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MANAGEMENT Once the diagnosis of breast cancer has been histologically established, the treatment options have to be discussed with the patient. These can be divided into four categories:
The main aim of any surgical procedure to remove cancer of the breast is to achieve local control. Local recurrence in the mastectomy wound or site of wide local excision is, not only very damaging psychologically to the patient, but may also compromise survival. Historically, mastectomy was the only treatment for breast cancer because the prevalent hypothesis at the time was that the tumour spread centrifugally and that the lymph nodes acted as filters with secondary spread only occurring only when their capacity was exhausted. Logically, therefore, ever more extensive surgery was attempted to get beyond the growing edge of the tumour and radical mastectomy remained the treatment of choice for almost one hundred years. There are now, however, a wide range of procedures available for the treatment of breast cancer. These vary from no surgery (neo-adjuvant) to incision and excision lumpectomy, wide local excision, segmentectomy, quadrantectomy, sub-cutaneous mastectomy, total mastectomy, modified radical mastectomy (Patey mastectomy) and radical mastectomy (Halsted's). Wide
Local Excision - Mastectomy More recently, it
has become clear that breast cancer can be a multifocal disease at the
time of presentation and the presence of micrometastases determines the
survival of patients rather than the surgery. Conservation therapy is
now the more normal mode of treatment rather than the more traditional
operations. Not everybody, however, is suitable for conservation therapy,
for example, patients with multifocal disease on clinical examination
or mammography or a large, centrally placed tumour. With the advent of
increasingly sophisticated plastic surgical techniques, patients can now
be offered reconstruction either as a primary or a secondary procedure.
The aims of local control also include attention to the axilla
which is the subject of another chapter in this web site. If
you require further advice or information please contact the |
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