Breast cancer surgery
Surgery is the main curative treatment of breast cancer. Breast conservation surgery and modified radical mastectomy are two most common types surgeries for the treatment of breast cancer. First let’s understand both:
Breast Conservation Surgery: commonly called as Breast Lumpectomy, involves removing the cancerous tumor and a small margin of surrounding normal breast tissue. It saves most of the breast.
Modified Radical Mastectomy involves removing the entire breast, including the skin, breast tissue.
In both procedures axillary lymph nodes are removed similarly. In early stage sentinel lymph nodes and in positive axillary node cases by complete axillary clearance.
Now, we’ll answer the most commonly asked question, which is effectiveness of breast conservation surgery compared to mastectomy. Studies have shown that for early-stage breast cancer, both Breast Conservation Surgery and modified Radical Mastectomy offer similar survival rates. There is no difference in cure rate and no difference in recurrence rate.
Breast Conservation Surgery is often preferred for its cosmetic benefits. Patients can maintain normal appearance, which can be important for their psychological well-being. However, it requires radiation therapy.
Suitable Patients for Breast Conservation Surgery: Breast lumpectomy surgery
Most of patients with early-stage breast cancer are suitable for breast conservation surgery. Common indications includes:
- Early-Stage Cancer: BCS is typically recommended for patients with early-stage breast cancer, where the tumor is localized and has not spread extensively.
- Tumor Size and Location: The tumor should be relatively small (usually less than 5 cm) and in a position that allows for its removal without significantly altering the breast’s appearance.
Single Tumor Site: Patients with a single area of cancer in the breast are ideal candidates. If there are multiple tumors, they should be close enough to be removed together. These are multifocal tumor within same quadrant or area of breast- Willingness for Radiation Therapy: BCS usually requires follow-up radiation therapy. Patients must be willing and able to undergo this additional treatment.
Patients Not suitable for Breast Conservation Surgery: when mastectomy is better option
Multicentric Tumors: Presence of cancer in two or more quadrants of the breast makes it difficult to achieve clear margins. - Diffuse Malignant or Indeterminate Microcalcifications: Extensive microcalcifications throughout the breast can indicate widespread disease, making BCS less effective.
- Inflammatory Breast Cancer: This aggressive form of breast cancer requires more extensive treatment than BCS can provide.
- Persistently Positive Margins: If cancer cells are found at the edges of the removed tissue, it indicates that not all the cancer has been removed, necessitating further surgery.
- Large Tumor Size Relative to Breast Volume: If the tumor is large compared to the size of the breast, removing it while maintaining a good cosmetic outcome can be challenging.
- Previous Radiation Therapy: Patients who have already received radiation therapy to the chestwall.
- Connective Tissue Diseases: Conditions like scleroderma or lupus can make patients more sensitive to the effects of radiation therapy.
- Unavailability of Radiation Therapy: If radiation therapy is not accessible or feasible for the patient, BCS is not recommended.
- Early Pregnancy: Radiation therapy, which is typically required after BCS, can be harmful to the developing fetus.
Breast Conservation Surgery in BRCA genetic Mutation
One of biggest question which scares most of the sufferers: Is Genetic Mutation or BRCA mutation a contraindindication for Breast Conservation Surgery?
Breast conserving therapy can be safely offered to women with BRCA1 and BRCA2 positive mutations. Many women with these mutations who have a newly diagnosed breast cancer do opt for bilateral mastectomy, But at the same time it is important to understand that breast conservation surgery is a safe option in these patients who want to maintain their breasts. These patients should be closely followed with surveillance for breast and ovarian cancer. Prophylactic removal of bilateral ovaries after child birth for reducing risk of ovarian cancer, also reduces risk of breast cancer upto 90%. So there should be a proper discussion between patient and surgical oncologist before surgical planning and Breast Conservation surgery can be done in suitable candidates with genetic mutation.
To Know more about breast cancer:
Discover more from CancerSurgery
Subscribe to get the latest posts sent to your email.
