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BreastCancerTreatment
Treatment
� 2aspects1. Treatmentofthebreastitself:“LocalTreatment”2. Treatmentofthewholebody=“Systemictreatment”
LocalTreatment� Surgery+/-RadiaFon� Usually:a.BreastConservingSurgery(“lumpectomy”)+radiaFon
ORb.Mastectomy(+/-radiation)
SystemicTreatment� Medicaloncologist=drugtreatment� 3possibiliFes1. Hormonaltreatment2. Chemotherapy3. Biologicaltherapies
Howdowechoosewhichsystemictherapy?� Basedonfeaturesofbreastcancer+riskofrecurrence
2ImportantIdeas:1. Forbreastcancer,therearealotofgoodtreatment
options2. Thechoiceoftreatmentdependsontheriskof
recurrenceandthegeneralhealthofthepatient
HighRiskofRecurrence=AggressiveTreatmentLowRiskofRecurrence=Moregentletreatments
HowdowedetermineRiskofrecurrence?Standard� sizeoftumor� lymphnodeinvolvement� Grade� ER� PR� Her2� MolecularTest
StandardFactors� Size
� Nodes
� LVI
� Grade
� ER/PR
ER� OnlyER+breastcancersbenefitfromhormonal
treatmentslikeTamoxifen
� Her2
Her2� amarkerofmoreaggressivetumorwithhighriskofrecurrence
� Recurrenceriskisreduced50%byusingthedrugHerceptinwithchemotherapy
MolecularTest� geneassay� molecularprofileØ AtestforDNAchangesinthetumor,NOTthepatient(e.g.oncotypeDx)
OncotypeDx� testisdoneonasampleoftumors� anotherwaytodetermineriskofrecurrenceandbenefitofchemo
OncotypeDx� RecurrenceScore0–50� low,intermediate,high� low:hormonaltherapy� high:hormonal+chemo� intermediate??
Whatischemotherapy?� DrugtreatmentgivenbyIV� Usuallylaststhreetosixmonths� Gettreatmentatcancercentreandgohomethesameday
� Eachvisitisabouthalfaday� Youmayneedadeviceinyourveintogetchemo� Youwillneedtoattendachemoclassbeforeyoustart� Chemoisgivenincycles
ChemoSchedule
ChemoSideEffectsCommon:
1. Hairloss2. Nausea+Vomiting3. Infection4. SoreMouth5. DiarrheaorConstipation6. Headache7. BodyPain8. Numbness/tinglingfingers+toes9. Fatigue10. EarlyMenopause11. “ChemoBrain”
ChemoSideEffectsRare:� heartmuscledamage� 2ndcancer(leukemia)� skin/tissuedamageatIVsite
ChemoRegimens� CMF� AC� TC� ddACT� FECD
TamoxifenSideEffectsCommon� Improvedbonedensity� Improvedcholesterolreducesriskofcancerinotherbreast
� Hotflashes� Vaginaldischarge� Irregularperiods
TamoxifenSideEffectsRare� Bloodclots<1%risk� Cancerofuterus<1%risk
Other� Moodchanges� Weightchanges
LetrozoleSideEffects� Hotflashes� Jointpain� Vaginaldryness� Thinningofbones� Reducesriskofcancerinotherbreast
ClinicalTrialsWhyparticipate?
Clinicaltrialsareimportantformanyreasons.Beforeyouorsomeoneyoucareabouttakespartinsucharesearchstudyforanewdrugortreatmentapproach,it’shelpfultounderstandboththepossiblebenefitsandthepotentialrisks.
PossiblebenefitsfromtakingpartinaclinicaltrialYouwillreceivestate-of-the-artcancercarefromexpertsinthefield.Youmaybeamongthefirsttobenefitfromanewandeffectivetreatmentforcancer.Youmayundergoaneffectivenewtreatmentthathasfewersideeffectsthanstandardtreatmentforyourtypeandstageofcancer.Youwillcomeincontactwithawiderangeofhealthprofessionalsandmaybenefitfromextrafollow-upcareoftenprovidedforparticipants.Whatevertheoutcomeofthetrial,youarehelpingscientistsanswerimportantquestionsaboutcancer.Theseanswersmaycontributenewknowledgeaboutcancerandeventuallyhelpotherswiththedisease.PossiblerisksfromtakingpartinaclinicaltrialThere’snoguaranteethatanytreatment–neworstandard–willproducepositiveresults.Thenewtreatmentorapproachbeingstudiedmaynotbeasgoodasthestandardcancertreatmentyouwouldreceiveoutsidetheclinicaltrial.Theremaybesideeffectsthatareworsethanthoseassociatedwithstandardtreatments.Takingpartinatrial,especiallyonethatlastsforyears,maybetime-consumingandinconvenient.Youmayrequireextratestsormedicationandbeaskedtokeeprecordsorfilloutdetailedhealthquestionnaires.
FeaturesofYourCancer� Tumorsize_________________� LymphNodes________________� LVI_________________� Grade___________________� ER____________________� PR___________________� Her2___________________
TreatmentRecommendaFon
Plan