Surgical (see Procedures):
Wide local excision/segmental mastectomy: Evidence suggests that long-term survival is similar after either mastectomy or wide local excision and radiother- ^^ apy. Smaller tumours may need radiological wire localisation pre-op. Surgery to the axilla is necessary for node staging and ranges from node sampling, e.g. sentinel node biopsy, to level III clearance (lymph nodes up past pectoralis minor to subclavius).
Modified radical mastectomy (Patey mastectomy) or segmental mastectomy: Removal of breast, surrounding fascia and axillary node clearance, but pector-alis major and pectoralis minor are preserved.
Radical mastectomy (Halstead): Very rarely performed now. Removal of breast, pectoralis major and minor and axillary node clearance. ^^
Reconstruction: May be performed concurrently with surgical excision. Latissi-mus dorsi or transverse rectus abdominis myocutaneous flap are used. Systemic therapy: Chemotherapy: Used in premenopausal women, rapidly progressive disease, visceral involvement, oestrogen receptor negative tumours and where hormonal treatment has failed. Many regimen options (e.g. 5-fluorouracil, cyclophosphamide, methotrexate, adriamycin) with response rates in ~ 50% using a combination of drugs. A promising new agent is herceptin, a monoclonal antibody against HER-2 protein (tumour cell growth promoter).
Fig. 5 Breast carcinoma: spiculated lesion.
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