1. Breast Cancer Treatment

2. Treatment 2 aspects 1. Treatment of the breast itself: “Local Treatment” 2. Treatment of the whole body = “Systemic treatment”

3. Local Treatment Surgery +/- Radiation Usually: a. Breast Conserving Surgery (“lumpectomy”) + radiation

4. OR b. Mastectomy (+/- radiation)

5. Systemic Treatment Medical oncologist = drug treatment 3 possibilities 1. Hormonal treatment 2. Chemotherapy 3. Biological therapies

6. How do we choose which systemic therapy? Based on features of breast cancer + risk of recurrence

7. 2 Important Ideas: 1. For breast cancer, there are a lot of good treatment options 2. The choice of treatment depends on the risk of recurrence and the general health of the patient

8. High Risk of Recurrence = Aggressive Treatment Low Risk of Recurrence = More gentle treatments

9. How do we determine Risk of recurrence? Standard size of tumor lymph node involvement Grade ER PR Her2 Molecular Test

10. Standard Factors Size

11. Nodes

12. LVI

13. Grade

14. ER/PR

15. ER Only ER+ breast cancers benefit from hormonal treatments like Tamoxifen

16. Her2

17. a marker of more aggressive tumor with high risk of recurrence Recurrence risk is reduced 50% by using the drug Herceptin with chemotherapy

18. Molecular Test gene assay molecular profile  A test for DNA changes in the tumor, NOT the patient (e.g. oncotype Dx)

19. Oncotype Dx test is done on a sample of tumors another way to determine risk of recurrence and benefit of chemo

20. Oncotype Dx Recurrence Score 0–50 low, intermediate, high low: hormonal therapy high: hormonal + chemo intermediate ??

21. What is chemotherapy? Drug treatment given by IV Usually lasts three to six months Get treatment at cancer centre and go home the same day Each visit is about half a day You may need a device in your vein to get chemo You will need to attend a chemo class before you start Chemo is given in cycles

22. Chemo Schedule

23. Chemo Side Effects Common: 1. Hair loss 2. Nausea + Vomiting 3. Infection 4. Sore Mouth 5. Diarrhea or Constipation 6. Headache 7. Body Pain 8. Numbness/tingling fingers + toes 9. Fatigue 10. Early Menopause 11. “Chemo Brain”

24. Chemo Side Effects Rare: heart muscle damage 2 nd cancer (leukemia) skin/tissue damage at IV site

25. Chemo Regimens CMF AC TC ddACT FEC D

26. Tamoxifen Side Effects Common Improved bone density Improved cholesterol reduces risk of cancer in other breast Hot flashes Vaginal discharge Irregular periods

27. Tamoxifen Side Effects Rare Blood clots < 1% risk Cancer of uterus < 1% risk Other Mood changes Weight changes

28. Letrozole Side Effects Hot flashes Joint pain Vaginal dryness Thinning of bones Reduces risk of cancer in other breast

29. Clinical Trials Why participate? Clinical trials are important for many reasons. Before you or someone you care about takes part in such a research study for a new drug or treatment approach, it’s helpful to understand both the possible benefits and the potential risks. Possible benefits from taking part in a clinical trial You will receive state-of-the-art cancer care from experts in the field. You may be among the first to benefit from a new and effective treatment for cancer. You may undergo an effective new treatment that has fewer side effects than standard treatment for your type and stage of cancer. You will come in contact with a wide range of health professionals and may benefit from extra follow-up care often provided for participants. Whatever the outcome of the trial, you are helping scientists answer important questions about cancer. These answers may contribute new knowledge about cancer and eventually help others with the disease. Possible risks from taking part in a clinical trial There’s no guarantee that any treatment – new or standard – will produce positive results. The new treatment or approach being studied may not be as good as the standard cancer treatment you would receive outside the clinical trial. There may be side effects that are worse than those associated with standard treatments. Taking part in a trial, especially one that lasts for years, may be time-consuming and inconvenient. You may require extra tests or medication and be asked to keep records or fill out detailed health questionnaires.

30. Features of Your Cancer Tumor size _________________ Lymph Nodes ________________ LVI _________________ Grade ___________________ ER ____________________ PR ___________________ Her2 ___________________

31. Treatment Recommendation

32. Plan