Breast Cancer

Breast Cancer Treatment

Breast cancer is cancer that forms in the cells of the breasts.

After skin cancer, breast cancer is the most common cancer diagnosed in women in the United States. Breast cancer can occur in both men and women, but it’s far more common in women.

Substantial support for breast cancer awareness and research funding has helped create advances in the diagnosis and treatment of breast cancer. Breast cancer survival rates have increased, and the number of deaths associated with this disease is steadily declining, largely due to factors such as earlier detection, a new personalized approach to treatment and a better understanding of the disease.

Patients are clinically grouped into one of the following categories:
•  Operable Breast Cancer
•  Large Operable Breast Cancer
•  Locally Advanced Breast Cancer
•  Metastatic Breast Cancer

Operable Breast Cancer: T< 5cm, N0 or N1 mobile, M0 Large Operable Breast Cancer: T> 5cm with no skin involvement, N0 or N1, M0 Locally Advanced Breast Cancer
•  Skin involvement in the form of oedema, ulceration, infiltration, satellite nodules.
•  Matted or fixed axillary lymph nodes.
•  Ipsilateral supraclavicular/internal mammary lymph node(s).

Operable Breast Cancer

Clinical Examination & Investigations:
•  I. Documentation of exact extent of primary tumour and axillary node(s)
•  Pathological confirmation of diagnosis by FNAC/ Incision biopsy.
•  Bilateral film mammogram (mandatory if BCT is contemplated)
•  Routine pre-anaesthetic tests including chest X-ray & LFT
• V. ER / PgR if neoadjuvant chemotherapy is planned.

Surgical Options:
•  Breast Conservative Therapy (BCT) – Wide excision with complete axillary clearance up to apex.
•  Modified Radical Mastectomy (MRM)
•  Sentinel node biopsy is presently an investigational procedure.

Contraindications to BCT

•  Multicentric disease ( > 1 quadrant )
•  Extensive microcalcification on mammogram
•  Doubtful compliance with adjuvant radiotherapy
•  Pregnancy (1[st] / 2[nd] trimesters & precious child)
• Satisfactory cosmesis unlikely (relative contraindication)

Options for BCT for relatively large tumours:
•  Down-staging with neo-adjuvant Chemotherapy.
•  BCT with latissimus dorsi reconstruction.

Adjuvant Therapy
Systemic: Hormone-therapy and or chemotherapy
Loco-regional: Radiotherapy

Candidates for Adjuvant Systemic Therapy:

All women with node-positive breast cancer and / or >1 cm tumor ER or PgR +ve ER & PgR -ve Premenopausal Chemotherapy + Hormonal therapy Chemotherapy only Postmenopausal Hormonal therapy +/- Chemotherapy Hormonal therapy + chemotherapy Ovarian ablation considered in pre-menopausal women > 40 years with ER positive tumour.
In postmenopausal women with ER positive tumor, Tamoxifen or Anastrozole can be used. II. Adjuvant Poly chemotherapy

Candidates for Adjuvant Loco-regional Radiotherapy:

•  Breast conservation surgery: All patients should receive radiotherapy.
•  Post MRM: T >5cm, skin/chest wall involvement or axillary node metastases. In the absence of other risk factors, loco regional RT may be avoided for <4 metastatic axillary nodes if the axillary surgery was adequate. >
•  For women who receive post op RT, the radiation target volume includes Breast / chest wall in all cases and SCF nodes when >3 axillary nodes

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