PRINCIPLE
- Local and Regional Treatment
Early breast cancer: lumpectomy with RT.
- Axillary Lymph-Node Dissection: Recurrence is higher in women with positive LN.
- Radiotherapy: RT is an integral part of breast-conserving treatment.
- Postmastectomy: RT reduces the incidence of local and regional recurrences by 50 to 75%.
- Distant Metastasis: Systemic Treatment.
MANAGEMENT IS BASED ON
- Clinical extent – Stage
- Nodal status
- Pathological characteristic of tumor
- Receptor status
- Age of the patient (Menopausal status)
- Individual patient preference
Risk factors
No one know the exact cause of breast cancer. A “risk factor” is anything that in creases your risk of developing breast cancer. Studies have found the following risk factors for breast cancer.
- Age
- Gender
- Reproductive and menstrual history
- Radiation therapy to the chest
- Breast density
- Atypical hyperplasia
- Hormone replacement therapy
- Oral contraceptive use
- Personal history of breast cancer
- Family history
- Certain breast changes
- Overweight or obese after menopause
- Lack of physical activity
- Drinking alcohol
STAGES
- EARLY BREAST CANCER
- Stage I
- Stage II A
- Subset of Stage II B (T2N1)
2. LOCALLY ADVANCED BREAST CANCER
- Stage II B
- Stage IIIA to IIIC
3. METASTATIC BREAST CANCER
•Indication for Mastectomy: not a candidate of BCS Patient choice
•Patient choice
MODIFIED RADICAL MASTECTOMY
It is of 3 types:
- Patey’s Modified Radical Mastectomy :- Pectoralis major muscle is preserved and Pectoralis minor removed
- Scanlon’s Modified Radical Mastectomy:- Pectoralis minor muscle is divided but not removed
- Auchincloss’ Modified Radical Mastectomy :-Pectoralis minor is retraced but not divided. Auchincloss’ Modified Radical Mastectomy is widely practiced nowadays.
Surgical management of Breast cancer
1. Removal of Primary tumor
2. Nodal excision
–Axillary LN dissection
- SLNB
- Lower Axillary Sampling
- ALND
–Supraclavicular LN dissection Infra-mammary LN dissection
Management of Primary Tumor
- Breast-conserving surgery
- Mastectomy
Breast Conserving surgery
- The aim of treatment is to maximise disease control and decrease the impact of breast cancer on the quality of life.
- Breast conserving surgery demands WLE, which by definition means clear histological margins with a rim of normal breast tissue around the periphery of the primary tumour on all sides.
- Includes lumpectomy and quadrantectomy.
Mastectomy
- Total or Simple mastectomy: Breast without nodal dissection
- Modified Radical Mastectomy (MRM): Breast + ALND
- Radical Mastectomy: Breast + Pectorals major + ALND
- Extended radical mastectomy: removal of breast parenchyma and pectorals major muscle + axillary level I/II and IMC dissection; also include a level III axillary lymph node dissection.
- Skin sparing mastectomy: Total or MRM with preservation of a significant component of the native skin of the breast to optimize the aesthetic result of an immediate reconstruction.
Management of the Axilla
1. Aims
- Assessment of nodal status
- For evaluation of prognosis
- To determine adjuvant therapy
- Eradication of metastatic disease within the axillary nodes
2. Includes
- Axillary lymph node dissection (ALND)
- Sentinel lymph node biopsy (SLNB)
