Breast Cancer: The surgical treatment

Surgical removal of the tumor remains essential for the treatment of the majority of women with breast cancer.

Surgical Management of Breast Cancer – Jennifer Baker, MD | UCLAMDChat

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Gene tests

The assessment of the risk of recurrence (prognosis) in women with early breast cancer determines their subsequent monitoring and treatment. For some patients the prognosis can not be determined solely on the basis of tumor characteristics on histological examination.

Recent data have shown that certain gene microarrays detected by specialized methods (Oncotype DX, MammaPrint) are associated with more aggressive forms of cancer. These methods are aimed at identifying women who, although they have early breast cancer, are expected to benefit from complementary chemotherapy. In fact, a recent study (TAILOR-X) identifies high-risk groups for chemotherapy.

The surgical treatment

Surgical removal of the tumor remains essential for the treatment of the majority of women with breast cancer. In early breast cancer, surgical preservation of the breast has in many cases replaced mastectomy. Surgical preservation of the breast involves removal of the tumor or part of the breast and a small number of lymph nodes (lymph nodes or sentinel lymph nodes), thus minimizing postoperative complications.

In some cases, in which the aesthetic result is not satisfactory, the removal of the tumor can be combined with restoration techniques to improve the aesthetic result (oncoplasty).

A percentage of women undergo radical mastectomy for personal or medical reasons. For these patients, breast reconstruction surgical techniques have proven to be safe and offer a satisfactory aesthetic result.

In recent years, for some molecular types of breast cancer (triple negative, Her2 / Neu +++), preoperative systemic treatment and then surgery are recommended for better therapeutic results.

Drugs targeting HER2

Her2 is a protein involved in the proliferation of cancer cells and is found on the surface of cancer cells in 20-30% of breast cancers. There are approved drugs that target HER2 protein, Trastuzumab in intravenous and subcutaneous form, Pertuzumab, Ado-trastuzumab emtansine and Lapatinib are the Anti HER2 therapies that increase disease free survival, while other Anti-HER2 treatments soon in the treatment of the disease.

Other targeted therapies

In recent clinical trials, new molecular agents such as CDK4 / 6 inhibitors have shown significant benefit when combined with antihormonal therapy with aromatase inhibitors or fulvestran. Other molecular factors such as P13K inhibitors are being investigated in clinical trials, the results of which hold great promise.

Other treatments

In the quiver of the treatment of the disease in the immediate future will be added the role of immunotherapy that seems promising in aggressive tumors.

The future

Further promising prospects are expected, when the new important drugs will be administered very early with the diagnosis of the disease and after its initial treatment (in adjuvant form).

Despite the progress that has been made, breast cancer remains the most common cause of cancer death in women aged 35-55 years. Ongoing studies are expected to further advance the understanding of pathogenesis and the potential for prevention and treatment of the disease with a promising message.

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