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Dictation - Essay Example

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Breast Cancer Okay can everybody hear me? So far - excellent. Hopefully everybody in the back can hear me too .Don’t judge me on the plethora of fluids, I will be up here for the next 2 hours to talk to you about breast cancer. Hopefully you will find it interesting as I do…
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Download file to see previous pages And so I will be going over things that I think are good study questions for the boards and I would let you know when I reach something that meets those criteria; but also I will tell you some things that are controversial. So, you cannot have a discussion about any disease state without talking about some things that are controversial. But I will tell you what is unlikely to be on the test because it is a grey area. I have no conflict of interest to present this morning, here are my learning objectives. And basically I have split this presentation up into 2 different sections .So they both are roughly an hour but the first one may run a little bit longer. Every year I have to tweak a little bit of the presentation what I cover because things change the emphasis gets changed , we have 3 new drugs to talk about breast cancer this year and so screening and prevention I won’t be able to cover that this year . It is covered extensively in your handouts. So the handout is enormous. So anything that I don’t talk about today will be in your hand out for your review and so I will talk about most important and pertinent things for breast cancer. So first of all I will start out with management of early adjuvant systemic therapy; I’ll talk a little bit about decision making tools and then talk about little endocrine therapy chemotherapy and biologics. So let us get started. There are cases throughout this presentation as well as cases throughout your handout. So like we are starting out with patient case 2 that is because it corresponds to case 2 in your handout. So we will start out with Elgie; she is a 45 year old pre menopausal African American women. She has newly diagnosed right breast cancer this was found on a screening mammogram and was confirmed by ultrasound and core biopsy and measures 2.1 cms lymph nodes by ultrasound were negative. Its invasive ducto carcinoma; which you are probably familiar is the most common histology for invasive carcinoma in the breast. Nuclear grade 2; meaning it is moderately differentiated; ER 85 % PR 80% HER2 by amino histo-chemistry is 0 HER2 by FISH is normal KEY 67 is 20 %. So all other staging studied were negative for metastases; which is good. So based on the information what are the treatment options for this patient? Just to summarize, this patient is T2 and 0, 0. The staging criteria was most recently updated in 2010. She is ER PR positive HER2 normal; moderate growth fraction - that is KEY 67 as a measurement of tumor proliferation. She has a moderate grade of course, nuclear grade 3 would be poorly differentiated and 1 would be well differentiated. She has several good prognostic features, for instance not having any positive lymph nodes her hormone receptor status, and not having KEY 67 or nuclear grade 3. So for this patient are there any other tests that we would like to have to make decisions regarding her systemic adjuvant therapy? Luckily for us there are several very helpful prognostic tools; which I will go through in detail. The first is adjuvant online, you may have heard of it. It is not only for breast cancer but I believe for colorectal as well. You all have access to this, It jus requires you to sign up for a password that is free. It is a validated decision making tool for adjuvant therapy both for chemotherapy and endocrine therapy. Then we have instead of population database we have two tests that actually take a piece of the tumor and send it off ...Download file to see next pagesRead More
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