BREAST CANCER: RADIOTHERAPY, CHEMOTHERAPY AND HORMONE THERAPY

Sentinel lymph node technique and surgical removal of axillary lymph nodes

During surgery, a radioactive tracer is always injected around the tumor mass to identify the "sentinel lymph node" (LS), which is the first lymph node that collects lymph (ie waste materials) from the tumor site. , once localized, because it stains with the radioactive dye, it will be removed and analyzed under a microscope to see if there are cancer cells inside.

The evaluation of the sentinel lymph node is able to accurately predict the state of the other regional lymph nodes of the armpit which, anatomically speaking, all come after it.It follows that, if the sentinel lymph node is devoid of tumor cells, it is possible to avoid the removal of the other lymph nodes, reserving this operation, not without side effects such as persistent swelling of the arm (lymphedema), only for patients who are really affected by a involvement of the lymph nodes by metastases (30-40% of cases).
Next to breast-focused surgery, there is therefore also the removal of axillary lymph nodes, which is useful not only for healing, but also for controlling the spread of the disease. In fact, the invasion of the axillary lymph nodes represents the predictive factor for the cure or not of breast cancer. The removal of these lymph nodes therefore plays an essential role and must be radical in most patients with invasive cancer. It is contraindicated in cases of invasive cancer. which the likelihood of invasion is minimal, as in the in situ or invasive forms in which the sentinel lymph node has been found to be metastatic. It has recently been proposed to abandon the removal of axillary lymph nodes even in tumoral forms smaller than one centimeter and low malignancy.

In fact, it is necessary to consider that the removal of the lymph nodes deprives the patient of an important defense tool, developed by the body precisely to act as a barrier to the spread of tumor disease.

Radiotherapy

Only in 40% of cases the neoplasm is confined to the primary nodule, while in 60% there are foci of tumor, in situ or invasive, also in other nearby sites of the breast. The probability of finding these lesions is greater near the primary tumor and progressively decreases with increasing distance from it. This forms the basis for the execution of radiotherapy after conservative interventions in all patients with invasive carcinoma, which is an integral part of the treatment. Possible exceptions to this rule are represented by elderly patients with small-diameter, non-aggressive tumors and absence. more foci of cancer cells in the breast.In other cases, if there are contraindications or inability to carry out radiotherapy, total mastectomy should be the treatment of first choice.
Radiotherapy after radical mastectomy is instead indicated in patients at high risk of relapse, such as those with involvement of more than 4 axillary lymph nodes, or with very extensive tumor lesions.

Hormone therapy

For further information: Breast Cancer Drugs

Some types of breast cancer consist of cells that are sensitive to estrogen. In the presence of these tumors, after 5 years of therapy, it has been seen that the reduction in the risk of relapse and mortality is respectively 47% and 26%.

Currently, it is administered tamoxifen for 5 years, as prolongation of therapy does not appear to provide additional benefit. It also appears to reduce the incidence of contralateral breast cancer and prevent osteoporosis and cardiovascular disease. Adverse effects of this therapy are the increased risk of developing endometrial cancer and thrombo-embolism.