Breast-conserving surgery
Encyclopedia
Breast-conserving surgery is a less radical cancer surgery than mastectomy
. Breast-conserving surgery, as in a lumpectomy
removes part of the breast tissue during surgery, as opposed to the entire breast.
s.
1. Pregnancy
is an absolute contraindication to the use of breast irradiation
. However, in many cases, it may be possible to perform breast-conserving surgery in the third trimester and treat the patient with irradiation after delivery.
2. Women with two or more primary tumors in separate quadrants of the breast or with diffuse malignant-appearing microcalcification
s are not considered candidates for breast conservation treatment.
3. A history of prior therapeutic irradiation to the breast region that would require re-treatment to an excessively high total-radiation dose to a significant volume is another absolute contraindication.
4. Persistent positive margins after reasonable surgical attempts: the importance of a single focally positive microscopic margin needs further study and may not be an absolute contraindication.
or active lupus erythematosus
, considering it an absolute contraindication. In contrast, rheumatoid arthritis
is not a relative or an absolute contraindication.
2. The presence of multiple gross tumors in the same quadrant and indeterminate calcifications must be carefully assessed for suitability because studies in this area are not definitive.
3. Tumor size is not an absolute contraindication to breast conservation treatment, although there is little published experience in treating patients with tumor sizes greater than four to five cm. However, a relative contraindication is the presence of a large tumor in a small breast in which an adequate resection
would result in significant cosmetic alteration. In this circumstance, preoperative chemotherapy
should be considered.
4. Breast size can be a relative contraindication. Treatment by irradiation of women with large or pendulous breasts is feasible if reproducibility of patient set-up can be assured and the technical capability exists for greater than or equal to six MV photon beam irradiation to obtain adequate dose homogeneity.
Mastectomy
Mastectomy is the medical term for the surgical removal of one or both breasts, partially or completely. Mastectomy is usually done to treat breast cancer; in some cases, women and some men believed to be at high risk of breast cancer have the operation prophylactically, that is, to prevent cancer...
. Breast-conserving surgery, as in a lumpectomy
Lumpectomy
Lumpectomy is a common surgical procedure designed to remove a discrete lump, usually a benign tumor or breast cancer, from an affected man or woman's breast...
removes part of the breast tissue during surgery, as opposed to the entire breast.
Contraindications
In the selection of patients for breast conservation treatment with radiation, there are some absolute and relative contraindicationContraindication
In medicine, a contraindication is a condition or factor that serves as a reason to withhold a certain medical treatment.Some contraindications are absolute, meaning that there are no reasonable circumstances for undertaking a course of action...
s.
Absolute contraindications
Absolute contraindications, which are reasons why the procedure absolutely cannot be done, include:1. Pregnancy
Pregnancy
Pregnancy refers to the fertilization and development of one or more offspring, known as a fetus or embryo, in a woman's uterus. In a pregnancy, there can be multiple gestations, as in the case of twins or triplets...
is an absolute contraindication to the use of breast irradiation
Radiation therapy
Radiation therapy , radiation oncology, or radiotherapy , sometimes abbreviated to XRT or DXT, is the medical use of ionizing radiation, generally as part of cancer treatment to control malignant cells.Radiation therapy is commonly applied to the cancerous tumor because of its ability to control...
. However, in many cases, it may be possible to perform breast-conserving surgery in the third trimester and treat the patient with irradiation after delivery.
2. Women with two or more primary tumors in separate quadrants of the breast or with diffuse malignant-appearing microcalcification
Microcalcification
Microcalcifications are tiny specks of mineral deposits , that can be scattered throughout the mammary gland, or occur in clusters. When found on a mammogram, a radiologist will then decide whether the specks are of concern - usually, this is not the case...
s are not considered candidates for breast conservation treatment.
3. A history of prior therapeutic irradiation to the breast region that would require re-treatment to an excessively high total-radiation dose to a significant volume is another absolute contraindication.
4. Persistent positive margins after reasonable surgical attempts: the importance of a single focally positive microscopic margin needs further study and may not be an absolute contraindication.
Relative contraindications
1. A history of collagen vascular disease is a relative contraindication to breast conservation treatment because published reports indicate that such patients tolerate irradiation poorly. Most radiation oncologists will not treat patients with sclerodermaScleroderma
Systemic sclerosis or systemic scleroderma is a systemic autoimmune disease or systemic connective tissue disease that is a subtype of scleroderma.-Skin symptoms:...
or active lupus erythematosus
Lupus erythematosus
Lupus erythematosus is a category for a collection of diseases with similar underlying problems with immunity . Symptoms of these diseases can affect many different body systems, including joints, skin, kidneys, blood cells, heart, and lungs...
, considering it an absolute contraindication. In contrast, rheumatoid arthritis
Rheumatoid arthritis
Rheumatoid arthritis is a chronic, systemic inflammatory disorder that may affect many tissues and organs, but principally attacks synovial joints. The process produces an inflammatory response of the synovium secondary to hyperplasia of synovial cells, excess synovial fluid, and the development...
is not a relative or an absolute contraindication.
2. The presence of multiple gross tumors in the same quadrant and indeterminate calcifications must be carefully assessed for suitability because studies in this area are not definitive.
3. Tumor size is not an absolute contraindication to breast conservation treatment, although there is little published experience in treating patients with tumor sizes greater than four to five cm. However, a relative contraindication is the presence of a large tumor in a small breast in which an adequate resection
Segmental resection
Segmental resection is a surgical procedure to remove part of an organ or gland. It may also be used to remove a tumor and normal tissue around it. In lung cancer surgery, segmental resection refers to removing a section of a lobe of the lung.- External links :* entry in the public domain NCI...
would result in significant cosmetic alteration. In this circumstance, preoperative chemotherapy
Chemotherapy
Chemotherapy is the treatment of cancer with an antineoplastic drug or with a combination of such drugs into a standardized treatment regimen....
should be considered.
4. Breast size can be a relative contraindication. Treatment by irradiation of women with large or pendulous breasts is feasible if reproducibility of patient set-up can be assured and the technical capability exists for greater than or equal to six MV photon beam irradiation to obtain adequate dose homogeneity.