الفهرس | Only 14 pages are availabe for public view |
Abstract Summary and Conclusion Breast cancer is one of the most common cancers in women. Many studies have shown that early detection of breast cancer and improved diagnosis of the extent of disease enable more appropriate treatment and treatment at an earlier stage, and help minimize the morbidity and mortality of this disease. Many risk factors increase the chance of a woman to developing breast cancer. The common is the effect of the level and duration of exposure to endogenous estrogen. Early menarche, nulliparity, and late menopause increase lifetime exposure to estrogen in premenopausal women, while obesity and hormone replacement therapy increase estrogen levels in postmenopausal women. Both breast self-examination and clinical breast examination involve inexpensive and noninvasive procedures for the regular examination of breasts. Breast imaging is largely indicated for detection, diagnosis, and clinical management of breast cancer and for evaluation of the integrity of breast implants. Mammography is currently the gold standard for early breast cancer detection and several analyses have shown that regular breast screening with mammography can significantly reduce the mortality rate due to breast cancer. MRI and ultrasonography have an increasingly important adjunctive role for imaging high-risk patients and women with dense breasts. Breast CT has demonstrated high-resolution three-dimensional imaging capabilities. Radionuclide based imaging techniques and x-ray imaging with intravenously injected contrast offer substantial potential as a diagnostic tool and for evaluation of suspicious lesions. Breast conservation surgery (BCS) combined with postoperative radiotherapy has become the preferred locoregional treatment for the majority of patients with earlystage breast cancer, with equivalent survival to that of mastectomy and improved body image and lifestyle scores. The success of BCS for breast cancer is based on the tenet of complete removal of the cancer with adequate surgical margins, while preserving the natural shape and appearance of the breast. Achieving both goals together in the same operation can be challenging, and BCS has not always produced good cosmetic results in all patients. One of the limiting factors is the amount of tissue removed, not only in terms of absolute volume but also in relation to tumor location and relative size of breast. If either of these two goals is not obtainable, mastectomy is often proposed to the patient. An alternative is to downsize the tumor preoperatively with either chemotherapy or hormone therapy. However, not all tumors respond to neoadjuvant treatment. The failure of classical BCS techniques to offer solutions for challenging scenarios has stimulated the growth and advancement of new techniques in breast surgery during the past decade. Oncoplastic surgery allows for wide resections with favorable cosmesis and integrates into a standard multidisciplinary approach for BCS. The ultimate goal is to allow large-volume resections with free margins and fewer reexcisions and mastectomies than is obtainable with standard BCS. OPS divided into two levels based on excision volume and the complexity of the reshaping technique. For resections less than 20% of the breast volume (level I OPS), a step-by step approach allows easy reshaping of the breast. For larger resections (level II OPS), a mammoplasty technique is required. Staging of the axilla in breast carcinoma is the single most important prognostic factor for selection of appropriate adjuvant therapy, loco-regional recurrence and long-term survival. Exact staging of axillary lymph nodes can be obtained in two ways, directly by axillary lymph node dissection (ALND) or indirectly by sentinel lymph node biopsy (SLNB). The purpose of radiation therapy following breastconserving surgery is to eradicate local subclinical residual disease while reducing local recurrence rates. radiation to the intact breast is considered standard of care even in the lowest risk disease with the most favorable prognostic features. Neoadjuvant Systemic Therapy or Administration of systemic chemotherapy or hormonal therapy before surgery can result in a significant reduction in tumor size in 50% to 80% of patients with locally advanced breast cancer. Adjuvant treatment of breast cancer is designed to treat micro-metastatic disease, or breast cancer cells that have escaped the breast and regional lymph nodes but have not yet established an identifiable metastasis. In estrogen-receptor positive early stage breast cancer, hormonal therapy plays a main role in adjuvant treatment, either alone or in combination with chemotherapy. |