BREAST CANCER BASE

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One, surgical treatment

Surgical treatment of breast cancer remain the main means of treatment. A variety of style, yet its lack of unified choice views, the general trend is to minimize the surgical destruction, the equipment allowed under the conditions of early breast cancer patients do much to preserve the breast contour. Regardless of the selection operation, must strictly adhere to radical mainly reservations function and appearance supplemented principle.

(1) surgical indications Halstyed pioneering radical mastectomy for cancer, surgery reasonable, clear effect, in the last century become the treatment of breast cancer followed by the standard method. For nearly half a century, the right type of breast cancer for a number of exploratory changes, the overall trend conservative and expand no more than two, since it is still going on. Local excision of breast milk and the whole conservative surgical resection is the representation of surgery. After need to be complemented by radiotherapy, radiotherapy dose mixed, but generally 30 to 70Gy, to the strict limitations of the choice of early cancer, can produce better results. But whether early breast cancer as conventional treatment methods, and how to choose the accuracy of such early cancer, the harder draw conclusions.

(2) surgical contraindication

1. Systemic contraindication : ① distant metastasis. ② the elderly and the infirm who can not tolerate surgery. ③ poor general condition, showing positive for cachexia persons. ④ important organ dysfunction can not tolerate the surgery.

2. Local lesions followed : Phase III patients with any of the following situations : ① breast orange peel-like skin edema more than half of the breast area; ② breasts skin-satellite nodules; ③ violations chest wall breast cancer; ④ clinical examination parasternal lymphadenopathy has proved to transfer; The affected ⑤ upper limb edema; ⑥ supraclavicular lymph nodes pathologically confirmed for the transfer; ⑦ inflammatory breast cancer. Any of the following five circumstances of the two : ① ulceration; ② breast orange peel-like skin edema entire breast area l / 3 or less; ② cancer and chest fixation; ④ axillary lymph node largest diameter over 2.5 cm; ⑤ axillary lymph node with each other adhesion or skin, deep tissue adhesion .

(3) surgery

1. Radical mastectomy for breast cancer : in 1894 and Meger Halstyed issued radical mastectomy operation of the principle of operation : ① original tumor and regional lymph nodes should be en bloc; ② removal of the breast and chest all the large and small muscle; ③ got the axillary lymph nodes for complete resection. Haagensen improved breast cancer surgery, stressed the operation should be performed particularly thorough, meticulous main ① stripping flap; ② flap completely separated from those of work-thoracic wandered goblet 1970? BR> small muscle cut, the field broken up; ③ axillary dissection, the long thoracic God Drive should be preserved, such as axillary no significant swelling of lymph nodes were then thoracodorsal nerve also be retained; ④ chest wall defects will be skin grafting. Intraoperative complications : ① axillary vein injury : more in the surrounding anatomy axillary vein fats and lymphoid tissue, the anatomic unclear, or by cutting off branches of axillary vein, too close to the trunk caused axillary vein. Therefore, a clear exposure and retain the branch ends, is important. ② pneumothorax : cut pectoralis major and pectoralis minor muscle rib breaks, and sometimes because of the small clamp chest wall penetrating vascular branch, under clamp too deep, and who contravene the break and pleural intercostal muscles, causing tension pneumothorax. Postoperative complications : ① subcutaneous fluid : more skin graft fixed by the poor or poor drainage caused. Subcutaneous use with multiple chest wall organizations suturing and continuing drainage and prevent. ② skin necrosis : skin suture overextended and skin can be too thin for such causes. More skin defect, it should use skin grafting. ③ limb edema. Limb favors limited : the main activities is to reduce postoperative skin scars caused traction. Therefore, the request for early postoperative functional training, should generally be about a month after the basic capability of easily attainable level.

2. Radical Surgery expand breast cancer : breast cancer, including radical surgery for treatment of breast cancer that is radical operation and internal mammary lymph node dissection was that the removal of lymph nodes 1-4 intercostal, when required resection of the second, third and fourth rib. Surgery is within the law and pleural Extrapleural France, the former trauma, complications, and they tend to use the latter.

3. Imitation of Radical Surgery (modified radical mastectomy) : used mainly for non-invasive carcinoma Phase I or invasive cancer. Phase II clinical no axillary lymphadenopathy, may choose to use.

(1) Type I : reservations pectoralis major and pectoralis minor muscles. The skin incision and flap with the principle of separation of radical operation. Then the whole milk resection (pectoralis major surgical resection together fascia), the whole milk lateral to the axillary dissection, and then OK axillary lymph node dissection, with the removal of the basic scope of radical operation. God chest Drive should be retained. Finally, the whole milk and axillary lymph en bloc.

(2) Type II : reservations chest, remove the pectoralis minor muscle. Steps such as skin incision with the former, breast dissociation to the outer edge of pectoralis major, the first cut ectopectoralis 4,5,6 rib attachment points and turned over to the operative field to expand the scapula Coracoid Department cut pectoralis minor muscle attachment points, the following steps with radical operation, it should be noted retain their chests with nerve and vascular Finally, we will all breast and pectoralis minor muscle and armpit lymph en bloc.

4. Resection of breast simple : As an ancient type of breast cancer and have been replaced by the radical operation. In recent years, with the development of breast cancer biology, and resection of the whole milk has once again aroused attention. Its indications : First, for non-invasive or without axillary lymph node metastasis in the early cases, can not increase postoperative radiotherapy. Two of local breast cancer in later with a simple after radiotherapy. If the growing demands of the beauty, the whole milk excision of the complexity of the needs of breast reconstruction. Young and middle-aged women will be unsuitable for early disease. It should be the main indication for the elderly and frail limit or only some of palliative resection of advanced cases.

5. Less than whole milk resection of operation : In recent years, due to radiation therapy equipment advances, the lesions were found earlier than before and right after the patient's quality of life requirements, it has been reported that there were a lot less than the removal of the entire breast conservative surgery. Since the operation of local excision until l / 4 breast surgery and postoperative radiotherapy for some applications.

Breast surgery is not suitable for all cases of breast cancer, and could not replace all the radical operation, but a breast cancer treatment improvements, should be taken to avoid recurrence. Their indication is as follows : ① smaller, applicable to clinical T1 and T2 part (less than 4 centimeters) below lesions; ② around the tumor, located under the areola were often inappropriate; ③ single lesion; ④ tumor clear boundary, such as the naked eye or under a microscope can not see a clear edge sector frequently inappropriate; ⑤ no clear axillary lymph node metastasis. The effect of the treatment with the following factors : ① margin must have normal boundaries, if adequate margin of normal organizers better prognosis; ② primary tumor size and histological classification; ③ postoperative radiotherapy treatment, if not for postoperative radiation therapy, the higher the rate of local recurrence.

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