Breast Surgery
Core Concepts
Understand the evaluation of breast lumps, breast cancer screening, and management of early and advanced breast cancer. Key topics: triple assessment (clinical, imaging, pathology), staging, and multidisciplinary treatment. Know the indications for breast-conserving surgery (BCS) vs. mastectomy, sentinel lymph node biopsy (SLNB), and axillary dissection. Understand the molecular subtypes (luminal, HER2-enriched, triple-negative) and their systemic therapies.
Traps in Questions
A common trap is the use of SLNB in patients with clinically node-positive disease – they should undergo axillary dissection or neoadjuvant therapy first. Another trap is the management of ductal carcinoma in situ (DCIS): BCS with clear margins and radiation is standard; SLNB is not routine. Also, beware of the “pregnancy and breast cancer” scenario – safe to operate in second trimester, but chemotherapy is avoided in first trimester. Know that inflammatory breast cancer is a clinical diagnosis (erythema, peau d’orange) and requires neoadjuvant chemotherapy.
Worked Example
A 55-year-old woman with a 2 cm ER+ PR+ HER2- breast cancer, clinically node-negative. What is the surgical management? Answer: BCS with SLNB, followed by radiation and endocrine therapy.
Rule of Thumb
In breast cancer, the goal is clear margins (no tumor on ink) for BCS; re-excision is needed if margins are positive.