Surgery is still one of the main treatments for breast cancer. The trend of surgery for breast cancer is to minimize the surgical damage and try to keep the appearance for patients for the early breast cancer.A variety of surgical indications and contraindications for breast cancer were introduced as followed:
Indications for surgery
Generally, breast cancer with international clinical stage at 0, Ⅰ, Ⅱperiod and some of Ⅲ period patients without contraindications. However, in the recent years breast cancer surgery tends to shrink, so for the patients with stage 0 and some Ⅰ, Ⅱ breast cancer, it was considered no longer applicable to the standard radical mastectomy. Therefore, some scholars have put forth more specific indications for surgery.
- Standard indications: tumor size is 5cm below in the outer half of the breast; axillary lymph nodes have been touched.
- Special indications: tumor size is more than 5cm; or nothing to do with the size of the tumor; the tumor has been fixed in the chest wall with infiltration ulcers and orange peel-like change of the skin.
2.Extended radical mastectomy
Extended radical mastectomy refers to removal of parasternal (internal mammary blood vessels) the lymph nodes during the radical mastectomy. It is Adapted to the primary cancer with medial area and central area, especially with axillary lymph node metastasis in clinical examination.
3.Modified radical mastectomy
Modified radical mastectomy is for the patients with the early stage ofⅠ and Ⅱ stage.
The indications are: ① in situ breast cancer. ② small breast cancer or eczema-like lesions confined to the nipple. ③ the elderly and infirm are not suitable for radical surgery, simple mastectomy can be used, if necessary, postoperative radiation therapy. ④ locally lesions at the late stage, as a part of the comprehensive treatments.
Partial excision is for early breast cancer without lymph node metastasis. tumor diameter should be less than 4cm, and the skin and chest muscle no adhesions; axillary lymph nodes can reach isolated, but no adhesions with chest wall and vessels and nerve bundles of axillary; in the meanwhile the breasts must be large enough so that can achieve satisfactory breast shape after surgery.
- tumor distant metastasis.
- frail and elderly cannot tolerate surgery.
- generally poor and cachexia.
- important organ dysfunction can not tolerate surgery.
2. Localized diseasen contraindications: patients of Ⅲ stage with one of the following conditions:
- orange peel-like skin, edema of the breast area of more than half of the breast;
- satellite nodular breast skin;
- violations of breast cancer chest wall;
- parasternal lymph nodes of clinical examination Enlargement and confirmed to be transferred;
- ipsilateral upper extremity edema;
- supraclavicular lymph node metastasis was confirmed by pathology;
- inflammatory breast cancer.
Both of the following five circumstances:
- tumor ulceration;
- breast orange peel skin, like breast edema of the total area of 1/3 or less;
- cancer with pectoralis major fixed;
- maximum diameter of axillary lymph node more than 2.5cm;
- axillary lymph adhesion to each other, or with nodes and skin, deep tissue