Contents
In line with its mission, the Editorial Board of MedTvoiLokony makes every effort to provide reliable medical content supported by the latest scientific knowledge. The additional flag “Checked Content” indicates that the article has been reviewed by or written directly by a physician. This two-step verification: a medical journalist and a doctor allows us to provide the highest quality content in line with current medical knowledge.
Our commitment in this area has been appreciated, among others, by by the Association of Journalists for Health, which awarded the Editorial Board of MedTvoiLokony with the honorary title of the Great Educator.
Until recently, the detection of a lump in the breast was associated with the need to remove it. Fortunately, more and more women can be offered sparing treatments, involving the removal of a part of the breast and preserving the lymph nodes under the armpit.
Annually, nearly 12 thousand. new cases of breast cancer. In 30 percent women are undergoing a saving operation, because the remaining 70 percent. he visits the oncologist too late. In the world, these proportions are opposite – conserving surgeries are performed in 50-70 percent of women with breast cancer, because most women present with a less advanced cancer.
The breast conserving treatment is called BCT (Breast Conserving Treatment) for short. The condition for the success of the surgery is early detection of the neoplasm, appropriate qualification of the patient for the procedure and selection of the appropriate treatment technique. The close cooperation of doctors: a radiologist, pathologist, surgeon, radiotherapist and chemotherapist is also of great importance.
Who is the therapy for
Surgery to conserve the breast and lymph nodes can be performed when the diameter of the nodule does not exceed 2 cm. Before the tumor reaches a diameter of 1 cm, it takes a few years for the tumor to grow to 2 cm, it takes as much as 6-8 years. That is why it is so important to check your breasts frequently. So if we examine the breasts after each menstruation and, in accordance with the doctor’s recommendation, we perform ultrasound and mammography in a timely manner – we guarantee ourselves safety. Only tests can detect cancer at an early stage, when it has not yet spread to lymph nodes or other organs.
According to specialists, modern surgery does not like cuts. In the case of breast cancer, if the patient’s health condition allows it, conserving surgeries are performed more and more often. Although they have been performed for years, the techniques for carrying out such procedures are constantly improving. In general, the procedure involves the removal of a fragment of pedestrians and the surrounding lymph nodes.
But it is not only the advancement of the disease that determines the possibility of carrying out a conservative surgery. The size of the tumor in relation to the size of the breast is also important. When the breast is small, even a lump of several centimeters can be, for example, a quarter of its size. In the large breast, it will be only a small fragment of it. Breast size is important to remove the tumor with an adequate margin of healthy tissue.
Contraindications to the sparing procedure
There are quite a few of them. But the most important are:
– multicentre crayfish,
– extensive microcalcifications in the breast,
– too large size and stage of the tumor,
– previous irradiation of both breasts,
– connective tissue diseases (collagen diseases) – because they can cause a significant tissue fibrosis in the operated breast, which will make the diseased breast look much worse than the healthy one,
– poor general condition (severe lung and heart diseases)
– pregnancy.
The physician may advise the patient not to undergo a sparing procedure if he foresees that the final aesthetic result will be unsatisfactory or that the use of radiotherapy will aggravate the existing coronary artery disease.
Various operating techniques
When it is found out that a woman has breast cancer, she should undergo surgery as soon as possible. In Poland, depending on the advancement of the neoplastic disease, operations are performed in several ways. The lump itself can be removed (tumorectomy), but it must not be larger than two centimeters and for safety the lymph nodes in the armpit. After the wound has healed, the operated breast is irradiated for 5-7 weeks.
In the case of a low stage of the disease, when the tumor is clearly demarcated from healthy breast tissue, it is possible to remove 1 breast quadrant (quadrantectomy). A part of the breast is removed from the so-called margin of safety and the lymph nodes in the armpit. After surgery, the patient usually has radiation therapy and sometimes chemotherapy as well.
During the BCT procedure, the tumor is treated in the same radical way as in the case of amputation, with the difference that the entire breast is not removed. The surgeon dissects a lump with an appropriate margin of healthy tissue and the axillary lymph nodes. Depending on the size and form of the cancer, more or less tissues are removed. Extensive cuts, however, are avoided as they may detract from the cosmetic effect. And with BCT operations, it is important for the woman to keep the breast.
A sparing operation cannot replace general treatment – chemotherapy or hormone therapy. Simultaneously with irradiation, you can take hormonal drugs. On the other hand, chemotherapy drugs are currently administered after surgical treatment and before radiotherapy. Only after the end of chemotherapy, which lasts 4-6 months, radiation therapy begins. In such a case, the entire course of treatment may take more than 8 months.
Regular hospital check-ups are also necessary to spot any relapse in time, which, unfortunately, is possible regardless of the form of the surgery performed. Neither total amputation nor sparing surgery protect against disease recurrence. But studies show that the probability of patients surviving without relapse after total amputation and conservative surgery is no different.
Prosthesis
Removal of a large fragment from a small breast results in a large asymmetry between the healthy and operated breasts. In such cases, the surgeon can insert a prosthesis that matches the shape of the missing part of the body during the operation. Prostheses come in a variety of sizes and shapes. They can be, for example, a small hemisphere or in the form of a quarter of an apple. If such a prosthesis can be hidden in the body, the matter is simple. Sometimes, however, it is necessary to remove a large part of the skin along with the tumor. Technically it is possible to stretch the remaining skin and cover the implanted implant with it, but from a medical point of view, such surgery cannot be done. There is one reason – excessively stretched skin is easily necrotic. But a solution was found for this problem as well. The skin can be replaced by a special mesh. This gives a chance to carry out conserving surgeries also in women with small breasts, who have so far been doomed to total amputation.
The insertion of a prosthesis during surgery does not close the way to further treatment, i.e. radiotherapy, hormone therapy or chemotherapy.
Anna Jarosz