1. Step 9
1.1. Review session 2
1.2. mechanism flow chart
1.3. 20 minutes
2. Step 10
2.1. Management
2.1.1. Goals
2.1.1.1. remove mass
2.1.1.2. to extend patients quality of life
2.1.1.3. absolute cure
2.1.1.4. prevent recurrence
2.1.1.5. pathological staging of disease to privde prognosis
2.1.2. Early
2.1.2.1. until 2b
2.1.2.2. breast conserving surgery
2.1.3. localy advanced
2.1.3.1. 2b and beyond
2.1.3.2. radio nd chemotherapy
2.1.4. Surgery
2.1.4.1. Early stage, first line
2.1.4.2. mastectomy
2.1.4.2.1. stage 3
2.1.4.2.2. stage 4 for relief of symptoms
2.1.4.2.3. male pts w/ breast cancer are candidates
2.1.4.2.4. BRCA 1 and 2 POSITIVE
2.1.4.2.5. Recurrence, wound infection, necrosis are complications ( they should be told to pt)
2.1.4.3. quadrentectomy
2.1.4.4. lumpectomy (BCS)
2.1.4.4.1. OUR patient
2.1.4.4.2. + chemo for our pt
2.1.4.4.3. complete resection of tumor with ideal 1cm margins
2.1.4.4.4. Contraindication
2.1.4.4.5. It provides survival equivelant of mastectomy and looks good
2.1.4.4.6. Needle localization is done to make sure of location (done by radiologist.
2.1.5. Chemotherapy
2.1.5.1. Adjuvent
2.1.5.1.1. REALLY IMPORTANT
2.1.5.2. stage 2-4
2.1.5.3. if estrogen recepotors are negative
2.1.5.4. Cycophosphomide
2.1.5.5. CAT
2.1.5.6. Targeted
2.1.5.6.1. Less SE
2.1.5.6.2. more expensive
2.1.5.6.3. HER 2 +
2.1.5.6.4. Antiangiongenisis
2.1.5.6.5. Hercipin
2.1.6. Hormonal
2.1.6.1. Tamoxifen
2.1.6.1.1. Estrogen receptor antagonist
2.1.6.1.2. Reduce recurrence by 50%
2.1.6.2. Aromatase Inhibitors
2.1.7. Radiotherapy
2.1.7.1. Similar to chemo in regards to given as adjuvent or neoadjuvent
2.1.7.2. usually given as brachytherapy
2.1.7.2.1. needle inserted to tumor
2.1.7.3. External beam radiation
2.1.7.3.1. More SEs
2.1.7.4. Opinion of patient
2.1.7.4.1. important
2.1.7.5. HIGH risk patients or deep tumors
2.1.7.6. Multidescpilinary approach
2.1.7.7. Partial: recommendedage above 45, tumor size less than 3cm
2.1.7.8. Skin irritation
2.1.8. f
2.2. Prevention
2.2.1. Followup
2.2.1.1. Mammography annualy
2.2.1.2. symptoms for recurrence we need to do plan
2.2.1.3. History and Physical exam every 4 months
2.2.1.4. MDT
2.2.1.4.1. Social worker, psychologist
2.2.1.5. patient should be reassured about survival rate
2.2.1.5.1. more than 70% survival rate
2.2.1.6. Genetic testing
2.2.1.7. Education of family
2.2.2. Prevent
2.2.2.1. Primary
2.2.2.1.1. Trial
2.2.2.1.2. Surgical mastecomy
2.2.2.2. Secondary
2.2.2.2.1. Early detection
2.2.2.2.2. Starting at 40
2.2.2.3. Tertiary
2.2.2.3.1. For mets and complications and prevent recurrence
2.2.2.3.2. .00.