1 Management of Breast Management of Breast Cancer Cancer By By Hussein M. Khaled Hussein M. Khaled Prof. Medical Oncology Prof. Medical Oncology Vice President Vice President Post graduate Studies and Research Post graduate Studies and Research Cairo University Cairo University
53
Embed
1 Management of Breast Cancer By Hussein M. Khaled Prof. Medical Oncology Vice President Post graduate Studies and Research Cairo University.
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
1
Management of Management of Breast CancerBreast Cancer
ByByHussein M. KhaledHussein M. Khaled
Prof. Medical OncologyProf. Medical OncologyVice President Vice President
Post graduate Studies and ResearchPost graduate Studies and ResearchCairo UniversityCairo University
2
BREAST CANCERBREAST CANCERWorldwide incidence in females*Worldwide incidence in females*
*Incidence per 100,000 population.
Parkin DM, et al. CA Cancer J Clin. 1999;49:33-64.
67.4
36.0
28.6
71.7
21.2
25.0
31.5
25.5
86.3
Eastern Eastern EuropeEurope
JapanJapan
Australia/Australia/New ZealandNew Zealand
South CentralSouth CentralAsiaAsia
Northern Northern AfricaAfrica
Southern Southern AfricaAfrica
Central Central AmericaAmerica
WesternWestern Europe Europe
NorthNorthAmericaAmerica
3
CANCER CONTROLCANCER CONTROL
EARLYEARLYDETECTIONDETECTION
DIAGNOSISDIAGNOSISPRIMARYPRIMARY
PREVENTIONPREVENTION
TREATMENTTREATMENT
4
BREAST CANCERBREAST CANCERSigns and symptoms at Signs and symptoms at
presentationpresentation Mass or painMass or pain
in the axillain the axilla
Palpable massPalpable mass ThickeningThickening PainPain
Clinical Pathology Imaging and lab testsDiagnoDiagnosissis
32
Controversial Issues :Controversial Issues :
FNAC or Frozen SectionsFNAC or Frozen Sections 5 or 10 years of HT5 or 10 years of HT T and AIT and AI Type of CTType of CT Herceptin and othersHerceptin and others Pre or post op CTPre or post op CT Ov ablationOv ablation Cases who do not need systemic Cases who do not need systemic
NCI Most Common Sites in Males NCI Most Common Sites in Males and femalesand females
40
National Cancer RegistryNational Cancer Registry
41
ProportionProportion Cumm. %Cumm. %
<35<35
35-35-
40- 40-
45-45-
50-50-
55-55-
60- 60-
65-65-
70+70+
7.77.7
12.612.6
14.814.8
17.617.6
16.216.2
10.410.4
11.211.2
5.05.0
4.54.5
7.77.7
20.320.3
35.135.1
52.752.7
68.968.9
79.379.3
90.590.5
95.595.5
100.0100.0
Age structure of Age structure of
Female breast cancer patients.Female breast cancer patients.
42
EgyptEgypt US SEERUS SEER
20-2420-24
25-2925-29
30-3430-34
35-3935-39
40-4440-44
45-4945-49
50-5450-54
…………
1.41.4
9.89.8
28.928.9
63.663.6
96.796.7
171.5171.5
181.2181.2
1.31.3
7.17.1
25.225.2
61.761.7
117.5117.5
192.1192.1
253.1253.1
Age-specific Incidence Rates of Breast cancerAge-specific Incidence Rates of Breast cancerin younger age groups: Egypt and US SEERin younger age groups: Egypt and US SEER
43
Magnitude of Breast Cancer in Magnitude of Breast Cancer in Egypt: 2025Egypt: 2025
Population size: 51 million females Population size: 51 million females Crude incidence rate: 55.1./100,000 femalesCrude incidence rate: 55.1./100,000 females Incidence: 14,000 Incidence: 14,000 28,000 breast cancer cases 28,000 breast cancer cases
Prevalence: 42,000 Prevalence: 42,000 84,000 breast cancer cases84,000 breast cancer cases
Magnitude of Breast Cancer in Magnitude of Breast Cancer in Egypt: 2050Egypt: 2050
Population size: 64 million females Population size: 64 million females Crude incidence rate: 68.8./100,000 femalesCrude incidence rate: 68.8./100,000 females Incidence: 14,000 Incidence: 14,000 44,000 breast cancer cases 44,000 breast cancer cases
Prevalence: 42,000 Prevalence: 42,000 132,000 breast cancer cases132,000 breast cancer cases
Projection of Magnitude of Breast CancerProjection of Magnitude of Breast Cancer in Egypt: 2025, 2050 in Egypt: 2025, 2050
44
Breast cancer T stage 1984 - 2006, Port Said, Breast cancer T stage 1984 - 2006, Port Said, EgyptEgypt
0
10
20
30
40
50
60
70
80
84-1985 86-1988 94-1999 2004 2005 2006
T1 T2 T3 T4
SOURCE: Prof. Dr. Ahmed Elzawawy
45
Cancer Control in Cancer Control in EgyptEgypt
46
Inflammatory Breast Cancer (IBC)Inflammatory Breast Cancer (IBC)
in Breast Cancer Cases in Breast Cancer Cases (2002)(2002)
Revision of the slides of 212 patients.Revision of the slides of 212 patients. Only 16 patients had both clinical and Only 16 patients had both clinical and
pathological features of IBC (8%)pathological features of IBC (8%) Age distributionAge distribution
4 patients4 patients 35 yrs or less35 yrs or less
8 patients8 patients 45 yrs or less45 yrs or less
8 patients8 patients More than 45 yrsMore than 45 yrs
The youngest The youngest 25 yrs25 yrs
The oldest The oldest 76 yrs76 yrs
48
More than 90% of IBC showed positive axillary nodes.
IBC’s are characterized by:
High histologic grade tumors with high Nuclear grade, necrosis and high PCNA and MIB-1(Ki-67) labeling indices.
ER & PgR are frequently negative.
p53 > 70% positivity.
HER-2/Neu > 60%.
Biologic profile“ Immunphenotypic signature”
49
Tumor emboli and LYVE-1 and RhoC expression in IBC Tumor emboli and LYVE-1 and RhoC expression in IBC tumors from Egypt and the United Statestumors from Egypt and the United States
50
RhoC Scoring and Tumor Emboli for Egyptian patients with IBC and non-IBC