.3 million breast cancer survivors in the U.S. More specific and less toxic

The future in breast cancer treatments Less is more Simple mastectomy instead of radical mastectomy Pulling back on treatment is hard for patients Lumpectomy with radiation instead of a mastectomy Remove cancer, but spare the patient from unnecessary surgical care

The future in breast cancer treatments Radiation treatments have improved Therapy that targets breast, but avoids the heart Radiation courses are getting shorter Instead of Dailey treatments for 6 weeks some come only for 3 weeks

Care for symptoms and side effects Palliative care Support physical, emotional, social needs Reducing symptoms Improving quality of life Supporting patients and their families Treatments: medications, nutritional support, relaxation techniques, emotional support, other therapies. Complementary therapies: music therapy, meditation, stress management, yoga, massage, and acupuncture.

Benefits Removal of cancer Benefits out way the risks

Risks There are side effects to each treatment Common side effects of surgery: Pain, lymphedema Common side effects of Radiation: Changes in appearance and feel of breast Common side effects to chemo: Early menopause, weight gain, fatigue, cognitive function

Reference page https://passionateinknowledge.com/2017/05/29/mastectomy-procedure-an-overview-and-coding-guideline/ https://www.cancer.org/cancer/breast-cancer/treatment/radiation-for-breast-cancer.html http://www.brainimmune.com/raloxifene-and-two-new-serms-m2-macrophage-shift-high-il-10/ https://www.cancercenter.com/breast-cancer/ebrt/ https://www.mayoclinic.org/tests-procedures/radiation-therapy-for-breast-cancer/about/pac-20384940 https://www.verywellhealth.com/what-to-expect-during-sentinel-node-biopsy-430109 https://www.breastcancer.org/treatment/surgery/mastectomy/what_is https://www.fairview.org/patient-education/83001