Options for curative management of breast cancer - Surgical

Question 1

What are the different managements according to the overall cancer stages

Answer 1

Stage 1: Surgery + Adjuvent
Stage 2: Surgery + Adjuvent
Stage 3: Neoadjuvent + Surgery + Adjuvent
Stage 4: Palliative (surgery/chemotherapy/radiotherapy/hormonal)

Question 2

Explain the indications and procedure for a modified radical mastectomy

Answer 2

It is indicated for cancer with adequate margins

All the ipsilateral breast tissue along with the nipple-areola complex, necessary skin and the level 1 and 2 axillary lymphnodes are removed

Question 3

Explain the different axillary lymph node levels

Answer 3

Level 1: Inferior to pectoralis minor
Level 2: Posterior to pectoralis minor
Lvel 3: Superior to pectoralis minor

Question 4

Explain the indication and procedure for breast conserving surgery

Answer 4

Wide local excision with a macroscopically clear margin of small T1 and T2 nodules

Little to no breast deformity afterwards

Question 5

What are the criteria for a sentinal lymph node biopsy

Answer 5

Early-stage cancer T1 or T2
Do not have nodal metastasis

Question 6

What are the guidelines to qualify for a SNB

Answer 6

Multicentric tumours
Ductal carcinoma in-situ
Prior breast and or axillary surgery
Preoperative/neoadjuvant systemic therapy

Question 7

Which conditions according to the guidelines do not qualify for SNB

Answer 7

Locally advanced cancer T3 or T4
Inflammatory breast cancer
DCIS when breast conserving surgery planned
Pregnancy

Question 8

Explain the technique for a sentinal lymphnode biopsy

Answer 8

Radioactive tracer or blue dye is injected around the tumour

Tracer and dye will drain into the lymphatics and to the axillary nodes.

Gamma probe over axilla detect SLN

Incision into the axilla and locate the blue node