The Different Methods Of Management Of The First Stagee Of Cancer Breast:

Ibrahem Ahmed Ibrahemd Awood

c-r~---- - ----- ----.. . SUMMARY1 -~SUMMARYCarcinoma of the breast is, currently, the most commonly diagnosedtumour among females ( nearly 1 in every 9 females, will exhibit thedisease during here life in and it is the second leading cause of cancerdeaths in females (after carcinoma of the lung).The breast is a modified sweat gland lying on the pectoral fascia as asubcutaneous organ.The aetiology of the disease is still unknown, but there are manyfactors, known as risk factors, which increase the women’s risk fordeveloping carcinoma of the breast. Of these factors, family history ofbreast cancer, previous history of contralateral breast cancer, earlymenarche and late menopause , hormones, nulliparity and age greater thanforty, nutrition and body size, alcohol, other malignancies ....etc.Pathologically, most breast cancers are duct cell carcinomas and aminority are lobular carcinomas, both may be present as non invasivelesions i.e. neTS and LCiS Inflammatory breast cancer and Paget’sdisease of the nipple represent special conditions of cancer breast. Stagingis grouping of patients according to the extent of their disease, and it isdone for prognostic purposes. The most commonly used system forstaging is the T.N.M. system. The first stage of cancer breast is defined,according to the T.N.M. system, as T] NO MO and according to theManchester classification as a localized growth in the breast without orwith skin attachement or ulceration not exceeding the size of the tumour,the tumour must not be adherent to the pectoral muscles or chest wall, andno palpable axillary lymph nodes.The only hope for improvement of outcome of different modalities oftreatment of breast cancer is early detection, which can be reached via101screemng programs, specially for high risk women, including both BSEphysician examination and screening mammography, as there is one thirdreduction in mortality, from cancer breast after screening.The ACS and NCI (1980) recommended a special program forscreening mammography aiming at early detection of breast cancer(mentioned before).However, even properly performed mammogram fail to disclose 10-15% of carcinomas of the breast and the causes of the negativemammography were mentioned before, so ,once the decision toinvestigate a suspecious area in the breast has been made, some type ofbiopsy must be done.Breast biopsy is indicated for mammographic abnormality suggestinga malignancy’ or for a solid mass on physical examination. Biopsytechniques include FNAC , needle core, excisional and incisional biopsy.Ultrasonography, thermography, MRI, breast transillumination areother methods for diagnosis.D.T.P.A. breast scintigraphy on suspected breast cancer, was ofvalue 1I1 establishment or exclusion of breast cancer, but this diagnosticvalue IS too low in comparison with mammography. DNA ploidy may beof value in predicting the most biologically aggressive pre-invasive breastdisease or invasive carcinoma arising from DCIS.Local and regional therapy include surgical and radiation therapy,the surgical options include mastectomy with or without axillary nodaldissection or conservative surgery with or without axillary nodaldissection and with or without radiation therapy. Conservative surgerywith radiation, in selected patients, provide survival equivalent to MRM,for larger lesions, MRM is the standard procedure.102,.’Adjuvant therapy (hormonal and non hormonal) improve the diseasefreesurvival and decrease the rate of local and distant recurrence in nodenegative patients.Reconstruction IS extremely important, immediate reconstruction isincreasingly accepted because it does not hinder follow-up care and, inselected cases reconstruction is a better alternative than breastconservation, resulting in a better cosmetic result with less chance ofrecurrence.