现在和未来乳腺癌预后和预测指标.ppt

* * * * * * * * * * * * * * In conclusion, the existence of CCLs, LN, DCIS with tubular and ILC is so common suggesting that these may represent a family of precursors, pre-invasive and invasive neoplastic lesions of the breast. * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * 2 * * * * * * * * * * * * * * * * * We are paying special attention now to the basal-like subtype in red because of this poor prognosis * Commentary: Pamela D. is a 63 year old, post-menopausal secretary. She was recently diagnosed with a right grade III, 2.5cm invasive ductal carcinoma, moderately ER+ and Pg+, with four out of seventeen lymph glands involved. She has completed a course of four cycles of AC chemotherapy and adjuvant radiotherapy to the right breast and supraclavicular fossa, was commenced on tamoxifen, which she was advised to take for a total of 5 years. Other considerations: Has been taking tamoxifen for several months and has been reporting significant weight gain (20lbs), some hot flushes, and mild vaginal discharge, all of which is having a negative impact on her sex life. She attributes her symptoms to tamoxifen and has stopped taking the tablets. She goes to see her specialist nurse to seek advice. How would you manage this patient and what would be your immediate course of action? What key factors should be considered when making treatment choices? What would be your recommendations to the MDT? With what sort of follow-up information would you provide the patient? Areas to explore: Causes of the patient’s symptoms Risk of endometrial abnormalities Management of side effects such as hot flushes Advice to the patient to encourage compliance Nurses’ perceptions of the tolerability of tamoxifen and anastrozole Significance of patient’s views in influencing choice of treatment Additional questions: Should the patient be recommended for a break in treatment and why? At what point should you discuss alternative treatment options with a patient? How