Breast Cancer: Breast Conserving Surgery
Breast conserving surgery is also sometimes called partial (segmental) mastectomy. Breast cancer…
Breast cancer surgery
Some surgical methods are applied to most women with breast cancer. Surgery is necessary to remove the tumor in the breast. Surgical options offered to patients with breast cancer; breast-conserving surgery and mastectomy. The breast can be reconstructed during or after surgery. Also, surgery is performed to control the spread of cancer to the lymph nodes in the armpit. Biopsy options that can be applied to determine breast cancer, the stage of the disease and the treatment plan; lymph node biopsy and axillary lymph node dissection.
Now, let’s examine the surgical methods and biopsy options applied in breast cancer together.
Breast Conserving Surgery
Breast conserving surgery is also sometimes called partial (segmental) mastectomy. In this surgery, only the affected part of the breast is removed. However, the portion to be removed depends on the size and location of the tumor and other factors. If the patient will be given radiotherapy after surgery, the radiotherapy treatment area can be marked with small metal clips (which will appear on the x-ray) placed on the area where the tumor was removed during surgery.
In lumpectomy, only the mass in the breast and surrounding tissues are removed. Radiotherapy is a treatment method usually applied after lumpectomy. If the patient is to be given adjuvant chemotherapy, radiotherapy is usually delayed until the chemotherapy treatment is complete.
In quadrantectomy, more breast tissue is removed than in lumpectomy. In this surgery, one quarter of the breast is removed. Radiotherapy is usually given after surgery. Again in this method, if chemotherapy is to be given, radiotherapy is delayed.
If a cancer cell is found at the edge of the removed tissue, it means the disease has a positive margin. If no cancer cells are found at the tissue margin, it is characterized as negative or with a clear margin. A positive margin indicates that some cancer cells may remain after surgery. If the pathologist finds a positive margin in the surgically removed tissue, the surgeon may need to remove more tissue with a new surgery. This operation is called re-excision. If a clean surgical margin cannot be obtained as a result of insufficient breast tissue removal, the patient may need to undergo a mastectomy.
The distance of the tumor to the marginal border is also important. It can be “closed” if its borders are “clear”. This means that the distance between the edge of the removed tumor and the edge of the tissue is very small and further surgery may be required. Surgeons may disagree about the adequate margins of the tumor.
I and II. For most women with stage 1 breast cancer, breast-conserving surgery plus radiotherapy treatment is as effective as a mastectomy. The survival rate of women treated with these two methods is the same. However, breast-conserving surgery is not an option for all women with breast cancer.
Radiotherapy may occasionally be omitted as part of breast-conserving therapy. This is a subject open to debate.
Therefore, breast-conserving surgery without radiotherapy should be preferred if the patient is at least 70 years old and all of the following are true:
- Breast cancer with a tumor of 2 cm or less, completely surgically removed (with clean margins)
- Breast cancer whose tumor is hormone-receptor positive and receiving hormone therapy (such as tamoxifen or aromatous inhibitors)
- Breast cancer that has not spread to the lymph nodes
The possibilities in patients should be discussed in detail with the treating doctor.
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