Breast conservation surgery for breast cancer is indicated in one of the following conditions:
Ans. is 'a' i.e. breast tumour & V Extensive in situ cancer It's quite sure that for Multicentric tumor and T4b breast tumor conservative surgery is not indicated.Multicentricity means occurrence of a second breast cancer outside the breast quadrant of the primary cancer (cf: Multifocality refers to the occurrence of a second cancer within vicinity or in the same breast quadrant as the primary cancer)T4b Breast tumor implies - tumor of any size with skin involvement (cf: T4a implies tumors of any size with chest involvement) Both T4a & T4b are relative contraindication for Breast Conservative SurgerySo we are left with two optionsT1 breast tumor and Extensive in situ cancerT1 breast tumour (means tumor <2 cm in size)BCT is done in T1 tumors (unless some contraindications are present)Extensive in situ cancer Here the examiner is talking about extensive intraductal component - EIC'EIC is a pattern of DC1S that is seen associated with invasive carcinoma.The above mentioned book writes - "At our institution EIC positive tumors are defined as invasive carcinomas that show the simultaneous presence of prominent DCIS within the tumor (usually comprising 25% or more of the area of the tumor) and DCIS beyond the edges of the invasive tumor. Also included among EIC positive cases are tumors that are predominantly DCIS with one or more foci of microinvasion.The significance of EIC positive tumors is that in these tumors the intraductal involvement is more extensive than can be appreciated clinically or at the time of surgery. Therefore EIC positive patients who undergo a limited resection of the clinically evident- tumor frequently have considerable residual DCIS in the vicinity of the tumor site. This earlier led to increased recurrence in EIC positive tumors managed by BCT.But, now these tumors are not a contraindication for BCT, provided that microscopically negative margins can be obtained (Ref: Washington Manual of Surgery 4th/e, p 533). More careful mammographic & pathological evaluation are necessary on EIC positive tumors to define the extent of the lesion and to determine the adequacy of excision.But if one answer is to be chosen, it would be option (a) i.e. T1 breast tumor.For complete management of Breast carcinoma Refer to Chapter- "Breast" in our 'Surgery for PGMEE'
T1 breast tumor
Multicentric tumor
Extensive in situ cancer
T4b breast tumor
Breast Cancer - Treatments