Breast%20Cancer%20Surgery%20%20Update - SlideFinder - PowerPoint search engine with thumbnail results
In The Name of God
Asieh S. Fattahi M.D.
Surgical Oncologist
Assistant Professor of Surgery
Department of Surgery ,Ghaem Hospital
Mashhad University of Medical Sciences
Jan 2011
Breast cancer treatment needs multidisciplinary approach and team
Good relation between radiologists ,Pathologists, Surgeons, Medical oncologists and radiotherapist is needed to choose the best treatment options for every patients
Trained nurses needed to help patient and physician in diagnosis and treatment
Supportive group and programs are needed to increase information of patient and her quality of life
With progress in screening modality breast cancer will detected in earlier stage and it can be treated more than before so:
New techniques and modalities are used in diagnosis and treatment of breast cancer
Before 1990
Frequency of DCIS : unusual
Biopsy: Surgical
Molecular biology :minimal understanding
Treatment: Mastectomy
Reconstruction: None/Delayed
After 1990
- Common
-needle
- Rapid knowledge growth
- Breast conservations
-immediate
Ductography
-Nipple Discharge specially bloody N.D.
-0.1-0.2 of contrast media is injected and Mamo are obtained
-Irregular mass or filling defects maybe be signs of cancer
-most of the time Intra ductal Papilloma
Ductoscopy for Nipple Discharge
-New technical improvement allow intraductal biopsy
-in Bloody Nipple increase risk of cancer detections
-can used specially in high risk patients
-helps having better clean margin with lumpectomy
Sonographic guided biopsy
mass is present
Mammography guided biopsy and Streotactic biopsy
micro calcifications are presents
MRI guided biopsy
when MRI indicated
wire localized Needle Biopsies
Non palpable mass,
Micro calcifications
With mass wire insert via ultrasound guidance ,and with calcifications via mammography guidance
With increase of screening mamo ,the number of non palpable lesions increase
Localization of lesion with wire guided surgeon to excise the exact lesion and helps to less aggressive resection with good results
It can be used for helping in lumpectomies for better cosmetic and trapuetic results
If one or two margins will be positive after lumpectomy reexcision will be done
breast conservation surgeries
# oncoplastic breast surgeries
long term follow up has confirmed that lumpectomy with radiations provides survival equivalent to mastectomy
Technical improvement in lumpectomy and radiation techniques have reduced local recurrence rate (2-5 % at 10 years)
radiotherapy has no added morbidity for patient
Lumpectomy with assessment of axillary lymph node status and Radiotherapy:
In early breast cancer ,stage I & II
In selected locally advanced patients can be used after neoadjuvant chemotherapy and downsize of tumor
¾ of breast cancer patients are eligible for BCT in USA
At least 2mm free margin needed
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