{"id":2493,"date":"2021-02-05T14:16:17","date_gmt":"2021-02-05T14:16:17","guid":{"rendered":"https:\/\/ashrafelzayat.com\/?p=2493"},"modified":"2021-11-29T11:55:13","modified_gmt":"2021-11-29T11:55:13","slug":"management-plan","status":"publish","type":"post","link":"https:\/\/ashrafelzayat.com\/en\/management-plan\/","title":{"rendered":"Management Plan"},"content":{"rendered":"

Management Plan<\/strong><\/span><\/h2>\n

After examination, investigation and biopsy results, almost full diagnosis should
\nhave been made. The Surgeon, in conjunction with the Medical Oncologist,
\nshould have a management plan for every individual patient.
\n1. Local control:<\/strong> management of the Breast.
\n2. Regional control:<\/strong> management of the Axilla.
\n3. Systemic control:<\/strong> management of the whole body \u2013 protection.<\/span><\/p>\n

[\/bt_text][bt_hr top_spaced=”topSmallSpaced” bottom_spaced=”not-spaced” transparent_border=”noBorder” publish_datetime=”” expiry_datetime=”” el_class=”” el_style=”” responsive=””][\/bt_hr][bt_header superheadline=”” headline=”Management plan could include:” headline_size=”medium” dash=”no” dash_style=”btNormalDash” subheadline=”” publish_datetime=”” expiry_datetime=”” el_class=”” el_style=”” responsive=””][\/bt_header][bt_text]<\/p>\n

.o Surgery<\/span>
\n.o Chemotherapy<\/span>
\n.o (Herceptin) Monoclonal antibodies<\/span>
\n.o Hormone therapy<\/span>
\n.o Radiotherapy<\/span>
\nManagement plan will depend on many factors and will be planned between the <\/span>Patient, the Surgeon and the Medical Oncologist<\/span>
\n.It could include some, all or some of the above mentioned modalities<\/span>
\n.The plan could be Surgery first or Chemotherapy first<\/span><\/p>\n

[\/bt_text][bt_hr top_spaced=”topSmallSpaced” bottom_spaced=”not-spaced” transparent_border=”noBorder” publish_datetime=”” expiry_datetime=”” el_class=”” el_style=”” responsive=””][\/bt_hr][bt_header superheadline=”” headline=”When is Neo-adjuvant Therapy (upfront\/ Therapy first) indicated?” headline_size=”large” dash=”no” dash_style=”btAlternateDash” subheadline=”” publish_datetime=”” expiry_datetime=”” el_class=”” el_style=”” responsive=””][\/bt_header][bt_text]<\/p>\n

\uf0b7 If the size of the Tumor, relative to the size of the Breast, is big and the<\/span>
\nPatient wishes to preserve her Breast.<\/span>
\n\uf0b7 Locally advanced \u2013 inoperable tumor-, to make Surgery feasible (To make<\/span>
\ninoperable, operable)<\/span>
\n\uf0b7 Inflammatory Breast Cancer.<\/span>
\n\uf0b7 It has been proven that in many cases, upfront Therapy reduces<\/span>
\nrecurrences more than otherwise, for instances Triple Negative disease<\/span>
\nand Her2 Positive cases.<\/span><\/p>\n

Could be either Chemotherapy for, 4, 6 or 8 Cycles \u2013 3 weeks apart- =12-<\/span><\/strong>
\n18 0r 18 weeks or Hormone therapy for 4-6 months<\/span><\/strong><\/p>\n

[\/bt_text][bt_text]<\/p>\n

    \n
  • \n
      \n
    • Surgical Management:<\/u><\/strong>:<\/u><\/strong><\/span><\/li>\n<\/ul>\n

      The usual is to try Breast Preservation.<\/span>
      \nExcision of the Lump + Radiotherapy = Mastectomy<\/span><\/p>\n

      \uf076 Lumpectomy (WLE),<\/strong> Breast Conservation whenever the tumour is<\/span>
      \nrelatively small and the Breast could be preserved without deformity<\/span>
      \nand respecting the Patient`s wish.<\/span>
      \nContraindicated if INFLAMMATORY Breast cancer<\/span>.<\/p>\n

      \uf076 Mastectomy:<\/strong> It also depends on the size of the Tumor relative to<\/span>
      \nthe size of the Breast and definitely indicated if:<\/span>
      \n– Inflammatory Breast Cancer.<\/span>
      \n– Locally advanced Breast Cancer.<\/span>
      \n– Multi-centric Tumors (unless experienced surgeon).<\/span>
      \n– Recurrent Tumors.<\/span>
      \n– In the very young may be advisable (e.g, under 30 years).<\/span>
      \n– Patients wish<\/span><\/p>\n

      \uf076 Mastectomy and Immediate Reconstruction:<\/strong> Every patient should<\/span>
      \nbe offered Reconstruction, regardless of age, culture or race.<\/span>
      \nThe exceptions are:<\/span>
      \n– Inflammatory Cancer.<\/span>
      \n– Heart or Lung severe restrictions.<\/span>
      \n– Insulin dependent diabetics are to be avoided.<\/span>
      \n– Chronic Kidney conditions.<\/span>
      \n– Auto-immune diseases, for example SLE, Rheumatoid\u2026.<\/span>
      \n– Smokers are to be discouraged.<\/span><\/p>\n

      \uf076 Dealing with the Lymph Glands:<\/strong> Removal of some or all of the<\/span>
      \naxillary Lymph Nodes is part of the local control as well as informing<\/span>
      \nthe treating team about the behavior of the Tumor, allowing optimal<\/span>
      \ncomplementary treatment. It is as follows:<\/span>
      \n– No Excision:<\/strong> If Non-Invasive Tumor.<\/span>
      \n– Sentinel Node Biopsy,<\/strong> Is the gold standard. This is studying the<\/span>
      \nfirst Lymph Node Tumor cells would reach if tried to move.<\/span>
      \n– Axillary Clearance,<\/strong> total removal, if the nodes prove to be<\/span>
      \ninvolved.<\/span><\/p>\n<\/li>\n

    • 2<\/strong>.Adjuvant Chemotherapy:<\/u><\/strong><\/span><\/span>\u00a0Complementry therapy after surgery.
      \nThe Medical Oncologist together with the Surgeon decides after
      \nsurgery the need for Chemotherapy. They take into consideration:
      \nAge \u2013 Grade – Size \u2013 Hormone Receptors \u2013 Her2 Receptors \u2013 Lymph
      \nNode status and General condition of the patient.
      \nCould be – None \u2013 4 \u2013 6 \u2013 8 cycles with 3 weeks in between.
      \nCould last up to 24 weeks.
      \nThe benefits and needs will be discussed with the Medical Oncologist.<\/span><\/p>\n
        \n
      1. \u00a03. Radiotherapy after surgery:<\/u><\/span><\/strong>Many factors are considered before
        \nRadiotherapy is planned.
        \nIf both Chemotherapy and Radiotherapy are indicated, the priority is always
        \nChemotherapy followed by Radiotherapy.
        \nCould take up to 3- 5 weeks = 15- 31 sessions.<\/span>.<\/li>\n<\/ol>\n

        4. Hormone Therapy: <\/u><\/span><\/strong><\/span><\/p>\n

        70% of Tumors are Hormone sensitive (The tumor cells<\/span>
        \nuse the patient`s own hormones to grow). Manipulating or Blocking<\/span>
        \nHormone production in these cases is beneficial in depriving any remaining<\/span>
        \ncancer cell (if any) from its feeds.<\/span><\/p>\n

        – Tamoxifen:<\/strong> is used at any age. 20 mg\/day 5-10 years<\/span>
        \n– A I :<\/strong> Femara , Arimidex, Aroumasine are used ONLY in post-<\/span>
        \nmenopausal patients.<\/span>
        \n– LHRH Agonists:<\/strong> Zoladex injections for example are used to<\/span>
        \nrender a young lady postmenopausal, (Chemical Ovariectomy)<\/span>
        \n– Ovarian ablation:<\/strong> By Surgical removal or Radiation destruction of<\/span>
        \nthe Ovaries to induce menopause.<\/span><\/li>\n

      2. 5. Targeted Therapy \u2013Monoclonal Antibodies, HERCEPTINE:<\/u><\/strong><\/span><\/li>\n<\/ul>\n

        around 20% of <\/span>tumors are Her2 Positive, carrying this protein on their surface. The drug <\/span>HERCEPTINE targets these cells only and hopefully destroys or disables <\/span>them. Shame for its COST.<\/span>
        \nOnly used if the patient needs chemotherapy<\/span>
        \nUsually for a year around 17 sessions, 3 weekly<\/span><\/p>\n

          \n
        • 6. ZOMETA \u2013 PROlEA \u2013 X-GEVA<\/u><\/strong>:<\/u><\/strong><\/span><\/li>\n<\/ul>\n

          are used (when needed) either monthly if <\/span>there is spread to bones or 6 or 12 monthly to treat or protect from <\/span>osteoporosis.<\/span>
          \nHave to be taken with plenty of calcium and vitamin D<\/span>
          \nHave to have the Kidney function regularly checked<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"

          Management Plan After examination, investigation and biopsy results, almost full diagnosis should have been made. The Surgeon, in conjunction with the Medical Oncologist, should have a management plan for every individual patient. 1. Local control: management of the Breast. 2. Regional control: management of the Axilla. 3. Systemic control: management of the whole body \u2013 […]<\/p>\n","protected":false},"author":11,"featured_media":1981,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_et_pb_use_builder":"","_et_pb_old_content":"","_et_gb_content_width":"","footnotes":""},"categories":[10],"tags":[],"class_list":["post-2493","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-benign-breast-tumors"],"acf":[],"jetpack_featured_media_url":"https:\/\/ashrafelzayat.com\/wp-content\/uploads\/2021\/01\/ribbon.jpg","_links":{"self":[{"href":"https:\/\/ashrafelzayat.com\/en\/wp-json\/wp\/v2\/posts\/2493"}],"collection":[{"href":"https:\/\/ashrafelzayat.com\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/ashrafelzayat.com\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/ashrafelzayat.com\/en\/wp-json\/wp\/v2\/users\/11"}],"replies":[{"embeddable":true,"href":"https:\/\/ashrafelzayat.com\/en\/wp-json\/wp\/v2\/comments?post=2493"}],"version-history":[{"count":0,"href":"https:\/\/ashrafelzayat.com\/en\/wp-json\/wp\/v2\/posts\/2493\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/ashrafelzayat.com\/en\/wp-json\/wp\/v2\/media\/1981"}],"wp:attachment":[{"href":"https:\/\/ashrafelzayat.com\/en\/wp-json\/wp\/v2\/media?parent=2493"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/ashrafelzayat.com\/en\/wp-json\/wp\/v2\/categories?post=2493"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/ashrafelzayat.com\/en\/wp-json\/wp\/v2\/tags?post=2493"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}