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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.
Breast cancer is a 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.
Carcinoma in situ (CIS) is a group of abnormal cells. While they are a form of neoplasm,there is disagreement over whether CIS should be classified as cancer. This controversy also depends on the exact CIS in question. Some authors do not classify them as cancer,however,recognizing that they can potentially become cancer. Others classify certain types as a non-invasive form of cancer. The term "pre-cancer" has also been used.
Lumpectomy is a surgical removal of a discrete portion or "lump" of breast tissue,usually in the treatment of a malignant tumor or breast cancer. 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. According to National Comprehensive Cancer Network guidelines,lumpectomy may be performed for ductal carcinoma in situ (DCIS),invasive ductal carcinoma,or other conditions.
Invasive carcinoma of no special type,invasive breast carcinoma of no special type (IBC-NST),invasive ductal carcinoma (IDC),infiltrating ductal carcinoma (IDC) or invasive ductal carcinoma,not otherwise specified (NOS) is a disease. For international audiences this article will use "invasive carcinoma NST" because it is the preferred term of the World Health Organization (WHO).
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.
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 that can be felt,typically being detected through screening mammography. It has been diagnosed in a significant percentage of men.
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.
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.
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).
Breast cancer classification divides breast cancer into categories according to different schemes criteria and serving a different purpose. The major categories are the histopathological type,the grade of the tumor,the stage of the tumor,and the expression of proteins and genes. As knowledge of cancer cell biology develops these classifications are updated.
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.
Atypical ductal hyperplasia (ADH) is the term used for a benign lesion of the breast that indicates an increased risk of breast cancer.
The Duke Cancer Institute (DCI) is a National Cancer Institute-designated Comprehensive Cancer Center,research facility,and hospital. Founded in 1971,the center is part of the Duke University School of Medicine and Duke University Health System located in Durham,North Carolina,United States.
A preventive mastectomy or prophylactic mastectomy or risk-reducing mastectomy (RRM) is an elective operation to remove the breasts so that the risk of breast cancer is reduced.
Laura Esserman is a surgeon and breast cancer oncology specialist. She is the director of the Carol Franc Buck Breast Care Center at the University of California,San Francisco School of Medicine. She leads the I-SPY trials,Athena Breast Health Network and the WISDOM study. Esserman is an inductee in the Giants of Cancer Care,2018,for Cancer Diagnostics and the "less is more" approach. She performs live in the show "Audacity" which she co-created. She is also known as the "singing surgeon" for singing to her patients as they go under anesthesia.
Aesthetic flat closure after mastectomy is contouring of the chest wall after mastectomy without traditional breast reconstruction. Vernacular synonyms and related vernacular and technical terms include "going flat","flat closure","optimal flat closure","nonreconstructive mastectomy","oncoplastic mastectomy","non-skin sparing mastectomy","mastectomy without reconstruction",and "aesthetic primary closure post-mastectomy".
Mammary secretory carcinoma (MSC),also termed secretory carcinoma of the breast,is a rare form of the breast cancers. MSC usually affects women but in a significant percentage of cases also occurs in men and children. Indeed,McDvitt and Stewart first described MSC in 1966 and termed it juvenile breast carcinoma because an increased number of cases were at that time diagnosed in juvenile females. MSC is the most common form of breast cancer in children,representing 80% of childhood breast cancers,although it accounts for less than 0.15% of all breast cancers.
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.
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 four 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 2 "Eun-Sil Shelley Hwang, MD, MPH". Duke Surgery. Retrieved March 29, 2020.
- ↑ "First female chief of breast surgery at Duke named one of Time's 'Most Influential Americans'". Associated Press. March 26, 2018. Retrieved March 29, 2020.
- ↑ Harris, Eva (October 20, 2004). "UCSF Breast Care Center's Shelley Hwang, MD, named 'Local Hero'". University of California, San Francisco. Retrieved March 29, 2020.
- ↑ Chustecka, Zosia (December 18, 2006). "Breast Density Not Predictive for Invasive Cancer in DCIS". Medscape . Retrieved March 29, 2020.
- ↑ Fernandez, Elizabeth (September 29, 2011). "$6.5 Million Study Targets High Breast Cancer Deaths in Black Women". University of California, San Francisco. Retrieved March 29, 2020.
- ↑ Neergaard, Lauran (June 15, 2010). "Some early cancer overtreated; few want to wait". NBC News. Archived from the original on June 5, 2015. Retrieved March 29, 2020.
- ↑ "Study Aims to Resolve How To Manage Pre-Cancers of the Breast". Duke University Health System. February 2, 2016. Retrieved March 29, 2020.
- ↑ Maguire, Marti (May 28, 2016). "Duke cancer surgeon champions fewer mastectomies". The News & Observer . Retrieved March 29, 2020.
- ↑ Khanna, Samiha (May 5, 2016). "Breast Surgeon Shelley Hwang, MD, Named Among Time's 100 Most Influential People". Duke University Health System. Retrieved March 29, 2020.
- ↑ "Dr. Shelley Hwang Appointed to NCCN Breast Cancer Risk Reduction Panel". Duke Surgery. June 3, 2016. Retrieved March 29, 2020.
- ↑ "Dr. Shelley Hwang Accepted as ELAM Program Fellow". Duke Surgery. May 9, 2018. Retrieved March 29, 2020.
- ↑ "Three Duke Surgery Faculty Members Receive Distinguished Professorships". Duke Surgery. May 3, 2019. Retrieved March 29, 2020.