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