1.1 Multidisciplinary treatment
The term “Multidisciplinary Treatment” refers to a collaborative approach in medicine where various disciplines, including breast surgeons, oncologists, radiologists, physical therapists, and others, come together on a common platform to form a specialized team and provide consultation services for breast cancer patients.
The advantage of multidisciplinary treatment lies in the expertise of each discipline, as they can provide practical professional opinions within their respective fields. By directly discussing and deliberating on the patient’s condition with other specialized healthcare professionals, breast cancer patients can receive the most appropriate, targeted, and personalized treatment plans.
1.2 Surgical treatment for breast cancer
Due to the potential spread of cancer cells through the lymphatic pathways to the axillary lymph nodes, breast cancer tumors not only grow within the breast but can also migrate to the lymph nodes under the arm. Therefore, the purpose of breast cancer surgery is not only to remove the malignant tumor from the breast but also to diagnose whether there is lymph node involvement in the axillary region and to remove any affected lymph nodes with cancer cells.
Surgical treatment can be divided into two aspects: breast surgery and axillary lymph node surgery. The following will provide a detailed explanation of each.
1.2.1 Surgical treatment - Breast Surgery
Total Mastectomy
Total Mastectomy is a curative surgery where the surgeon completely removes the affected breast, including the tumor, nipple, areola, and a portion of the breast skin.
If the surgeon also performs Axillary Dissection, which involves removing the lymph nodes under the arm, during the total mastectomy, the entire procedure is called “Modified radical mastectomy.”
Patients who undergo total mastectomy may consider breast reconstruction during the same surgery, using implants or their own body tissue to reshape the breast. Alternatively, patients can choose to have the breast reconstruction performed in a separate surgery at a suitable time after the mastectomy.
Additionally, when appropriate, doctors can perform “Skin-sparing mastectomy” or “Nipple-areolar sparing mastectomy” to preserve the skin and nipple of the breast, resulting in a more natural and aesthetically pleasing outcome after the total mastectomy.
Breast Conservative Surgery
Breast Conservative Surgery refers to a procedure in which the surgeon preserves the patient’s normal breast tissue while removing the tumor along with the surrounding healthy breast tissue to ensure complete removal of cancerous cells at the surgical site. Breast conservative surgery includes types such as “Lumpectomy” and “Quadrantectomy.”
In most cases, doctors will perform breast conservative surgery along with axillary lymph node dissection. After the surgery, patients typically receive radiation therapy to ensure the clearance of any residual tumor cells within the breast, reducing the risk of recurrence.
The principle behind “Lumpectomy” is to remove the primary tumor and surrounding tissue within the breast, while “Quadrantectomy” involves removing a larger portion, approximately one-fourth, of the breast compared to a lumpectomy.
1.2.2 Surgical treatment - Axillary surgery
Axillary Dissection
Axillary Dissection, also known as Axillary Lymph Node Dissection, is a surgical procedure in which the surgeon removes two-thirds of the lymph nodes in the armpit (known as Level II Dissection) of breast cancer patients. Since breast cancer cells can potentially spread to the axillary lymph nodes through the lymphatic channels, axillary dissection helps to remove potential lymph node metastases and reduce the risk of cancer cells remaining in the body after surgery. The excised axillary lymph nodes are sent for pathological examination to determine if there are cancer cells present, which helps in staging the breast cancer tumor and planning postoperative adjuvant therapies.
However, due to the primary function of the axillary lymph nodes, which is to drain lymphatic fluid from the arm back into the bloodstream, approximately 10% of patients may experience a complication called lymphedema, characterized by swelling of the arm, after axillary dissection.
Sentinel Lymph Node Biopsy
The sentinel lymph node refers to the first lymph node that receives lymphatic drainage from the breast. If breast cancer cells spread to the axillary lymph nodes, they first reach the sentinel lymph node before spreading to other axillary lymph nodes through different lymphatic channels.
Sentinel Lymph Node Biopsy is a surgical procedure that involves the removal of the sentinel lymph node, which is then examined pathologically to determine if cancer cells are present. Through this procedure, doctors can infer the presence of cancer metastasis in other axillary lymph nodes. If cancer cells are detected in the sentinel lymph node, the patient may undergo axillary dissection to remove the potentially affected lymph nodes. Conversely, if no cancer cells are found in the sentinel lymph node, the axillary lymph nodes are usually left intact.
Medical research has shown that in 95% of cases, the absence of cancer cells in the sentinel lymph node indicates the absence of cancer spread to other lymph nodes.
Sentinel Lymph Node Biopsy helps to avoid unnecessary axillary dissection in patients without lymph node involvement, thus reducing the risk of complications such as lymphedema and nerve damage associated with axillary dissection.
However, not all breast cancer patients are suitable candidates for sentinel lymph node biopsy. It is typically recommended for patients with relatively small tumors, a single tumor in the breast, and no clinically apparent axillary lymph node metastasis.
