breast - fmg22

[ArchivalUser]

A 62-year-old woman has a 4-cm, hard mass under the nipple and areola
of her rather small left breast. The mass occupies most of the breast, but
the breast is freely movable from the chest wall. There is no dimpling or
ulceration of the skin over the mass, and careful palpation of the axilla
is completely negative. A core biopsy of the breast mass has established a
diagnosis of infiltrating ductal carcinoma, and the mammogram showed no other
lesions in that breast or the other one. A chest x-ray film and liver function
tests are normal. She has no symptoms suggestive of brain or bone metastasis. Which of the following should be offered to this woman


A. Lumpectomy
only


B. Lumpectomy
with axillary sampling and post-op radiation


C. Total mastectomy
only


D. Modified
radical mastectomy (including axillary sampling)


E. Radical
mastectomy (including complete axillary dissection

[ArchivalUser]

D. Modified radical mastectomy (including axillary sampling)? not sure

[ArchivalUser]

D>...

[ArchivalUser]

dddddddd

[ArchivalUser]

why not b..

[ArchivalUser]

its a small breast...mass occupies whole of the breast.....how do u plan to do a lumpectomy with a cancer free margin...it will be easier to do mastectomy

[ArchivalUser]

got it. thanks

[ArchivalUser]

The correct answer is D. The
mass is too large, in a breast that is too small, to allow an adequate lumpectomy.
Local control of the tumor requires mastectomy. However, mastectomy alone
is not sufficient. We need to know what is happening in the axilla to make
a decision regarding postoperative systemic therapy. The physical examination
was negative, but the reliability of that finding is not much better than
flipping a coin.
Lumpectomy alone (choice A)
cannot be done here, and it would not be the appropriate management even if
the cancer had been smaller.
Lumpectomy, axillary sampling, and post-op radiation (choice B) would have been the correct answer for a smaller tumor
in a larger breast.
Total mastectomy alone (choice C)
would have been a wise palliative choice if she had had evidence of distant
metastasis. She does not. We have to go for cure. We need the standard potentially
curative operation: modified radical mastectomy, which includes axillary sampling.
Radical mastectomy (choice E)
is no longer used for the treatment of breast cancer. It offers no survival
advantage over the less mutilating modified radical

[ArchivalUser]

D. Modified
radical mastectomy (including axillary sampling)