Kanser Payudara

Wanita dan kanser

DR NIK ROSMAWATI NIK HUSAIN

MD(USM), MASTER OF COMMUNITY MEDICINE (USM)PENSYARAH, JABATAN PERUBATAN MASYARAKAT

KANSER

PAYUDARA

cells change and grow out of control

Most cancer cells form a lump or mass called a tumor, and are named after the part of the body where the tumor first starts

Most tumors in the breast are benign; that is, they are not cancer at all, abnormal growths, but they do not grow and spread, and are not life threatening

Some breast tumors are cancerous, but are called in situ, confined within the ducts or lobules, majority will not progress to become an invasive tumor, and at this early stage nearly all of these cancers can be cured.

Other cancerous breast tumors are invasive, or infiltrating local stage; confined to the breast; regional stage; spread to the lymph nodes; distant stage; metastasized (spread to distant sites).

KONSEP KANSER /BARAH

Breast Anatomy

Lymph node areas adjacent to breast area.A pectoralis

major muscleB axillary

lymph nodes: levels IC axillary

lymph nodes: levels IID axillary

lymph nodes: levels IIIE supraclavicular

lymph nodesF internal mammary lymph nodes

Breast profile:A ductsB lobulesC dilated section of duct to hold milkD nippleE fatF pectoralis major muscleG chest wall/rib cage

Enlargement:A normal duct cellsB basement membraneC lumen (center of duct

Range of Ductal Carcinoma in situ (DCIS)

Vascular and Lymphatic Invasion

Epidemiology of Breast Ca - WORLDWIDE

most common cancer among women, nearly one of every three cancers diagnosed in American women

> than 1 million cases annually (IR=>80/10,000)

2nd leading cause of death by Ca in women (1% occur in male)

Incidence is high in developed country (US,UK<Australia), but mortality rate is low there compare to the developing countries

There is a marked geographical diff due to genetic, lifestyle and environ



In 2003, 3738 incidence of BC Accounted for 31.3 % of all newly diagnosed cancers in womenCommonest female cancer in all age groups from the age of 15 years64.1% were in women aged 40-59 yearsMortality high in Malay

Malaysian Cancer Registry 2003-2005

Epidemiology of Breast Ca - MALAYSIA

Percentage of all cancers



CR= crude rate (per 100,000 per year)

TANDA-TANDA KANSER PAYUDARA

Most-

painless mass10% of patients - breast pain and no massLess common symptoms; persistent changes to the breast - thickening,

swelling, skin irritation or distortion nipple symptoms - spontaneous discharge,

erosion, inversion, or tenderness

Note: Early breast cancer, when it is most treatable, typically does not produce any symptoms.




TANDA-TANDA AM KANSER PAYUDARA

Cepat

letih

dan

rasa tidak

sihatHilang

selera

makan

Susut

berat

badanSakit-sakit

seluruh

badan

dan

tulang

How can breast cancer be detected early?

Kepentingan Mammogram & PSP

Mammogram

detect ~ 90% of the breast cancers in women without symptoms

more accurate in postmenopausal women compared with premenopausal women

best method available

identify cancer several years before physical symptoms develop.

low-dose x-ray procedure that allows visualization of the internal structure of the breast

Mammogram

Pemeriksaan Sendiri Payudara

Gunakan tapak jari-jariKaedah –

Vertical Strip MethodCircular Method

Breast Self-Exam - Step 1

Begin by looking at your breasts in the mirror with your shoulders straight and your arms on your hips

Here's what you should look for:Breasts that are their usual size, shape, and colorBreasts that are evenly shaped without visible distortion or swelling

If you see any of the following changes, bring them to your doctor's attention:

Dimpling, puckering, or bulging of the skinA nipple that has changed position or become inverted (pushed inward instead of sticking out).Redness, soreness, rash, or swelling

Breast Self-Exam - Steps 2 and 3

Raise arms and look for the same changes

While you're at the mirror, gently squeeze each nipple between your finger and thumb and check for nipple discharge


Feel your breasts while lying down, using your right hand to feel your left breast and then your left hand to feel your right breast.


Finally, feel your breasts while standing or sitting.

Many women find that the easiest way to feel their breasts is when their skin is wet and slippery, so they like to do this step in the shower

Checking your Armpit Bring your right arm down by your side and feel your armpit firmly and carefully for any lumps.

Peringkat

awal

-

Rawatan

bertujuan

untuk menyembuhkan

pesakit

dari

kanser

payudara

Peringkat

lanjut

-

Rawatan

bertujuan memastikan

kualiti

hidup

yang sebaik

mungkin

dalam

masa

yang ada

RAWATAN KANSER PAYUDARA

1. Surgery : The primary goal of breast cancer surgery is to remove the cancer from the breast and lymph nodes

Lumpectomy - Hanya membuang benjolan kanser, (jika saiz Benjolan < 2 sm)

Simple or total mastectomy - removal of the entire breast

Modified radical mastectomy - removal of the entire breast and lymph nodes under the arm (not include removal of the underlying chest wall)

Radical mastectomy - removal of the underlying chest wall muscle



2. Radiation Therapy to destroy cancer cells remaining in the breast, chest wall, or

underarm area after surgery or to reduce the size of a tumor before surgery

3. Systemic Therapya) chemotherapy [cyclophosphamide, methotrexate, fluorouracil,

doxorubicin (adriamycin), epirubicin, and paclitaxel (taxol)]

Adjuvant systemic therapy is used after all visible cancer has been surgically removed in order to kill any undetected tumor cells that may have migrated to other parts of the body - reducing rates of recurrence and death that persist more than 15 years after treatment.

treating women with advanced breast cancerb) hormone therapy - Tamoxifen

Lumpectomy

A: dark area indicates tumorB: light pink highlighted area indicates tissue removed at lumpectomy

Total (Simple) Mastectomy eg; multiple or large areas of ductal carcinoma in situ (DCIS)

A: pink highlighted area indicates tissue removed at mastectomyB: axillary

lymph nodes: levels IC: axillary

lymph nodes: levels IID: axillary

lymph nodes: levels III

removes the entire breast.

No removal of axillary lymph node dissection

No muscles are removed from beneath the breast

A: pink highlighted area indicates tissue removed at mastectomyB: axillary

lymph nodes: levels IC: axillary

lymph nodes: levels IID: axillary

lymph nodes: levels IIIE: supraclavicular

lymph nodesF: internal mammary lymph nodes

Radical Mastectomy

removal of both breast tissue and lymph nodes levels I and II

No muscles are removed from beneath the breast (modified radical)

removes the chest wall muscles under the breast and level III LN (radical)

Breast reconstruction

Right modified radical mastectomy, immediate TRAM-flap reconstruction, chest wall radiation, later lymphedema

Left modified radical mastectomy with immediate

reconstruction, tissue expander, saline implant

Can breast cancer be prevented?

At this time, there is no known strategy Best strategy

early detection through BSE & mammographyincrease physical activityminimizing alcohol intake Avoiding obesity antiestrogen drug tamoxifen (women at very high Risk) – side effects, particularly an increased risk of endometrial cancerProphylactic mastectomy - one or both breasts are removed before there is a known breast cancer

TERIMAKASIH

Documents

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