Breast Cancer
One in ten women and rarely men will develop breast cancer.
Early diagnosis means better prognosis, since almost 90% of women will manage to overcome their problem if they are treated properly.
Early diagnosis is the result of a well informed woman for signs of the disease, a regularly tested patient and the use of the right diagnostic method.
Recognizing and dealing with in situ carcinoma prevents the development of breast cancer.
Precancerous lesions of the breasts that are diagnosed mainly by screening
Breast Cancer
The signs of breast cancer
A breast or armpit lump, breast irregularity, skin retraction, bloody nipple secretion and infection are the most common signs of breast cancer.
Breast Nipple Retraction
Breast cancer staging depends on the tumour size,
lymph node involvement and metastases.
Breast Cancer
Diagnostic method
The breast surgeon should define the diagnostic tools and frequency of regular breast examination.
The decision make criteria are the existence of cancer risk factors, the age, the breast density, the findings of previous tests and some of the previous biopsies. The major breast cancer risk factor is heredity and the stronger it is, the regular breast examination should start in younger age and be performed more frequently and by all available tests.
Young age and great breast density necessitates on occasions the use of magnetic tomography of the breast together with ultrasound and digital mammography. Patients with previous biopsies for precancerous lesions need also more frequent testing.
In case of a suspicious lesion found on regular tests the breast surgeon should decide which is the best form of biopsy between fine needle aspiration(FNA) -cytology, core biopsy, mammotome, breast lesion excision system biopsy(BLES) – histology examination at the outpatients department and an open biopsy in theatre.
The cutting needle inside the breast lesion as it shows on ultrasound
Cutting needle biopsy (core biopsy), under ultrasound guidance.
In case of a nonpalpable breast lesion, biopsy with the help of a hook wire is performed.
The hook wire in mammography.
On the left, the hook wire in the lesion – mammography. On the right, a mammography of the breast tissue excised is regularly performed to confirm the adequacy of the excision.
Breast Cancer
Treatment
It is the responsibility of the breast surgeon to offer the best management, which though will be decided at the multidisciplinary team meeting.
In the MDT meetings participate breast surgeons, radiologists, oncologists, radiotherapists, pathologists and plastic surgeons. They decide for the appropriate operation, the need for any adjuvant treatment and in some occasions for the need of preoperative chemotherapy.
The most commonly performed operation for early breast cancer is lumpectomy and sentinel lymph node biopsy.
When axillary’s lymph nodes are not suspicious on palpation and on ultrasound, a sentinel lymph node biopsy should be performed, with radioisotope injection few hours earlier and blue dye injection just before the operation
The sentinel lymph node blue stained as it shows during operation.
Gamma probe used to locate sentinel lymph node.
Early postoperative result, a week after lumpectomy and sentinel lymph node biopsy. Axillary’s lymph node clearance and hence pain and lymph edema are avoided
” Science is evolving rapidly and what we think is best today might change tomorrow. We should not consider permanent what we read today as indisputable. We should always seek the expert’s opinion, because it is his duty to be well informed and updated and this cannot be replaced by any magazine, newspaper or website information. “