{"title":"Management of breast cancer: basic principles","authors":"Anita Sharma, Charlotte Ives","doi":"10.1016/j.mpsur.2024.09.005","DOIUrl":"10.1016/j.mpsur.2024.09.005","url":null,"abstract":"<div><div>Breast cancer is the most common cancer in the UK and in the world, exceeding lung cancer incidence. Screening has resulted in the earlier detection of breast cancer and resulted in a reduction in breast cancer deaths. Symptomatic presentation of breast disease should be investigated in specialized clinics where triple assessment involving clinical, radiological and pathological findings is recommended for optimal care. Treatment for breast cancer falls broadly into four categories – surgery, radiotherapy, chemotherapy (with or without anti-HER-2 treatments) and endocrine therapy. These depend on the type and extent of cancer, and recommendations for treatments should be made within a multidisciplinary team setting.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"42 12","pages":"Pages 892-899"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142758912","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Anatomy and physiology of the breast","authors":"Peter J Bazira","doi":"10.1016/j.mpsur.2024.09.003","DOIUrl":"10.1016/j.mpsur.2024.09.003","url":null,"abstract":"<div><div>Sound knowledge of the anatomy and physiology of the breast is crucial for surgeons performing oncoplastic, aesthetic, or reconstructive breast surgery. This article presents an outline of surgically relevant anatomy and physiology of the breast, including its arterial and nerve supply, venous and lymphatic drainage, ligamentous framework, and the nipple–areolar complex.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"42 12","pages":"Pages 859-864"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142758911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Imaging techniques in breast cancer","authors":"Stebia Beremauro, Constantine Girio-Fragkoulakis","doi":"10.1016/j.mpsur.2024.09.006","DOIUrl":"10.1016/j.mpsur.2024.09.006","url":null,"abstract":"<div><div>Imaging is the mainstay in breast cancer diagnosis, with mammography being the primary screening tool used to detect small/asymptomatic cancers. Symptomatic patients undergo triple assessment, which includes a clinical assessment, imaging and, if indicated, an image-guided biopsy for histological diagnosis. We discuss current and emerging breast imaging techniques used in breast cancer care. These include mammography, digital breast tomosynthesis, ultrasound and magnetic resonance. We also discuss image-guided biopsy and miscellaneous image-guided interventions that influence the management of breast cancer care.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"42 12","pages":"Pages 875-883"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142758781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Adjuvant treatment for breast cancer","authors":"Jane Dufton, Shaveta Mehta","doi":"10.1016/j.mpsur.2024.10.003","DOIUrl":"10.1016/j.mpsur.2024.10.003","url":null,"abstract":"<div><div>The primary treatment for early breast cancer (EBC) is surgery. Adjuvant treatments, including systemic treatments and radiotherapy aim to reduce the risk of local (LR) and distant recurrence, resulting in improved survival in breast cancer (BC). Multiple components of the clinical and histopathological characteristics can be used to risk stratify patients and are helpful in decision making about adjuvant treatments. Recent advances in both systemic treatments (SACT) and radiotherapy (RT) techniques have led to more personalized treatment for patients with the aim to reduce BC mortality and improve quality of life long term.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"42 12","pages":"Pages 911-917"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142758788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Samantha Su Ping Low, Jennifer Morgan, Ruth Fullerton, Grace Tze-en Ding
{"title":"Treatment of locally recurrent and advanced breast cancer","authors":"Samantha Su Ping Low, Jennifer Morgan, Ruth Fullerton, Grace Tze-en Ding","doi":"10.1016/j.mpsur.2024.09.010","DOIUrl":"10.1016/j.mpsur.2024.09.010","url":null,"abstract":"<div><div>The incidence of breast cancer continues to rise, however mortality rates have fortunately been declining. This can be attributed to earlier detection, increased and better use of imaging modalities as well as advancing systemic therapy and radiotherapy options. Breast cancer is primarily subtyped according to the hormone and HER2 receptor status of the tumour. In locally advanced and metastatic breast cancer, this subtyping influences first line and subsequent systemic treatments and helps with prognostication. Systemic anti-cancer treatments such as endocrine therapy, chemotherapy, immunotherapy or targeted therapy form the main treatment backbone in metastatic disease. Bone metastases are commonly seen in breast cancer and bisphosphonates can be given in this setting to reduce skeletal related events. Brain metastases in breast cancer can be treated with surgery, radiotherapy or systemic treatments. In the advent of increasing effective cancer treatment options, it is important to be aware that breast cancer patients can have a very good prognosis with many years of good quality life.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"42 12","pages":"Pages 926-931"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142758791","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Test yourself: MCQ and Single Best Answer","authors":"Adrian Ben Cresswell","doi":"10.1016/j.mpsur.2024.10.010","DOIUrl":"10.1016/j.mpsur.2024.10.010","url":null,"abstract":"","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"42 12","pages":"Pages 932-933"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142758790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Benign breast disorders","authors":"Lisa Sheehan, Anthony Skene","doi":"10.1016/j.mpsur.2024.09.001","DOIUrl":"10.1016/j.mpsur.2024.09.001","url":null,"abstract":"<div><div>Benign breast disorders encompass a wide range of presentations and account for approximately 90% of breast outpatient referrals. Although the conditions discussed in this article are labelled ‘benign’, they can cause much anguish for the patient. A specialist breast clinician frequently has the privilege of being able to reassure patients in a single trip to the breast department and unburden them from their worry. One-stop breast clinics were designed to ensure that patients with worrying symptoms are promptly seen to aid early detection of breast cancer and optimize patient outcomes. This is a comprehensive overview of benign breast disorders and covers all that is required for the MRCS examination and serves as a revision aid for FRCS candidates.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"42 12","pages":"Pages 884-891"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142758780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Breast cancer in the elderly, in men and during pregnancy","authors":"Emanuele Garreffa, Deeksha Arora","doi":"10.1016/j.mpsur.2024.09.004","DOIUrl":"10.1016/j.mpsur.2024.09.004","url":null,"abstract":"<div><div>Female breast cancer is the most common tumour diagnosed worldwide and is one of the leading causes of cancer-related death. The management of elderly, male and pregnant patients with breast cancer requires some additional considerations which are reviewed in this chapter. Breast screening is routinely offered to women aged between 50 and 70 years in England. There are substantial regional variations among UK hospitals in the clinical management of elderly breast cancer patients. Primary endocrine therapy is used in the treatment of ER-positive elderly breast cancer patients not fit for surgical intervention. Male breast cancer is rare, accounting for less than 1% of all breast cancers. It is more common in elderly men and tends to behave like post-menopausal breast cancer. Although breast cancer is one of the most frequently diagnosed malignancies among pregnant women, breast cancer during pregnancy is a rare condition and has been associated with more aggressive, high-grade, poorly differentiated tumours and with a predominance of more aggressive molecular subtypes such as triple negative, HER-2-positive and lower rates of ER and PR expression.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"42 12","pages":"Pages 918-925"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142758786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Breast pathology update","authors":"Katy AT Teo, Elizabeth A Mallon","doi":"10.1016/j.mpsur.2024.09.009","DOIUrl":"10.1016/j.mpsur.2024.09.009","url":null,"abstract":"<div><div>The surgeon involved in the management of breast disease must work as part of an effective multidisciplinary team. The surgeon must work with all team members communicating effectively and working together. Histopathology provides diagnostic, prognostic and predictive information. The surgeon must understand the implications of the histopathology report for effective patient management. Improvements in core biopsy techniques have provided additional information resulting in lower open biopsy rates and improved preoperative diagnostic rates for facilitating surgical planning. Assessment of margin status, lymph node status and prognostication are continually evolving and shaping surgical practice towards less surgical intervention in the field of breast disease. Molecular testing is becoming an increasingly important aspect of breast cancer management in the era of precision medicine.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"42 12","pages":"Pages 865-874"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142758782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Janhavi Venkataraman, Shonnelly Novintan, Jajini S Varghese
{"title":"Surgical techniques in breast cancer: an overview","authors":"Janhavi Venkataraman, Shonnelly Novintan, Jajini S Varghese","doi":"10.1016/j.mpsur.2024.09.002","DOIUrl":"10.1016/j.mpsur.2024.09.002","url":null,"abstract":"<div><div>With advancements in oncology and oncoplastic training, the options for treating breast cancer have expanded exponentially over the past two decades. In particular, surgical techniques have advanced to the point where oncological safety and aesthetic outcomes are now the pillars of contemporary breast surgery. Studies have demonstrated that by using oncoplastic techniques, breast conservation has become an alternative for many patients who would otherwise undergo mastectomy. Nonetheless, a considerable cohort of patients will still require, or request, a mastectomy. Surgical options range from a simple wide local excision, therapeutic mammoplasty, volume replacement techniques with a local flap or mastectomy with whole breast reconstruction using autologous tissue or a prosthetic implant. Deciding between surgical options involves careful consideration of tumour characteristics, patient comorbidities and the potential effects of neoadjuvant and adjuvant treatments. The key message for surgeons is to ensure the chosen surgery does not compromise oncological outcomes and provides an excellent aesthetic outcome with timely healing to prevent delays in commencing adjuvant oncology treatments. In this article, we discuss techniques for breast conservation surgery and reconstructive options after mastectomy. In addition, we detail the safety and influence of neoadjuvant and adjuvant treatments on surgery.</div></div>","PeriodicalId":74889,"journal":{"name":"Surgery (Oxford, Oxfordshire)","volume":"42 12","pages":"Pages 900-910"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142758789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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