Lumpectomy Health Dictionary

A surgical operation to remove part or all of the breast (see BREASTS). It is usually done to treat cancer, when it is commonly followed by CHEMOTHERAPY or RADIOTHERAPY (see BREASTS, DISEASES OF). There are four types of mastectomy: lumpectomy, quandrantectomy, subcutaneous mastectomy and total mastectomy. The choice of operation depends upon several factors, including the site and nature of the tumour and the patient’s age and health. Traditionally, radical mastectomy was used to treat breast cancer; in the past three decades, however, surgeons and oncologists have become more selective in their treatment of the disease, bringing the patient into the decision-making on the best course of action. Lumpectomy is done where there is a discrete lump less than 2 cm in diameter with no evidence of glandular spread. A small lump (2–5 cm) with limited spread to the glands may be removed by quadrantectomy or subcutaneous mastectomy (which preserves the nipple and much of the skin, so producing a better cosmetic e?ect). Lumps bigger than 5 cm and ?xed to the underlying tissues require total mastectomy in which the breast tissue, skin and some fat are dissected down to the chest muscles and removed. In addition, the tail of the breast tissue and regional lymph glands are removed. In all types of mastectomy, surgeons endeavour to produce as good a cosmetic result as possible, subject to the adequate removal of suspect tissue and glands.

Breast reconstructive surgery (MAMMOPLASTY) may be done at the same time as the mastectomy – the preferred option – or, if that is not feasible, at a later date. Where the whole breast has been excised, some form of arti?cial breast (prosthesis) will be provided. This may be an external prosthesis ?tted into a specially made brassiere, or an internal implant – perhaps a silicone bag, though there has been controversy over the safety of this device. Reconstructive techniques involving the transfer of skin and muscle from nearby areas are also being developed. Post-operatively, patients can obtain advice from Breast Cancer Care.... mastectomy

An OESTROGENS receptor antagonist – namely, the drug blocks the action of oestrogen – which is the treatment of choice for breast cancer (see BREASTS, DISEASES OF) in postmenopausal women in conjunction with LUMPECTOMY or partial or complete MASTECTOMY. Around 30 per cent of patients in whom breast cancer has spread to adjacent glands or beyond respond to this hormonal treatment. In patients with tumours that are oestrogen-sensitive, the positive response to tamoxifen is 60 per cent; those tumours that are not oestrogen-sensitive are much less likely to respond to the drug. Tamoxifen increases both survival rates and the period between the diagnosis of the tumour and appearance of metastatic growth (see METASTASIS) in tumours sensitive to it. The drug has fewer adverse effects than most others used for treating breast cancer. Patients in whom the cancer has spread to the bone(s) may suffer pain with tamoxifen treatment.

Tamoxifen is also used to treat INFERTILITY, being taken on certain days of the menstrual cycle (see MENSTRUATION).... tamoxifen

A surgical procedure that involves the removal of tissue in one quadrant of a breast in order to treat breast cancer. (See also lumpectomy; mastectomy.)... quadrantectomy

a malignant tumour of the breast, usually a *carcinoma, rarely a *sarcoma. It is unusual in men but is the most common form of cancer in women, in some cases involving both breasts. Cumulative exposure to higher oestrogen levels is implicated as a causal factor: breast cancer is most strongly associated with early menarche and late menopause, childlessness, and late age at the birth of the first child, and hence with an increase in the total number of menstrual cycles in a woman’s life. Approximately 5% of cases are due to the *BRCA1 and BRCA2 gene mutations.

The classic sign is a lump in the breast, usually painless; bleeding or discharge from the nipple may occur infrequently. Sometimes the first thing to be noticed is a lump in the axilla (armpit), which is caused by spread of the cancer to the drainage lymph nodes. The tumour may also spread to the bones, lungs, and liver. Current treatment of a localized tumour is usually by surgery (see lumpectomy; mastectomy), with or without radiotherapy; cytotoxic drugs and hormone therapy are used as *adjuvant therapy and *neoadjuvant chemotherapy and for widespread (metastatic) disease. Anti-oestrogenic agents used include *tamoxifen and (more recently) *aromatase inhibitors and *trastuzumab (Herceptin).... breast cancer