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- external radiation boost or internal implant as well as the usual external beam therapy to the entire breast.
- • Removal of a larger wedge or portion of the breast, again with an axillary node dissection and radiation to the
- breast. This has a lower failure rate than lumpectomy with radiation. For both lumpectomy and wedge
- resections, the margins must be free of cancer. If they are not, there is a much higher local failure rate.
- Sometimes (less than 10 percent of the time for Stages I and II) a tumor seems small, but with microscopic
- study is found in multiple sites or is found to be so extensive that a mastectomy may be needed to remove all
- cancer and improve the chance for cure.
- • Modified radical or a total mastectomy, with removal of axillary Iymph nodes . Radiotherapy is sometimes
- used after a modified radical mastectomy in patients at high risk for microscopic residual tumor that could lead
- to a recurrence in the area of surgery. If possible, however, the surgeon will ensure that the tissues at the edge
- of the surgical incision are free of cancer cells . If radiotherapy is used, it is 90 to 95 percent effective in
- eliminating these cells and preventing tumor recurrences in the skin of the chest, which is a very troublesome,
- hard to manage problem that is far easier to prevent.
- Removing the tumor and a portion of surrounding tissue while conserving a major part of the breast, usually
- if followed by radiation therapy , provides a cure rate about the same as the modified radical mastectomy.
- The conventional recommendation has been to remove the axillary lymph nodes, since about one-third of
- patients who do not have obviously enlarged nodes still have microscopic involvement (positive nodes
- reclassifies the disease as Stage II, a treatment category requiring adjuvant chemotherapy or hormone therapy).
