Don’t cut your breast first if you have breast cancer, you can save your breast

  The results of basic and clinical research on breast cancer show that breast cancer is a local manifestation of systemic disease and its lesions are not only limited to the breast, but can metastasize throughout the body when they are less than 1 cm in diameter. Surgery is the main treatment, together with chemotherapy, radiotherapy, endocrine therapy, immunotherapy and other comprehensive treatment measures. Clinically, corresponding treatment methods should be selected rationally according to its clinical stage, histological classification, sign type and individual patient’s condition for comprehensive treatment. Currently, the effective treatments for breast cancer include surgery, radiotherapy, chemotherapy and endocrine therapy; the first two are local treatments and the last two are systemic treatments. The first two are local treatment methods and the latter two are systemic treatment methods. The clinical selection of specific treatment methods depends on the stage of the disease. Treatment principle: Breast cancer in clinical stage I can be treated by radical surgery, or by breast-conserving surgery and post-operative radical radiotherapy. Those with tumor diameter ≥1cm should be treated with adjuvant chemotherapy and oral triamcinolone acetonide (TAM) for 5 years after hormone receptor positivity or menopause. For stage II patients, adjuvant chemotherapy is required within 2-4 weeks after radical surgery, adjuvant radiotherapy for patients with high possibility of local recurrence, and oral triamcinolone acetonide (TAM) for 5 years after hormone receptor positivity or menopause. In stage III cases, preoperative chemotherapy followed by modified radical surgery or simple mastectomy with axillary lymph node dissection followed by adjuvant radiotherapy. In stage IV patients, easy chemotherapy or hormonal therapy including ovarian denervation is the mainstay, and palliative surgery or radiotherapy is performed if necessary.  (1) Surgical treatment. Surgery is still the main treatment for breast cancer. The aim is to remove the local lesion, while clearing the axillary lymph nodes and obtaining information about regional lymph node metastasis in order to decide on a comprehensive treatment plan. There are various surgical procedures for breast cancer, and the commonly used surgical procedures include radical mastectomy, modified radical mastectomy, extended radical mastectomy, total mastectomy, and partial mastectomy with breast conservation, and there is no unified opinion on their selection. The surgical scope of surgical treatment for stage I and II breast cancer is shrinking significantly, and the classical Halsted radical mastectomy is rarely used in the treatment of stage I and II breast cancer. Several foreign studies have confirmed that there is no statistical difference in tumor-free survival and recurrence-free survival and overall survival rates between the two groups when comparing breast preservation treatment with radical mastectomy. To preserve the shape of the breast and the function of the upper extremity, a variety of less-than-total mastectomy procedures with a combination of radiotherapy and chemotherapy have been performed. In Europe and the United States, the use of radical surgery or modified radical surgery is decreasing, and the number of cases treated with local excision and radiation therapy has reached 20%-30% of breast cancer patients, thus breast preservation has become the main treatment modality for stage I and II breast cancer in western countries. Breast reconstruction is also considered. Since axillary lymph node metastasis is found in about 20% of cases, and axillary lymph node dissection has certain risks and may cause upper limb edema, dysfunction, abnormal sensation and other comorbidities, the current development of breast cancer anterior lymph node detection is intended to save patients without axillary lymph node metastasis from lymph node dissection. The purpose of the current anterior lymph node detection is to save patients without axillary lymph node metastasis from the complications of lymph node dissection.  (2) Chemotherapy treatment. Combination chemotherapy can significantly improve the outcome of breast cancer, especially premenopausal breast cancer. The current popular view is that patients with tumors larger than 1 cm in diameter can benefit from chemotherapy, regardless of the presence or absence of lymph node metastases and receptor status. One of the advances in breast cancer chemotherapy is the preoperative administration of chemotherapy to resectable breast cancer, known as preoperative chemotherapy. Preoperative chemotherapy can shrink tumors and increase the proportion of treatments that preserve the breast.  (3) Radiation therapy. It is mostly used for preoperative, postoperative local treatment and local control of recurrent breast cancer, and now it is mostly used for postoperative treatment of axillary lymph node metastasis more than 4, whole breast irradiation after breast-conserving surgery and preoperative tumor reduction for surgical treatment. Local irradiation (chest wall, supraclavicular region, internal breast lymphatic chain) can improve the survival of most of the cases in locally advanced cases and those with more axillary lymph node metastases.  (4) Endocrine therapy. It is to improve the endocrine environment required for the growth of hormone-dependent tumors, and then control the proliferation of tumors, so as to achieve the purpose of treatment, which is currently based on drug therapy. Commonly used endocrine therapy drugs include triamcinolone acetonide for estrogen and progesterone receptor positive cases, either alone or in combination with chemotherapy application of triamcinolone acetonide can improve the survival of breast cancer patients, especially for menopausal breast cancer patients. The application of triamcinolone acetonide also reduces the chance of contralateral breast cancer. The side effects are negligible. Also commonly used are aromatase inhibitors. Aromatase is an important part of estrogen production in the body after menopause and inhibition of its activity helps to reduce estrogen levels for therapeutic purposes.  (5) Adjuvant therapy for breast cancer surgery. The general strategy of adjuvant therapy is to give TAM to patients with good prognostic indicators and hormone receptor positive tumors, while adjuvant chemotherapy should be given to patients who have metastases in axillary lymph nodes and other prognostic indicators that are also poor, regardless of whether they are hormone receptor positive or negative. In contrast to the chemotherapy situation, the main beneficiaries of endocrine therapy are postmenopausal patients.  ① Adjuvant chemotherapy. Hematogenous metastasis is the main cause of treatment failure in breast cancer, and systemic chemotherapy can control it. In addition, hematogenous metastasis of breast cancer often occurs at an early stage, and it is assumed that 50%-60% of breast cancer has already developed hematogenous metastasis at the time of clinical diagnosis, and microscopic cancer foci are hidden in the body, so breast cancer should be considered as a systemic disease to enhance systemic treatment such as systemic chemotherapy and endocrine therapy. Breast cancer is one of the most effective tumors for chemotherapy among solid tumors, and chemotherapy plays an important role in the overall treatment. The commonly used chemotherapy regimens are CMF, CMFVP, CAF, TAC and so on. Adriamycin and paclitaxel are the most efficient chemotherapeutic agents and are now also used in combination chemotherapy. The efficiency of combined chemotherapy for advanced breast cancer is about 30% to 80%, which can prolong the survival, and the median survival of those in complete remission can be more than 2 years, but most patients eventually develop recurrence and drug resistance.  ②Adjuvant radiotherapy. Postoperative adjuvant radiotherapy has the effect of reducing local recurrence and is a local treatment. In recent years, with the improvement of radiation equipment and technology as well as the progress of radiobiological research, radiation can make local tumor get higher dose with less damage to surrounding normal tissues, and the effect of radiation therapy is obviously improved. For locally advanced breast cancer without surgical indications, radiation therapy can also achieve better local control and improve survival rate than other methods. Radiation therapy is becoming one of the means of local treatment for breast cancer.  (iii) Adjuvant endocrine therapy. Adjuvant endocrine therapy has been used to treat microscopic metastases from primary breast cancer. The role of oophorectomy in the treatment of breast cancer in premenopausal women is uncertain. Recent studies have favored the use of triamcinolone acetonide (TAM) after surgical treatment at a dose of 10 mg/dose twice daily for up to 5 years. This treatment may delay the time to tumor recurrence as well as improve survival rates. The effect of endocrine therapy is slow, often taking several weeks to achieve remission. The efficacy of endocrine therapy is related to the hormone receptor status.  The main modalities are: (1) bilateral oophorectomy: a common treatment for advanced premenopausal breast cancer; (2) adrenalectomy and pituitary resection; (3) ovarian radiotherapy; and (4) pharmacological amenorrhea such as norethindrone and inhibition of endocrine drug therapy.