Worldwide breast cancer is the most common malignancy in women. It is the second commonest female malignancy in sub–Sahara African countries after cervical cancer. It arises from glandular or lobular tissue of the breast. Ductal carcinoma is the commonest histological type followed by lobular carcinoma.
Includes surgery, chemotherapy, radiotherapy, hormonal therapy and targeted therapy
Surgery is the mainstay of treatment. It is either Breast Conserving Surgery (BCS) or mastectomy depending on the tumour characteristics, patient status and patient preference.
Mastectomy modalities include:
• Modified radical mastectomy
• Simple mastectomy with axillary node dissection
• Toilet mastectomy to improve patient’s quality of life
Radiotherapy is strongly indicated in the following conditions:
• After BCS
• T3–4 tumor
• Positive surgical margin
• If ≥ 4 sampled lymphnodes are positive
• Palliation for fungating and bleeding tumor, mets to bones, brain etc.
Radiotherapy dose: 50Gy/25fr given in 5 weeks. For palliative intent usually 30Gy/10fr in 2 weeks
Signs and Symptoms
• bone pain/fracture
• or neurological symptoms depending on site of metastasis
A solitary hard lump or mass in the breast that may be associated with
• Changes of breast skin appearance or ulceration
• Nipple retraction
• Presence of axillary lymphadenopathy or elsewhere
• Attachment/fixed to chest wall muscles
• FBC, LFTs, urea, creatinine
• ECHO Mammogram or Mammography where indicated
• CXR, abdominal USS
• Bone scan
• CT scan and or Pet CT where indicated
• Open biopsy for histopathology and IHC
• IHC – ER, PR and Her 2
- Chemotherapy is indicated for almost all patients as neo-adjuvant, adjuvant or palliative.
Patients, who are planned for surgery and have ≥ T3 tumors, should receive neo-adjuvant chemotherapy before operation. Several regimens are available.
Few of them include:
Dosing schedules for combinations for HER 2 negative disease:
Dose-dense Adrimycin + Cyclophosphamide followed by paclitaxel
• Doxorubicin 60 mg/m2 IV day 1 + Cyclophosphamide 600 mg/m2 IV day 1 given every 2 weeks for 4 cycles
• Paclitaxel 175 mg/m2 by 3hr IV infusion day 1, given every 14 days for 4 cycles.
Dose-dense Adrimycin + Cyclophosphamide followed by weekly Paclitaxel
• Doxorubicin 60 mg/m2 IV day 1 + Cyclophosphamide 600 mg/m2 IV day 1 given every 14 days for 4 cycles followed by
• Paclitaxel 80 mg/m2 by 1 h IV infusion weekly for 12 weeks.
• Adrimycin + Cyclophosphamide followed by Taxanes
• Doxorubicin 60 mg/m2 IV on day1 + Cyclophosphamide 600 mg/m2 IV day 1 given every 21 days for
4 cycles then followed by
• Paclitaxel 175 mg/m2 by 3 h IV infusion day 1, given every 21 days for 4 cycles
• Docetaxel 100 mg/m2 IV day 1 Cycled every 21 days for 4 cycles.
TAC chemotherapy regimen S: Docetaxel 75 mg/m2 IV day 1+ Doxorubicin 50 mg/m2 IV day 1+ Cyclophosphamide 500 mg/m2 IV day 1 given every 21 days for 6 cycles.
NOTE: FBC, RFT, LFT before each cycle
Dosing schedule for combinations for HER2-Positive disease:
• Adrimycin + Cyclophosphamide followed by Taxane chemotherapy with Trastuzumab
• Doxorubicin 60 mg/m2 IV day1 AND Cyclophosphamide 600 mg/m2 IV day 1 given every 21 days for 4 cycles followed by Paclitaxel 80 mg/m2 by 1 h IV weekly for 12 wks
• Trastuzumab 4 mg/kg IV with first dose of paclitaxel followed by Trastuzumab 2 mg/kg IV weekly to complete 1 y of treatment. As an alternative, Trastuzumab 6 mg/kg IV every 21 days may be used following the completion of Paclitaxel, and given to complete 1 year of Trastuzumab treatment.
NOTE. 1. All cycles are with myeloid growth factor support
2. FBC, RFT, LFT before each cycle
3. Cardiac monitoring at baseline, 3, 6, and 9 months.
Premenopausal ER/PR Positive
• Tamoxifen 20 mg (PO) daily for 5 years
Post-menopausal ER/ PR Positive
Anastrazole 1 mg daily for 5 years OR Tamoxifen 20 mg daily for 2 years followed Anastrazole 1 mg daily for 3 years.
● All patients must be referred to a specialized oncology center for proper management.
● For prevention and early detection, all women aged 25 years and above should be taught on breast self–examination and should be advised to have regular physical check with a heath provider and have a regular annual ECHO mammogram or mammography.
They should also be encouraged on physical excise and proper diet
5 Novemba 2020 10:07:59