Soballe Breast Lecture abbrev

Views:
 
Category: Entertainment
     
 

Presentation Description

No description available.

Comments

Presentation Transcript

Slide 1: 

Breast Cancer For Surgery Residents The Problem P.W. Soballe MD, FACS W.R. Drucker Professor of Surgery Uniformed Services University

1. Which ONE is TRUE ? : 

1. Which ONE is TRUE ? ~ 100k new cases / yr 1:8 lifetime risk at age 38 ~ 25% DCIS Platypus: no milk 20% of breast in UOQ

Slide 4: 

Modified Skin Appendage (Sweat) Gland

Slide 5: 

5

Slide 6: 

latissimus dorsi muscle inframammary ridge sternum 2nd rib clavicle

2. Which ONE is TRUE ? : 

 Growth rate with  size Improved imaging -> 0 mortality Mets unlikely to metastasize Adjuvant Rx proves micromets Fisher hypothesis original / novel 2. Which ONE is TRUE ?

Tumor Doubling Time : 

Tumor Doubling Time 1 cell 2 4 8 16 100 billion cells 1 cm 100 days 200 days 300 days 400 days 8 years - visible on mammogram 10 years - palpable Window of Opportunity = “Sojourn Time”

Gompertzian Growth : 

104 Gompertzian Growth 1010 8 10 2 cm 1 cm 1 mm Years

“Negative Cancer Control Window” : 

“Negative Cancer Control Window” 10,000 Cells = 1 mm 10,000 Cells - Angiogenesis Angiogenesis  Metastasis NO “Early” Detection

Slide 11: 

Talmadge J E , Fidler I J Cancer Res 70:5649, 2010

Slide 12: 

Anatomic spread: Breast-> Lymph Nodes -> Distant Treatment failure = inadequate surgery William Halsted, 1894

3. Which ONE is TRUE ? : 

3. Which ONE is TRUE ? Most breast cancers depend on hormones  ER =  prognosis  Estrogen: no  incidence for years M’grams best in luteal phase Premarin:  risk of breast cancer

5 Diseases : 

5 Diseases 70%: “Luminal” A & B (ER pos) ?%: “Normal breast” (ER pos) 20%: Her2 amplified (20% also ER Pos) 10%: Basaloid (“triple negative”)

When Good DNA Goes Bad: : 

When Good DNA Goes Bad: Germline Somatic Local mutation Mutation in egg or sperm All cells affected in offspring Parent Child Inherited in Cancer Pedigrees Sporadic & Not inherited

5. Which ONE is TRUE ? : 

5. Which ONE is TRUE ? Breast cancers from stroma DCIS only within ducts Invasives : discrete margins Push stroma aside as they grow Pre-op chemo may not eliminate metastatic-competent cells

authorStream Live Help