Pre-treatment evaluation in a woman diagnosed with breast cancer begins with a detailed medical history. How long the complaints have been present and the family’s disease history should be questioned in detail. The drugs used and known diseases of the patient are important when presenting the treatment options.
After taking the detailed personal and family history of the patient, the physical examination findings come next. The breast is observed/examined in terms of asymmetry between the two breasts, skin disorder, skin recession, redness, and nipple collapse. The location of the mass, its proximity to the breast skin and chest wall, and swelling of the underarm lymph nodes, if any, should be recorded. These findings and history will shed light on the treatment we will choose.
Then imaging tests are examined. Mammography and breast ultrasonography give us information about the spread of the tumor. We use tomography, bone scintigraphy or PET imaging tests for distant spread of the tumor. The clinical staging of the patient, whose entire examination has been completed, is made according to the results of the examination. This staging is not definitive staging. The final staging is only done according to the pathology report to be released after the operation. However, preoperative clinical staging is also required before treatment. Accordingly, the prescribed treatment options are shared with the patient.
Treatment usually requires a combination of surgery + chemotherapy + radiotherapy. Surgery is mostly used in the first place. But sometimes we can give priority to chemotherapy. The goal of surgery is to remove the cancerous tissue. In addition, we can make the final staging according to the criteria included in the post-surgical pathology report. The final pathology report will guide the chemotherapy and radiotherapy plan.
The type of surgical treatment is determined by talking to the patient according to the clinical stage of the patient, personal disease and family history, age of the patient and expectations from the treatment. Breast-conserving surgery can be applied in cases where the breast volume is suitable, the tumor diameter is small and there is no objection to receiving radiotherapy. Radiotherapy is essential to prevent tumor re-development in the remaining breast tissue after these operations. Breast-conserving surgery should not be considered in patients who do not want to receive radiotherapy or who are inconvenient to receive radiotherapy due to their personal disease history. In these cases, it is recommended to completely empty the breast, that is, to perform a mastectomy.
During breast-conserving surgery, the tumorous tissue is completely cleared. The surgery is completed with a cosmetically acceptable breast image by using healthy breast tissue to fill the remaining space. Sometimes silicone prosthesis can be used for this purpose. Sometimes, if both breast volumes are more than desired, bilateral breast reduction can both remove the tumor and achieve a cosmetically satisfactory result. a new breast tissue can be created.
A part of the surgical treatment is the evaluation of the lymph nodes under the arm. For this purpose, a special dye is given from the nipple during the operation. With the massage applied to the breast, it is ensured that the dye reaches the lymph nodes under the arm. Then, the dyed lymph nodes are accessed with a 1-2 cm incision made under the arm. The dyed lymph nodes taken from here are subjected to rapid pathological examination (frozen). If no tumor is detected in the lymph nodes, it is not possible to go further.