Lumpectomy

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Lumpectomy
Lumpectomy 02.jpg
Lumpectomy and axillary dissection performed through one incision
Other namesPartial mastectomy
ICD-9-CM 85.21
MeSH D015412

Lumpectomy (sometimes known as a tylectomy, partial mastectomy, breast segmental resection or breast wide local excision) is a surgical removal of a discrete portion or "lump" of breast tissue, usually in the treatment of a malignant tumor or breast cancer. [1] It is considered a viable breast conservation therapy, as the amount of tissue removed is limited compared to a full-breast mastectomy, and thus may have physical and emotional advantages over more disfiguring treatment. Sometimes a lumpectomy may be used to either confirm or rule out that cancer has actually been detected. A lumpectomy is usually recommended to patients whose cancer has been detected early and who do not have enlarged tumors. Although a lumpectomy is used to allow for most of the breast to remain intact, the procedure may result in adverse affects that can include sensitivity and result in scar tissue, pain, and possible disfiguration of the breast if the lump taken out is significant. [2] According to National Comprehensive Cancer Network guidelines, lumpectomy may be performed for ductal carcinoma in situ (DCIS), invasive ductal carcinoma, or other conditions. [3]

Contents

Examples of cancers treated

DCIS, or intraductal carcinoma, is by definition a breast cancer that is limited to the lining of the milk ducts, [4] and accounts for about 20% of breast cancer in the US. [5] Although early treatment of DCIS was similar to invasive breast cancer, involving full mastectomy and sometimes lymph node dissection, an evolution in understanding about the different kinds of breast cancer prompted investigations into the adequacy of less extreme surgical treatments. The results of an eight-year randomized clinical trial in the late 1980s showed that, although lumpectomy alone was associated with significant recurrence, lumpectomy with local radiation therapy achieved similar outcomes to total mastectomy in treatment of DCIS. [6] This was the first substantial data that showed that so-called "breast conserving therapy" was a real possibility.

After a lumpectomy is performed for DCIS, local radiation therapy is typically performed to help eliminate microscopic-level disease. Axillary sentinel lymph node biopsy, as a method of screening for metastatic disease in otherwise non-invasive DCIS, is falling out of favor because the risks of procedure outweigh any effect on outcomes. [7] For DCIS, chemotherapy is not recommended, but tamoxifen may be recommended for tumors which contain an abundance of estrogen receptors. [8]

For patients with invasive ductal carcinoma who have lumpectomies, lymph node biopsy and radiation therapy are usually recommended. Adjuvant chemotherapy is often recommended, but it may not be recommended if the tumor is small and there are no lymph node metastases. For larger tumors, neoadjuvant chemotherapy may be recommended.

Procedure

A lumpectomy is a surgery to remove a breast tumor along with a resection margin of normal breast tissue. The margin is the healthy, noncancerous tissue that is next to the tumor. A pathologist analyzes the margin excised by the lumpectomy to detect any possible cancer cells. A cancerous margin is "positive", while a healthy margin is "clean" or "negative". A re-excision lumpectomy is performed if the margin is detected to be positive or cancerous cells are very close to the margin. [9] Sentinel lymph node biopsy (SLNB) or axillary lymph node dissection (ALND) may be used to determine if the cancer has progressed away from the breast and into other parts of the body. [10] Sentinel lymph node biopsy is the analysis of a few removed sentinel nodes for the presence of cancerous cells. A radioactive substance is used to dye the sentinel nodes for easy identification and removal. [2] If cancer is detected in the sentinel node then further treatment is needed. Axillary node dissection involves the excision of lymph nodes connected to the tumor by the armpit (axilla). Radiation is usually used in conjunction with the lumpectomy to prevent recurrence. [11] The radiation treatment can last five to seven weeks following the lumpectomy. Although the lumpectomy with radiation helps to decrease the risk of the cancer returning (local recurrence); it does not prolong survival; it is not a cure, and cancer may still come back. However, local recurrences (confined to the breast area) after lumpectomy can be treated effectively with mastectomy, and these women were still disease-free 20 years after their original lumpectomies and recurrence treatments. [12]

See also

Related Research Articles

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Mastectomy is the medical term for the surgical removal of one or both breasts, partially or completely. A mastectomy is usually carried out to treat breast cancer. In some cases, women believed to be at high risk of breast cancer have the operation as a preventive measure. Alternatively, some women can choose to have a wide local excision, also known as a lumpectomy, an operation in which a small volume of breast tissue containing the tumor and a surrounding margin of healthy tissue is removed to conserve the breast. Both mastectomy and lumpectomy are referred to as "local therapies" for breast cancer, targeting the area of the tumor, as opposed to systemic therapies, such as chemotherapy, hormonal therapy, or immunotherapy.

<span class="mw-page-title-main">Breast cancer</span> Cancer that originates in mammary glands

Breast cancer is cancer that develops from breast tissue. Signs of breast cancer may include a lump in the breast, a change in breast shape, dimpling of the skin, milk rejection, fluid coming from the nipple, a newly inverted nipple, or a red or scaly patch of skin. In those with distant spread of the disease, there may be bone pain, swollen lymph nodes, shortness of breath, or yellow skin.

<span class="mw-page-title-main">Paget's disease of the breast</span> Medical condition

Paget's disease of the breast is a rare skin change at the nipple nearly always associated with underlying breast cancer. Paget's disease of the breast was first described by Sir James Paget in 1874. The condition is an uncommon disease accounting for 1 to 4% of all breast cancers cases. 92% to 100% of patients with Paget's disease of the breast have an underlying breast cancer.

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<span class="mw-page-title-main">Invasive carcinoma of no special type</span> Medical condition

Invasive carcinoma of no special type (NST) is also referred to as invasive ductal carcinoma or infiltrating ductal carcinoma(IDC) and invasive ductal carcinoma, not otherwise specified (NOS). Each of these terms represents to the same disease entity, but for international audiences this article will use invasive carcinoma NST because it is the preferred term of the World Health Organization (WHO).

<span class="mw-page-title-main">Radical mastectomy</span> Removal of cancerous breast

Radical mastectomy is a surgical procedure that treats breast cancer by removing the breast and its underlying chest muscle, and lymph nodes of the axilla (armpit). Breast cancer is the most common cancer among women. During the early twentieth century it was primarily treated by surgery, when the mastectomy was developed. However, with the advancement of technology and surgical skills in recent years, mastectomies have become less invasive. As of 2016, a combination of radiotherapy and breast conserving mastectomy are considered optimal treatment.

<span class="mw-page-title-main">Ductal carcinoma in situ</span> Medical condition

Ductal carcinoma in situ (DCIS), also known as intraductal carcinoma, is a pre-cancerous or non-invasive cancerous lesion of the breast. DCIS is classified as Stage 0. It rarely produces symptoms or a breast lump one can feel, typically being detected through screening mammography. It has been diagnosed in a significant percentage of men.

<span class="mw-page-title-main">Axillary lymph nodes</span> Lymph nodes in the human armpit

The axillary lymph nodes or armpit lymph nodes are lymph nodes in the human armpit. Between 20 and 49 in number, they drain lymph vessels from the lateral quadrants of the breast, the superficial lymph vessels from thin walls of the chest and the abdomen above the level of the navel, and the vessels from the upper limb. They are divided in several groups according to their location in the armpit. These lymph nodes are clinically significant in breast cancer, and metastases from the breast to the axillary lymph nodes are considered in the staging of the disease.

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<span class="mw-page-title-main">Breast-conserving surgery</span> Surgical operation

Breast-conserving surgery refers to an operation that aims to remove breast cancer while avoiding a mastectomy. Different forms of this operation include: lumpectomy (tylectomy), wide local excision, segmental resection, and quadrantectomy. Breast-conserving surgery has been increasingly accepted as an alternative to mastectomy in specific patients, as it provides tumor removal while maintaining an acceptable cosmetic outcome. This page reviews the history of this operation, important considerations in decision making and patient selection, and the emerging field of oncoplastic breast conservation surgery.

<span class="mw-page-title-main">Medullary breast carcinoma</span> Rare type of breast cancer

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Comedocarcinoma is a kind of breast cancer that demonstrates comedonecrosis, which is the central necrosis of cancer cells within involved ducts. Comedocarcinomas are usually non-infiltrating and intraductal tumors, characterized as a comedo-type, high-grade ductal carcinoma in situ (DCIS). However, there have been accounts of comedocarcinoma which has then diversified into other cell types and developed into infiltrating (invasive) ductal carcinoma. Recurrence and survival rates differ for invasive breast cancer which has originated as comedocarcinoma compared with other types of cancer cells.

<span class="mw-page-title-main">Lobular carcinoma in situ</span> Medical condition

Lobular carcinoma in situ (LCIS) is an incidental microscopic finding with characteristic cellular morphology and multifocal tissue patterns. The condition is a laboratory diagnosis and refers to unusual cells in the lobules of the breast. The lobules and acini of the terminal duct-lobular unit (TDLU), the basic functional unit of the breast, may become distorted and undergo expansion due to the abnormal proliferation of cells comprising the structure. These changes represent a spectrum of atypical epithelial lesions that are broadly referred to as lobular neoplasia (LN).

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<span class="mw-page-title-main">Male breast cancer</span> Medical condition

Male breast cancer (MBC) is a cancer in males that originates in their breasts. Males account for less than 1% of new breast cancers with about 20,000 new cases being diagnosed worldwide every year. Its incidence rates in males vs. females are, respectively, 0.4 and 66.7 per 100,000 person-years. The worldwide incidences of male as well as female breast cancers have been increasing over the last few decades. Currently, one of every 800 men are estimated to develop this cancer during their lifetimes.

<span class="mw-page-title-main">Atypical ductal hyperplasia</span> Medical condition

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Papillary carcinomas of the breast (PCB), also termed malignant papillary carcinomas of the breast, are rare forms of the breast cancers. The World Health Organization (2019) classified papillary neoplasms of the breast into 5 types: intraductal papilloma, papillary ductal carcinoma in situ (PDCIS), encapsulated papillary carcinoma (EPC), solid-papillary carcinoma (SPC), and invasive papillary carcinoma (IPC). The latter four carcinomas are considered here; intraductal papilloma is a benign neoplasm. The World Health Organization regarded solid papillary carcinoma as having two subtypes: in situ and invasive SPC.

<span class="mw-page-title-main">Pure apocrine carcinoma of the breast</span> Medical condition

Pure apocrine carcinoma of the breast (PACB) is a rare carcinoma derived from the epithelial cells in the lactiferous ducts of the mammary gland. The mammary gland is an apocrine gland. Its lactiferous ducts have two layers of epithelial cells, a luminal layer which faces the duct's lumen and a basal layer which lies beneath the luminal layer. There are at least 4 subtypes of epithelial cells in these ducts: luminal progenitor cells and luminal mature cells which reside in the luminal layer and mammary stem cells and basal cells which reside in the basal layer. Examination of the genes expressed in PACB cancer cells indicate that most of these tumors consist of cells derived from luminal cells but a minority of these tumors consist of cells derived from basal cells.

References

  1. ↑ "Breast lump removal: MedlinePlus Medical Encyclopedia". medlineplus.gov. Retrieved 2018-11-07.
  2. 1 2 "Lumpectomy - Mayo Clinic". Mayoclinic.org. Retrieved 19 April 2018.
  3. ↑ "Lumpectomy". Desertsurgical.com. Archived from the original on 27 March 2016. Retrieved 19 March 2013.
  4. ↑ "Ductal Carcinoma In Situ (DCIS)". PubMed Health Glossary.
  5. ↑ DeSantis C, Siegel R, Bandi P, Jemal A (2011). "Breast cancer statistics, 2011". CA: A Cancer Journal for Clinicians. 61 (6): 409–18. doi: 10.3322/caac.20134 . PMID   21969133. S2CID   207727461.
  6. ↑ Fisher B, Redmond C, Poisson R, Margolese R, Wolmark N, Wickerham L, Fisher E, Deutsch M, Caplan R, Pilch Y (March 1989). "Eight-year results of a randomized clinical trial comparing total mastectomy and lumpectomy with or without irradiation in the treatment of breast cancer". The New England Journal of Medicine. 320 (13): 822–8. doi:10.1056/nejm198903303201302. PMID   2927449.
  7. ↑ Zujewski J, Eng-Wong J (August 2005). "Sentinel lymph node biopsy in the management of ductal carcinoma in situ". Clinical Breast Cancer. 6 (3): 216–22. doi:10.3816/cbc.2005.n.023. PMID   16137431.
  8. ↑ "Ductal carcinoma in situ". Getglue.com. Retrieved 19 March 2013.[ permanent dead link ]
  9. ↑ "About 20% of Women Need More Surgery After Lumpectomy". Breastcancer.org. 2015-02-05. Retrieved 19 April 2018.
  10. ↑ "Surgery for Breast Cancer". Cancer.org. Retrieved 19 April 2018.
  11. ↑ Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER, Jeong JH, Wolmark N (October 2002). "Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer". The New England Journal of Medicine. 347 (16): 1233–41. doi: 10.1056/NEJMoa022152 . PMID   12393820. S2CID   4634763.
  12. ↑ "Lumpectomy Plus Radiation". Breastcancer.org. 2015-03-04. Retrieved 19 April 2018.
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