Breast Disease

One in eight women who live until age 85 will develop breast cancer during their life time. When breast cancer is diagnosed early the five-year survival rate is 96%. Breast disease has become a chronic but manageable disease as compared to several years ago. 80% of breast masses are not cancerous.

If you have found a lump during a routine self-examination, don’t panic. Call your doctors office for a mammogram and ultrasound. Once you have completed the mammogram and ultrasound you can be examined by Dr. Denes and he will decide which of the following two procedures are right for you.

1. Stereotactic Biopsy : Procedure that uses a computer to guide a needle into an abnormality seen on mammography but is not palpable. The first part of the procedure is performed like a normal mammogram, except that the patient lies face down on the table. Once the abnormally is identified, the skin is cleansed with an antiseptic and a local anesthetic is injected into the skin. One small incision is made through the skin and the biopsy needle is placed into precalculated targets.
2. Core Biopsy : This procedure is done in the office and takes approximately 15 minutes to complete. The skin is cleansed with an antiseptic and a local anesthetic is injected into the skin and a device is inserted into the lump, the device is activated, a 1.5 cm biopsy is taken. This is repeated several times until Dr. Denes is satisfied with the amount specimen.

The results from the pathologist take between 7-10 days to arrive back to the office. This will determine whether the lump is malignant or benign. If the lump is found to be malignant, there are several surgical approaches that are open to you. The approach which will best suit your situation will be decided by your surgeon, medical oncologist, radiation oncologist, and you, the patient.

Your options include:

LUMPECTOMY:

In a lumpectomy, the breast mass is removed along with a healthy rim (margin) of tissue. The pathology of the lump and healthy tissue are checked. Women are usually concerned that this type of procedure will lead to dimpling, or a reduction in the size of the breast, most lumpectomies result in a very acceptable cosmetic result and a minimal reduction in breast size. Radiation therapy is usually necessary after a lumpectomy, in order to obtain recurrence rates which are achieved by mastectomies. Most, but not all women, are candidates for this type of surgery, with radiation to follow.

MASTECTOMY:

Occasionally, a mastectomy is recommended to remove the cancer. There are three different types of mastectomies. In a Total Mastectomy, the entire breast including the nipple is removed along with some of the lymph nodes from under the arm. This is also referred to as a Simple Mastectomy. In a Modified Radical Mastectomy, the breast including the nipple, most of the lower and middle lymph nodes and the lining over the chest muscles are removed. Occasionally, part of the chest wall muscles may have to be removed. The third type of mastectomy is called a Radical Mastectomy, which involves removing the breast including the nipple, chest muscles, and most of the lower, middle and upper lymph nodes. This surgery was very popular in treating breast cancer, in the past but fortunately it is rarely used today.

Skin sparing mastectomy with reconstruction:

With many mastectomies, a skin-sparing mastectomy can be performed. The surgeon and plastic surgeon work together to complete both procedures during the same operation. The breast and nipple is removed along with a small amount of healthy tissue, as well as reconstruction of the breast to restore volume. The need for further plastic surgery may be required for a nipple reconstruction.

Types of breast cancer:

1. DCIS (Ductal Carcinoma In Situ) : is the most frequently identified type of noninvasive breast cancer. Cancer cells located inside the breast milk ducts have not spread beyond the walls of the ducts into the tissue of the breast.
2. Lobular Carcinoma In Situ : This cancer begins in the lobules, which are the milk-producing glands of the breast. Insitu indicates that it has not passed beyond the lobule wall into the breast tissue. It may, however, put woman at a higher risk for other types of breast cancer.
3. Invasive (infiltrating) Ductal Carcinoma (IDC) : This begins in the milk ducts, and spreads through the duct walls and invades the tissue of the breast. It can also spread throughout the body via the lymph nodes or bloodstream. This cancer accounts for about 80% of all breast cancer diagnosed.
4. Invasive (infiltrating) Lobular Carcinoma (ILC) : This cancer starts in the milk ducts, spreading through the gland walls and into other parts of the body. 10-15% of invasive cancers are this type.
5. Medullary Carcinoma : 5% of all breast cancers, this type have a well defined, distinct boundary between normal breast tissue and normal tissue.
6. Colloid Carcinoma : A rare type of invasive breast cancer.
7. Tubular Carcinoma : Accounts for about 2% of all breast cancer. It is invasive in nature.
8. Inflammatory Breast Cancer : Referred to as “inflammatory” because the affected breast feels warm to the touch, appears red and swollen, with a course or thickened skin surface. This is caused by the spread of the cancer cells within the lymphatic systems of the breast and accounts for 1% of invasive breast cancers.
9. Adenoid Cystic Carcinoma : Although, rarely occurring in the breast, is a form of invasive cancer.

Staging breast cancer:

Staging of the cancer is an important aspect in selecting the treatment for breast cancer. The stage indicates how far a breast cancer has spread within the breast, to nearby tissues and to other organs. Physicians gather information about the cancer to determine its stage by means of exams and tests.
In order to stage the cancer, the status of the axillary lymph nodes is necessary. In other words, it is important to know whether or not there is cancer in the lymph nodes in the armpit. The high-tech approach in this area is called a sentinel lymph node biopsy. Nuclear medicine imaging allows the localization of the first lymph node in the draining basin of the axilla. The accuracy rates can be increased by an intraoperative (during surgery) injection of blue dye.

An incision is then made over the sentinel lymph node and the lymph node is excised (removed). The contents of the lymph node are studied by usual stain methodology, as well as immunochemistry stains. If this sentinel lymph node is not involved with cancer, no further surgery is indicated in the axilla. Only those patients whose sentinel lymph node is involved are then advised to undergo an axillary lymph node dissection, which can be done on an outpatient basis.

Patients who have involvement of the lymph nodes should be seen by a medical oncologist and undergo a course of adjuvant chemotherapy.

This modern approach to breast tumors actually allows cure of many small breast cancers and excellent control of even larger breast cancers

Breast Cancer Stage Definitions:
From Breast Cancer Treatment Guidelines for Patients by the National Comprehensive Cancer Network and American Cancer Society

* Stage 0 (Nonivasive or In Situ Breast Cancer)
Included in Stage 0 are both lobular carcinoma in situ and ductal carcinoma in situ.
* Stage I
Tumor measures smaller than 2 centimeters in diameter (three fourths of an inch or less). Does not appear to have spread beyond the breast.
* Stage II
Tumor measures larger than 2 centimeters in diameter and/or it has spread to lymph nodes under the arm on the same side as the breast cancer. Lymph nodes have not yet adhered to one another or to the surrounding tissues, a sign that the cancer has not yet advanced to stage III.
* Stage III
* Stage III is divided into substages known as IIIA and IIIB.
* Stage IIIA: Tumor or tumors either measure larger than 5 centimeters (over 2 inches) in diameter and/or have spread to lymph nodes that adhere to one another or surrounding tissue.
* Stage IIIB: Breast cancers of any size that have spread to the skin, chest wall, or internal mammary lymph nodes (located beneath the breast and inside the chest).
* Stage IV
The cancer, regardless of its size, has spread (metastasized) to distant sites such as bones or lungs, or to lymph nodes not near the breast.

Source: Dr.Naanam.com

The medical information provided in this site is for education/information purposes only. It is not a substitute for a professional medical opinion. No operation is without risk.