Breast cancer case - Your approach please - Forum

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Alalo

Re: Breast cancer case - Your approach please - Ärzteforum

Post#11 »

Sweden surgeon wrote:FNA of lympho node!

You and others suggested FNA but how easy it is to FNA a mobile node in the depth of a obese axilla?


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Old surgeon

Re: Breast cancer case - Your approach please - Ärzteforum

Post#12 »

If you can feel the axillary node, you can stick a needle in it
Now, if you can't feel it that well, I wouldn't bother worrying about
it
If you feel you need to biopsy the breast calcifications, do that as
the first order of business--if malignant, you don't have to worry
about the node now--it's gonna come out, right? If the breast lesion
is benign, and nothing else on breast exam or mammogram, just follow
the lady up in 6 months.
If the breast lesion is malignant (I may be getting too far ahead
here) also , consider the possibility that she may not be a candidate
for breast conservation the way you described her breasts--overly
large breasts are contraindication to radiation therapy, and
therefore conservation. Have a radiotherapist see the patient first
before committing to this course.

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A Doctor

Re: Breast cancer case - Your approach please - Ärzteforum

Post#13 »

I would biopsy (my bias is open excisional biopsy) this lymph node
if the breast calicification biopsy comes back negative. If the breast
lesion comes back positive, then will treat like any breast cancer with
clinically positive axilla.

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A Doctor

Re: Breast cancer case - Your approach please - Ärzteforum

Post#14 »

John Dissector wrote: Lumpectomy alone without radiation is even
an option for DCIS if the lesion is small enough (<1cm) Mastectomy only
indicated if breast conservation can not be carried out, usually due to too
extensive disease--just like for invasive Ca


This option is not universally agreed upon. Back to the NSABP protocol
B-17, Dr. Edwin Fiscer came to the conclusion that he found no factor or
factors as yet that indicated any subset of patients treated by
lumpectomy [for DCIS] that should not receive XRT. Some will consider no
XRT if all the following are met: pure DCIS, lesion equal to or less
than 0.4 cm, clear margins for 5-10 mm, and no distant calcifications by
magnification mammography.

An excellent review of the subject can be found in:
Pathobiological considerations relating to the treatment of intraductal
carcinoma (ductal carcinoma in situ) of the breast.

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