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Hereditary Breast and Ovarian Cancer
Published in Dongyou Liu, Handbook of Tumor Syndromes, 2020
For breast cancer patients, surgery includes (i) breast-conserving surgery (or lumpectomy, partial mastectomy, segmental mastectomy, quadrantectomy, or breast-sparing surgery) for removing the cancer and some normal tissue around it, but not the breast itself; (ii) total mastectomy (or simple mastectomy) for removing the whole breast that has cancer; breast reconstruction with the patient's own (nonbreast) tissue or by using implants filled with saline or silicone gel may be undertaken at the time of the mastectomy or at some time after; (iii) modified radical mastectomy for removing the whole breast that has cancer, many of the lymph nodes under the arm, the lining over the chest muscles, and sometimes part of the chest wall muscles.
Breast cancer
Published in Peter Hoskin, Peter Ostler, Clinical Oncology, 2020
Breast-conserving surgery excises the tumour with a small margin of uninvolved surrounding breast tissue. This gives an excellent cosmetic result as it preserves the bulk of the breast and nipple/areola complex, even in women with small breasts. It is unsuitable for very large tumours (>5 cm in maximum dimension), particularly if located centrally, although with successful preoperative chemotherapy (or in some cases preoperative endocrine therapy) such surgery may become possible. Inflammatory carcinomas are never treated with breast-conserving surgery. Even if the excision margins are clear after microscopic examination of the specimen, there is up to 25% risk of local recurrence without further local treatment − this risk varies with tumour size, grade, node status and age, reducing significantly with small, low grade node-negative tumours in patients over the age of 65.
Reconstructive perspectives
Published in Steven J. Kronowitz, John R. Benson, Maurizio B. Nava, Oncoplastic and Reconstructive Management of the Breast, 2020
Steven J. Kronowitz, John R. Benson, Maurizio B. Nava
There are very few contraindications to mastectomy and breast reconstruction and relatively few absolute contraindications to breast-conserving surgery. The principle objection to breast-conserving surgery is the maximum limit to the volume that can be excised while maintaining an acceptable appearance. Breast-conserving surgery is the most efficient surgical procedure for treating breast cancer in most women. It can be undertaken as an ambulatory procedure, is the best option for leaving a sensate breast, and when performed as an appropriate option in selected patients will be associated with the best aesthetic outcomes for breast cancer surgery in most cases. However, there are potential disadvantages to this procedure that include: (1) the possibility of incomplete margins requiring further surgery, (2) the need for radiotherapy with concomitant side effects of breast tenderness, fibrosis, skin changes, and potentially varying degrees of long-term atrophy, and (3) long-term radiological surveillance with the need for further investigation or surgical intervention in up to 50% of patients over a 10-year period. In addition, there is a possibility of developing a second breast cancer in the remaining ipsilateral breast tissue.1–3
Dosimetric evaluation of the benefit of deep inspiration breath hold (DIBH) for locoregional irradiation of right breast cancer with volumetric modulated arctherapy (VMAT)
Published in Acta Oncologica, 2023
Pierre Loap, Jeremi Vu-Bezin, Virginie Monceau, Sophie Jacob, Alain Fourquet, Youlia Kirova
Between January 2022 and October 2022, 15 R-BC patients were treated with locoregional normofractionated DIBH-VMAT. The median age was 51 years [range: 30–68]; 9 patients (60%) were treated after total mastectomy, and 6 patients (40%) after breast conserving surgery. Patients characteristics are provided in Table 1. All patients received full course treatment and well-tolerated the DIBH procedure. Average right lung volume increased from 1425 cc [range: 1110–2022] in FB to 2324 cc [1588–3046] with DIBH (p < 0.001), corresponding to a + 63.0% [range: 20.0–84.3%] relative volume change; average left lung volume increased from 1242 cc [range: 895–1650] in FB to 2017 cc [range 1337–2460] with DIBH (p < 0.001), corresponding to a + 74.0% [range: 32.3–113.8%] relative volume change.
Current status of biopsy markers for the breast in clinical settings
Published in Expert Review of Medical Devices, 2022
Elian A. Martin, Neeraj Chauhan, Vijian Dhevan, Elias George, Partha Laskar, Meena Jaggi, Subhash C. Chauhan, Murali M. Yallapu
A breast biopsy is essential for the management of suspicious breast lesions or abnormalities of the breast such as lumps and/or changes in size, shape, and skin color. About 175,000 women undergo breast-conserving surgery every year with 30% of them undergoing repeated surgery due to post-surgical margin status in the United States [1]. During assessment or screening of clinical abnormalities, often an image guided surgical or radiological biopsy procedure is involved, which removes a portion of suspect breast tissue for surgical pathologic evaluation [2]. During such procedures, placing of a breast tissue marker has become a standard practice in clinical care [3]. A breast biopsy marker or breast marker is a small device made up of surgical-grade material such as titanium or stainless steel that is placed in the area where biopsy tissue is removed by way of image guidance. The use of breast markers has become a key component of patient management [4]. The breast biopsy markers allow physicians to distinguish between tissue that has or has not been biopsied before. The placement of biopsy markers also differentiates various biopsied lesions within the tissue of the same breast. This differentiation averts physicians from performing biopsy on the same tissue twice preventing unnecessary discomfort, time, complications, and increased cost to patients [5].
Is the TCH-P regimen active in early or locally advanced HER2-positive breast cancer? Results of a retrospective study
Published in Acta Oncologica, 2022
Raffaele Longo, Victoire Thiebaut, Pierre-Olivier Legros, Marco Campitiello, Francesca Plastino, Christophe Goetz, Bogdan Margineanu, Julie Pujois, Michel Gunther, Julie Egea, Chloé Wendel
A clinical/radiological complete response was found in 6 patients (31.8%). Twelve patients (63.6%) presented a partial response and only 1 patient (5.3%) showed a local progression, but this patient achieved a pCR after surgery. The pathological tumor and lymph node response is reported in Figure 1. A primary tumor and lymph node pCR was achieved by 13 (68.9%) and 16 (84.8%) of the patients, respectively. Thirteen patients (68.9%) achieved a ypT0/is and ypN0 tumor response. Two patients (10.6%) presented a partial tumor and lymph node response and 3 patients (15.9%) a partial primary tumor and a complete lymph node response. Only one patient (5.3%) did not show any tumor and/or lymph node response. Subtype analysis showed a higher pCR rate in HR- tumors (Figure 1) and in patients with a Ki-67 grade > 20% (Figure 2). Among the 2 patients with a HER2 2+ score, one reported a pCR and one a partial primary tumor and a complete lymph node response (Figure 3). Breast-conserving surgery was done in 7 patients (37.1%). Twelve patients (63.6%) underwent a radical mastectomy. A radical axillary lymph node dissection was performed in 12 patients (63.6%). All patients received adjuvant radiotherapy and 10 patients (53%) a post-surgery hormonotherapy. T-DM1 vas administered in only one patient (5.3%) who did not achieve a pCR.