Endoscopic breast surgery for breast cancer

Since 1995, endoscopic breast surgery (EBS) has been gradually established in Japan. Establishment of EBS was inextricably linked to explosive development of instruments for endoscopic surgery and profound theoretical understanding, how to perform broad & stable dissection of the compact connective tissue thorough small incisions. EBS consisted chiefly of two procedures added to breast and axilla and procedures to breast is classified into three methods according to incisions, axillar, periareolar and combined incisions. With EBS technique, any kind breast surgery, sentinel node biopsy, reconstruction, augmentation, and benign tumor excision, could be performed through same skin incisions. Curability of breast cancer EBS is same as that with conventional method and local recurrence rate after total and partial mastectomy. All breast cancer without skin involvement of cancer would be candidate for EBS. To minimize invasiveness of treatment and maintain cosmetic outcome of breast, combination treatment of ablation treatment, EBS and evolution of radiation therapy would be important.     

Inflammatory breast cancer

The very original definition of carcinomatous mastitis suggests the main diagnostic difficulty of this onchologic condition. Actually it is more correctly appointed as inflammatory breast cancer, because notwithstanding the inflammatory appearance, it is a true systemic breast cancer, for which surgery represents an only marginal treatment resource. If is now well known that radical mastectomy is ineffective and only a combination of CT and RT offers survival results of some value. But the actual correct multi modal treatment cannot be undertaken if not after a correct diagnostic confirmation, avoiding an anti-inflammatory therapeutic attempt that is time consuming and possibly deceptive. Surgery and histology can be the only means of a correct diagnosis when FNAB is falsely negative, but the lymph nodes must be the preferential tissue to examinate to avoid long lasting drainage from the breast parenchyma after a biopsy, that delays the beginning of the true treatment.     

Metastatic breast cancer

The unfortunate reality of metastatic breast cancer is that all treatment is palliative in nature. This is a disease that currently has no cure and for which therapy is directed towards accentuating survival and relieving symptoms. Current technology allows the prediction and detection of metastases earlier and with greater accuracy. These achievements need to be consolidated by the discovery of innovative therapies that can alter the inevitable outcome of this disease.     

Male breast cancer

Male breast cancer is rare, and many patients and health care providers are not familiar with this entity. Although the underlying causes are not well understood, certain populations are at higher risk, including certain gene mutation carriers, men with Klinefelter syndrome, and certain ethnic groups. Male breast cancer typically presents at a later stage than female breast cancer. A palpable mass is the most common presentation, but nipple discharge or other nipple changes may be seen. Because the number of affected individuals is small, prospective trials have not been conducted; thus, treatment recommendations are typically taken from large trials involving female breast cancer populations. Although outcomes in male breast cancer were previously thought to be worse than female breast cancer outcomes, it appears that they are similar. Questions regarding the most effective surgical and adjuvant therapies remain. Mastectomy with axillary lymph node evaluation, adjuvant hormonal therapy, and chemotherapy are commonly used. Providers of health care to male patients must be aware of the possibility of breast cancer and appropriately evaluate any suspicious changes.     

Inflammatory breast cancer

Of all malignancies in women, perhaps none is as lethal or as frustrating to the surgeon as inflammatory breast cancer. No significant progress in curing or controlling inflammatory breast cancer was made until the last decade, when investigators, noting the futility of local therapies, applied systemic therapies with some significant improvement in survival. This article outlines the epidemiology, clinical signs, differential diagnosis, pathology, and treatment of this disease.     

Bilateral breast cancer

A second primary breast cancer in the opposite breast can be either synchronous or metachronous. The majority are metachronous. A woman who has had breast cancer has a fivefold increase in risk for a second breast cancer. Additional risk factors include multifocal cancer, lobular carcinoma in situ, and an original cancer at an early age with long survival. Lobular carcinoma in situ is predominantly a marker for the subsequent development of a second primary breast cancer. The incidence of synchronous bilateral cancer is approximately 1% to 2% and that of metachronous cancer 5% to 6%. The cancer can be invasive or noninvasive. Mammography has increased the number of synchronous cancers found but not the overall incidence. The incidence of invasive cancer detected by random biopsy of the opposite breast is not high enough to justify routine adoption of this procedure. The remaining breast must be followed for the remainder of the patient's life by physical examination and annual mammography. The treatment of the secondary primary breast cancer should be that appropriate for the stage of the disease. The prognosis for the woman with a second primary breast cancer is quite favorable and is dependent on the stage of both the first and the second cancer.     

Inflammatory breast cancer

Historically, the prognosis of inflammatory breast cancer has been poor. We conducted a retrospective review to evaluate the recent Memorial Sloan-Kettering Cancer Center experience, to evaluate the role of combination chemotherapy, and to compare the effect of surgery and radiation on local/regional failure. Fifty-six patients with local/regional inflammatory breast cancer diagnosed between 1975 and 1984 were identified. All were treated with combination chemotherapy. Overall 5-year survival was 45% with a 5-year disease-free survival rate of 37%. Twenty-one patients were treated with induction chemotherapy followed by mastectomy and adjuvant chemotherapy. Survival and disease-free survival rates were similar to those achieved in patients treated with mastectomy followed by chemotherapy. Residual cancer was found in all 21 patients treated with induction chemotherapy, with extensive disease present in 18, including six of seven complete responders. The local/regional failure rate was 34%.     

Non-metastatic breast cancer

Seen before as a secondary branch in the field of surgery, the surgery of breast cancer is now a fully stand-alone specialty. A number of factors explain this trend: a dramatic increase of incidence, which practically doubled during the past twenty years, an evolution of the surgical practices leading to a "therapeutic coming-down" and, above all, a complexification of indications and elements of classification. The surgeon still remains the first actor of the treatment, often seing the patient in first place, and having by his surgical treatment a key action on the prognosis and the patient's quality of life. Nevertheless, the surgeon is not anymore the only master of the situation, as he once could have been. Breast cancer is now the archetypal disease where a multidisciplinary approach is mandatory at every stage. The aim of this article is to overview the reality of breast cancer at present, trying to clarify the numerous elements of classification, otherwise confusing.     

炎性乳腺癌

目的　探讨炎性乳腺癌的病理特点,诊断及治疗。方法　对７ 例病人的临床资料进行回顾性分析。结果　７ 例均手术治疗,１ 例行单纯乳腺切除术,６ 例行乳癌根治术。２ 例术前行化疗,５ 例术后行化疗及放疗。７ 例均在术后２ 年内死亡。结论　本病有其独特的临床表现及病理特点;诊断主要依靠临床表现及病理检查;治疗以综合治疗为佳。     

Bilateral breast cancer

The magnitude of the clinical problem of bilateral occurrence of breast cancer is controversial. In order to evaluate clinical and pathologic factors associated with increased risk for metachronous, contralateral breast cancer, we reviewed the records of 187 patients undergoing operative treatment for primary breast cancer by the same surgeon at a single institution. Variables analyzed included age, race, history of tuberculosis or cancer at other sites, family history of breast cancer or cancer at other sites, prior use of estrogens, tobacco, and alcohol, marital status, parity, age at first pregnancy, tumor size and location, histologic diagnosis, degree of cellular differentiation and involvement of axillary lymph nodes. The incidence of metachronous, contralateral breast cancer was 11.8 per cent. The only factor with a statistically significant association with bilateral cancer was histologic diagnosis characterized by multicentricity. Life table survival analysis revealed that the five-year survival following treatment for metachronous, contralateral cancer was 59 per cent. We conclude that bilateral breast cancer is a significant clinical problem, that histology characterized by multicentricity is associated with a higher incidence of bilateral breast cancer, and that favorable survival justifies an aggressive approach.     

Male breast cancer

Male breast cancer is uncommon but important. The diagnosis is easily made by breast biopsy, and patients are presenting earlier in the course of the disease than in the past. Despite this, patients are often first seen with tumors that have metastasized to the axillary nodes, which markedly decreases the survival rate. Therapy of localized disease includes simple excision, modified radical mastectomy, and radical mastectomy, but there is no consensus for which operation is appropriate. Radiation therapy should be strongly considered in patients with metastases to the axillary nodes, but the role of adjuvant hormonal therapy or chemotherapy is unclear. For treatment of disseminated disease, tamoxifen seems to be replacing orchiectomy. The favorable response rate, especially in patients with estrogen-receptor-positive tumors, the lack of side effects, and the high level of patient acceptability make it an attractive therapeutic choice.