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LOCAL TREATMENT OF EARLY BREAST CANCER

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Treatment components

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There are three components of the treatment of breast cancer: (1) local treatment of the cancer in the breast, (2) treatment of the loco-regional draining nodes, principally in the axilla, and (3) systemic treatments to eradicate any disease which may be present outwith the breast and loco-regional nodal basins (Figure 3.1). Breast cancer is uncommon in men and may present at a more advanced stage because of a smaller volume of breast tissue; however, the principles of management are the same in women and men.

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3.1

Mammograms of a male patient showing an irregular opacity on the left due to a breast cancer.

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Early (operable) disease

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Breast
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Initial treatment of the primary breast tumour in an individual with early or operable breast cancer is usually surgical (Figures 3.2, 3.3, 3.4, 3.5, 3.6, 3.7). Some patients with locally advanced breast disease and most with cancers involving underlying muscle are suitable for a primary surgical approach, as long as other features such as inflammatory changes or distant metastatic disease are not present. The primary surgical options for management of the breast are mastectomy and breast conservation. Breast conservation therapy consists of excision of the tumour with a 1 cm macroscopic margin of normal tissue (wide local excision) plus breast radiotherapy. Controversy has surrounded how much extra tissue should be removed and what constitutes an involved or positive margin. Current evidence suggests that microscopic margins of 1 mm or more are adequate and that increasingly wide margins will not reduce local recurrence rates but will adversely affect cosmetic outcomes. Local recurrence rates should be less than 1% per annum following wide excision and radiotherapy.

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3.2

Wide excision specimen of breast cancer cut in half to show central tumour.

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3.3

Potential protocol for the management of the breast following diagnosis of breast cancer.

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3.4

Potential protocol for management of the axilla following diagnosis of breast cancer.

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3.5

Well healed scar following breast conservation therapy with wide excision of the breast cancer and radiotherapy.

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3.6

Specimen X-ray showing satisfactory margins following excision of a screen-detected, impalpable breast cancer. The lesion has been localized using a hooked wire and the specimen has been orientated using clips.

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3.7

DCIS (arrow) extending close to the inked margin ...

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