Breast cancer is the commonest cause of death in middle-aged women in Western countries. In england and Wales one in 12 women will develop the disease during their lifetime. Early awareness should be taken to prevent carcinoma of the breast.
Investigation for staging of Breast Cancer
1) Chest X-ray
2) Serum alkaline phosphatase
3) Gamma glutamine transaminase (GGT)
4) Liver ultrasound
5) Isotope bone scan
Treatment of Breast Cancer
Principles of treatment breast cancer is to reduce the chance of local recurrence and reduce the risk of metastatic spread.
#All patients with T1-3, N0 orM1 should be considered for primary surgery
#Some patients with larger T2 (>3cm) or T3, N0, M0 may be considered for primary systemic therapy (neoadjuvant endocrine or chemotherapy) prior to surgery
#Most T4 tumors are initially inoperable but may become operable after a course of primary systemic therapy or radiotherapy
#Very small numbers of patients (usually elderly) with potentially operable breast cancer are not medically fit for any surgical procedure
#Patients with established distant metastatic disease should be managed palliatively but actively. FNA and/or core biopsy are used to confirm the diagnosis, and through the use of these samples for oestrogen receptors, progesterone receptors and HER-2, the likely sensitivity to systemic therapy may be assessed
Treatment Option of Breast Cancer
Early breast cancer
- Surgery with or without radiotherapy
- Systemic therapy is added if adverse prognostic factors are present
Locally advanced or metastatic breast cancer
- Systemic therapy
- Toilet mastectomy Options
Surgery for Breast Cancer
Mastectomy: It includes the following procedures
i) Simple Mastectomy
Removal of the breast only with no dissection of the axilla except for the regions of the axillary tail of the breast which usually has attached to it a few nodes low in the anterior group
ii) Modified radical (Patey mastectomy)
Excision of The whole breast A large portion of skin, the centre of which overlies the tumour but always includes the nipple all of the fat, fascia and lymph nodes of the axilla
iii) Radical (Halsted mastectomy)
Excision of The breast Axillary lymph nodes Pectoralis major and minor muscles
1) Quadrantectomy: It involves removing the entire segment of the breast which contains the tumour. Usually combined with the axillary surgery via a separate incision in the axilla.
2) Wide local excision: It involves removal of tumour with a rim of 1cm of normal breast tissue. Usually combined with axillary surgery.
It is conventional to combine radiotherapy with conservative breast surgery. Largely abandoned except in cases of extensive local disease with chest wall infiltration.
- Tamoxifen (20mg/day in single or twice daily dose for 2 years) reduces recurrence
- Favourable in cases with oestrogen receptor (ER)-positive cases
- LHRH agonist
- Useful in pre-menopausal receptor positive patients
- Oral Aromatase inhibitors
- Useful in recurrent disease in post-menopausal receptor positive patients
6 monthly cycle of CMF
Humanized mouse antibody ,Trastuzumab (Herceptin) is the first new biological therapy to enter clinical use.
Bailey & Love’s Short Practice of Surgery