BREAST CANCER TREATMENT OVERVIEW –

DR. TEJINDER SINGH (Fortis Hospital)

Incidence:- Breast cancer is the second most common  cancer in Indian women. The lifetime risk of breast cancer is 1 in 8 women. At least one third of diagnosed die from the disease.

As opposed to Women of developed countries, who being aware of the disease, present at early stage of the disease whereas Indian women who lacks proper awareness more than 50 to 70% of patients come late for treatment, commonly with locally advanced breast cancer.

Most common risk factors

1. strongest risk factors for developing breast cancer include being female
2. Increasing age.
3. Women who have a first-degree relative
4. Exposure to both endogenous and exogenous estrogen.
5. Both early menarche and late menopause.
6. Women who have their first child after the age of 30.

Common Symptoms:-

a) Breast tumors can produce puckering, dimpling, or retractions.

b)  A sanguinous discharge is strongly suggestive of breast cancer.

c)  Change in breast size,

d)  Pain or tenderness, redness and change in nipple position, scaling around nipples,

e) Sore on breast that does not heal.

Breast masses require tissue diagnosis by fine needle              aspiration cytology, tru-cut biopsy Or open biopsy. Management Multimodality treatment includes involvement of medical, surgical and radiation oncologists. Treatment is mainly based on whether disease is early, locally advanced or metastatic.

Early disease has a survival of > 90%, locally advanced > 50% and nearly 10-20% patients with metastatic disease survive for more than five years.

Early detection by monthly self examination and annual mammography has an impact on survival.

HYPERTENSION CRISIS MANAGEMENT IN ICU &  ICCU ORIENTATION FOR FAMILY PHYSICIAN –

1) DR. NILESH GAUTAM (Asian Heart Institute)

2) DR. DARSHANA RATHOD (Asian Heart Institute)

Hypertension Crisis: – Classified into 3 categories based upon their symptoms and the organ systems that are affected at the time of presentation:

Category 1:- HYPERTENSIVE EMERGENCY: also called hypertensive crisis, is severe hypertension with acute impairment of an organ system (e.g., central nervous system [CNS], cardiovascular, renal). In these conditions, the blood pressure (BP) should be lowered aggressively over minutes to hours.

Presence of papilloedema indicates MALIGNANT HYPERTENSION.

Category 2:-HYPERTENSIVE URGENCY: the BP is a potential risk but has not yet caused acute end-organ damage. These patients require BP control over several days to weeks.

Category 3:-ACCELERATED HYPERTENSION: recent significant increase over baseline blood pressure that is associated with target organ damage. This is usually vascular damage.

An important point to remember in the management of the patient with any degree of BP elevation is to “treat the patient and not the number.”

Treatment

Initial considerations: Place patient who is not in distress in a quiet room and reevaluate after an initial interview. Consider the context of the elevated BP (e.g., severe pain).Screen for end-organ damage- Patients with end-organ damage usually require admission and rapid lowering of BP using IV meds. Suggested medicines depend on the end-organ system damaged.

Patients without evidence of end-organ effects may be discharged with follow–up. It is a misconception that a patient should not be discharged from the Emergency Room with elevated BP. Giving oral meds such as nifedipine to rapidly lower BP may be dangerous as the BP may have been elevated for some time and there may be organ hypo perfusion. Acute control has not improved long term mortality and morbidity rates.