MANGEMENT OF LOCAL RECURRENCE OF BREAST CARCINOMA AFTER CONSERVATIVE BREAST SURGERY

Alaa Mohamed El kamel Ahmed


Abstract


Breast cancer is the most common cancer in women in Developed western countries and is becoming even more significant in many developing countries. In Egypt, breast cancer is the most common cancer among women. Over the years, operable breast cancer was treated by total mastectomy, but nowadays, there are two options for treatment of early breast cancer (stage I and II) either by modified radical mastectomy or by conservative breast surgery. Breast conserving therapy has become a standard treatment option for patients with early stage breast cancer with low rates of local recurrence and good cosmetic outcome. Many risk factors for local recurrence after breast conserving surgery have been studied widely .the most established risk factors are young age, positive resection margins, multicentric disease and vascular invasion. Clinical history, physical examination and breast imaging are the most effective means of follow up. mammography is important for the early recognition of recurrence and should then be done at least annually. Radio-therapy given post-operatively after weeks reduces the risk of isolated local recurrence by approximately 66%, thus radio-therapy is of potential benefit to all patients undergoing breast conservative surgery. Adjuvant systemic therapy includes endocrine therapy (Tamoxifen ) and cytotoxic chemotherapy(5- fluorouracil adriamycin and cyclophosphamide) The incidence of isolated loco-regional recurrence of breast cancer is between 2–20 %. It constitutes the most common type of breast cancer recurrence Early detection and accurate restaging of recurrent breast cancer are important to define appropriate therapeutic strategies and increase the chances of a cure A number of diagnostic tests are available for confirmation. In addition to imaging studies, a biopsy is usually recommended to be certain of the diagnosis Diagnosis of recurrent breast cancer is primarily made mammographically,. Postsurgical and postirradiation changes may diminish mammographic sensitivity Magnetic resonance mammography (MRM) has high sensitivity, high specificity and high accuracy in differentiating physiologic changes of the scar from tumoral tissue. Any new clinical or radiographic finding after BCT for operable breast cancer should prompt a biopsy. Fine needle aspiration (FNA) biopsy is a simple and accurate method for differentiating scar from recurrent carcinoma Patients who present with an invasive local recurrence after BCT should have complete restaging to rule out distant metastases Treatment of recurrent breast cancer include : 1-surgical procedures (mastectomy –repeat BCS-mangement of Axilla) 2-Radiotherapy 3-Systemic therapy (Hormonal-Chemotherapy –Targeted and Biological therapy) The standard approach for an IBTR after BCS and RT is mastectomy, provided there is no evidence of distant metastatic disease Repeat breast conserving therapy (BCS) with or without breast radiation is an investigational alternative to mastectomy for patients who experience a local recurrence ,,provided that tumor is localized and confined to biopsy site , tumor size is less than 2 cm ,time to relaps is less than 48 months or presence of significant comorbid illessses.


Other data

Other Titles تشخيص وعلاج إرتجـــاع أورام الثـــدي بعـــد الجـــراحــات التــحـفـظـيـة لإستــئـصــال أورام الثــدى
Issue Date 2014
URI http://research.asu.edu.eg/handle/12345678/9431


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