MALIGNANT Breast Cancer 6

7. TREATMENT

The treatment modes available for Cancer Breast are:

   1.  Surgery

   2.  Radiotherapy

   3.  Chemotherapy

   4.  Hormonal therapy

*  Surgery is reserved for early cancer breast in cases of  stage

   I(T1 No) and stage II(T1, T2, N1).

   The operations in use today are:

   1.  Radical Mastectomy (Halstead)

       This  procedure is aimed at removing the whole  breast  the

       underlying  Pectoralis  major and minor  and  the  regional

       lymph  nodes  along  the  axillary  vein.   No   prosthatic

       reconcentration  is possible after the chest  wall  muscles

       have been removed.

   2.  Modified Radical Mastectomy (Patey's)

       In  this procedure all the structure accept the  Pectoralis

       Major are removed

   3.  Modified Radical Mastectomy (Maddon's)

       In  this procedure the pectoralis minor is divided but  not

       removed

   4.  Simple Mastectomy and clearance of lymphnodes from the

       axilla

       The  skin incision is eliptical and starts at over  rectus

       sheath and includes the nipple and the upper end is  above

       the  margin of the pectoralis major.  Both upper flap  are

       mobilised till the upper and lower limits of breast tissue

       are expanded.  The breast tissue (and nipple) are directed

       off  the pectoralis major.  The later end of the  incision

       allows excessing axillary lymph nodes.

   5.  Wide  local  excision of the tumour  with  preservation  of

       breast followed by radiation.

The  surgical procedure is dependent on the  surgeons  preference

and  the  clinical  stage of the disease. There is  a  trends  to

choose a less radical procedure among surgeons today.

*   Chemotherapy and hormone therapy (adjuvant therapy)is added to

    surgery in cases of Stage II.

It  has  been shown that chemotherapy has benefitted  both  those

with  nodes and those without nodes. 

Tomoxifen has also been  of benefit  to receptor positive and receptor poor tumours when  the

patient is over 50 years.

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