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Living Beyond Breast CancerLiver and Lung Metastases Workshop
April 29, 2012
Paul B. Gilman, MD Lankenau Medical Center
Presentation of Liver/Lung Presentation of Liver/Lung MetastasesMetastases
SymptomaticSymptomatic Incidental finding on physical examIncidental finding on physical exam Incidental finding on imagingIncidental finding on imagingLaboratory studiesLaboratory studies
LBBC/04.29.2012
Liver MetastasisLiver MetastasisSymptomsSymptoms
Nausea, anorexia, weight lossNausea, anorexia, weight lossPainPainJaundiceJaundiceFeverFever
LBBC/04.29.2012
Liver Metastasis Liver Metastasis Laboratory EvaluationLaboratory Evaluation
Liver function testsLiver function testsBlood countsBlood countsCoagulation testsCoagulation testsTumor markersTumor markers
LBBC/04.29.2012
Liver Metastasis Liver Metastasis Imaging EvaluationImaging Evaluation
UltrasoundUltrasoundCT ScanCT ScanMRIMRIPET-CTPET-CT
LBBC/04.29.2012
Lung MetastasisLung MetastasisSymptomsSymptoms
DyspneaDyspneaCough, hemoptysisCough, hemoptysisPainPain
LBBC/04.29.2012
Lung MetastasisLung MetastasisLaboratory EvaluationsLaboratory Evaluations
Sputum analysisSputum analysisTumor markersTumor markersPulmonary Function TestingPulmonary Function Testing
LBBC/04.29.2012
Lung MetastasisLung MetastasisImaging EvaluationsImaging Evaluations
Chest x-rayChest x-rayCT ScanCT ScanPET-CTPET-CT
LBBC/04.29.2012
DiagnosisDiagnosis
ClinicalClinicalLaboratoryLaboratoryRadiologicRadiologicPathologicPathologic
LBBC/04.29.2012
BiopsyBiopsyTissue DiagnosisTissue Diagnosis
Needle BiopsyNeedle Biopsy• FNAFNA• CoreCore
Surgical BiopsySurgical Biopsy Endoscopic (ultrasound)Endoscopic (ultrasound) US-guidedUS-guided CT-guidedCT-guided
LBBC/04.29.2012
Biopsy AnalysisBiopsy Analysis
Tissue of originTissue of originHormone receptorsHormone receptorsHER-2HER-2Biomarkers (investigational)Biomarkers (investigational)
LBBC/04.29.2012
Treatment GoalsTreatment Goals
Palliation (Symptoms, QOL)Palliation (Symptoms, QOL) Organ FunctionOrgan Function Improved Survival (chronic disease)Improved Survival (chronic disease)
LBBC/04.29.2012
Treatment ObjectivesTreatment Objectives
Response vs. Stable (clinical benefits)Response vs. Stable (clinical benefits) Disease Free Survival vs. Overall SurvivalDisease Free Survival vs. Overall Survival ToxicityToxicity
LBBC/04.29.2012
Treatment ApproachesTreatment Approaches
Lines of Therapy (First-line, etc.)Lines of Therapy (First-line, etc.) SequentialSequential CombinationCombination ““Maintenance”Maintenance” InvestigationalInvestigational
LBBC/04.29.2012
TreatmentTreatment LocalLocal
• Ablation (cryo, radiofrequency)Ablation (cryo, radiofrequency)• Radiation (external beam, brachytherapy)Radiation (external beam, brachytherapy)• Surgery Surgery
SystemicSystemic• Hormonal therapyHormonal therapy• ChemotherapyChemotherapy• Targeted TherapiesTargeted Therapies
LBBC/04.29.2012