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Surgical treatment Options in Screening Detected Breast Cancer


Cancer Doctor in Kota

Recently a Bollywood actor’s young wife was diagnosed with “Ductal Carcinoma in situ Of Breast”, diagnosed during routine screening.( Stage 0 ). She was treated with Mastectomy+ free flap breast Reconstruction of breast. As per media reports she is to be treated with Chemotherapy also.

This may raise a question in many person’s mind as to what constitutes optical treatment for non-invasive Breast Cancer. ( the breast Cancers which are diagnosed during screening procedures and are generally non-palpable.

The biopsy of Breast Cancer screening detected abnormality may show one of the following diagnoses.


LOW GRADE PRE-MALIGNANT LESIONS:

Columnar cell lesions.

Atypical ductal hyperbolas.

Lobular Carcinoma in situ.

Ductal Carcinoma in Situ (DCIS).


HIGH GRADE PRE-MALIGNANT LESIONS:

Microglandular adenosis.

Pleomorphic lobular carcinoma in situ.

High Grade Ductal Carcinoma in situ.


SURGICAL MANAGEMENT: MOST ACCEPTED VIEW:

Untreated DCIS has 30% to 50% risk of turning in to invasive cancer over 10 to 20 years.

Survival rate of patients with DCIS is similar between patients undergoing mastectomy or Breast Conservation Surgery with post-operative radiation.

Proper local control may be achieved without radiation therapy if margin width is at least 10 mm.

If resection margin is between 1 and 10 mm., there is higher chances of relapse. Such cases require re excision or radiation Therapy.

Mastectomy is reccomonded procedure for multi centric or lesions more than 4 Cm. In size

Up to 8% patients with DCIS show sentinel lymph node involvement.

In case of micro-invasive DCIS Sentinal node positivity range up to 30%. Here SLN biopsy is indicated.

Sentinal lymph node biopsy is indicated with dragon’s of;
- Micro-invasion,
- High grade of DCIS,
- Palpable tumour and/or tumour mass on mammogram.

Extensive DCIS summer ( more than 4 Cm.), histologically poorly differentiated lesion & presence of Comedy necrosis are Clear indications for sentinel node removal.


INDICATIONS FOR MASTECTOMY:

Removal entire breast ( Simple mastectomy) may be needed if;

The area of DCIS is very large,

If breast has several areas of DCIS ( Multicentric Cancer)

Sentinal lymph node biopsy will be done by surgeons along with mastectomy since the Doctor will not be able to go back and do Sentonal lymph node biopsy later.



Dr. Bhargav Maharaja,

Cancer Surgeon,
Shrey Hospital,
Navrangpura,Ahmedabad.