الفهرس 
Anatomy of the breastsOnly 14 pages are availabe for public view
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Abstract
Summary and conclusion
Breast cacer is a progressive disease, and small tumors are more likely to be at an early stage, have a better prognosis, and more successfully treated.
With the advent of wide spread screening of mammography, many women are now diagnosed in the pre-clinical stage, with subsequent increase in diagnosis of breast cancer in the early stage.
Diagnosis of breast cancer is made by combination of clinical assessment, imaging and a tissue biopsy. Palpable masses detected by clinical examination should be evaluated by mammography to determine the extent of the cancer within the breast and to identify other occult sites of cancer within the same and the opposite breast. Ultrasound became an important adjunct to mam¬mography and is an excellent method for guiding some interventional procedures.
MRI in breast imaging has undergone much advancement in the last 25 years. It shows promise in many areas, including staging of breast cancers, determination of tumor size and spread, and may be a valuable screening tool for those patients with a high risk of breast cancer. It may also be of value in patients whose breasts that are too dense for mammography.
Breast cancer management has been evolving toward minimally invasive approaches. Image-guided percutaneous biopsy techniques provide accurate histological diagnosis without the need for surgical biopsy.
An increasing number of treatment options are available for early breast cancer (stage 0, stage I, and stage II), and some patients can now be cured of breast cancer by a combination of surgery, radiotherapy and systemic adjuvant therapy.
The surgical treatment of breast cancer has changed dramatically in the last 100 yr from extended radical mastectomy to breast preservation. Breast-conserving surgery combined with radiation is now well established as the preferred local-regional treatment for a majority of patients with early stage breast cancers.
The long-term survival of women with early breast cancer who were treated with breast-conserving surgery and postoperative radiotherapy to the ipsilateral breast was virtually identical to the rate among women who underwent radical mastectomy. After a median follow-up of 20 years, the overall and breast-cancer–specific survival rates were also similar in the two groups.
Excision of the primary tumor with preservation of the breast has been referred to by many names, including lumpectomy, partial mastectomy, and segmentectomy. Wide local excision seems to be the most descriptive term for the conservative surgery.
Mastectomy, with or without immediate breast reconstruction, is the surgical approach for the patient with breast cancer who has contraindications to BCT or who prefers treatment with mastectomy.
The pathologic status of the axillary lymph nodes is a key prognostic factor in patients with breast cancer. Identification of metastatic tumor deposits in the axillary nodes indicates a poorer prognosis and often prompts a recommendation for more aggressive systemic and local therapy, there are two methods for surgical staging of the axilla; the axillary dissection and axillary sentinel lymph node biopsy (SLNB).
Sentinel lymph node biopsy is a new procedure that can predict axillary lymph node status without the need of axillary lymph node dissection, SLN biopsy, in experienced hands, is a very accurate method for assessing lymph node status in women with breast cancer and clinically negative nodes.
Minimally invasive techniques are being developed in the treatment of invasive breast cancer. Tumor ablation approaches include cryotherapy, radiofrequency ablation, as well as less studied techniques such as ethanol ablation, laser therapy, microwave techniques or focused ultrasound, the most extensive work and progress have been made with RFA.
Irradiation of the breast following partial mastectomy reduces local recurrence in the breast from almost 50 to about 10%.
Whole-breast radiotherapy has become a standard component of breast-conserving treatment regimens for early-stage breast cancer; The use of accelerated partial breast irradiation (APBI) in place of whole breast irradiation for breast-conservation therapy is an area of intensive clinical investigation.
Adjuvant systemic therapy includes combination cytotoxic chemotherapy and endocrine therapy.
Cyclophosphamide, methotrexate and 5-fluorouracil (CMF) was the established chemotherapy regimen; however, newer regimens have more recently been introduced that may offer some benefit over CMF including anthracycline-containing regimens and taxane-containing regimens.
Tamoxifen is an integral part of the management of early-stage breast cancer. However, A variety of trials have now shown the superiority of the third-generation aromatase inhibitors over tamoxifen in postmenopausal women with ER-positive tumours, Since then, there have been several further reports from other adjuvant trials supporting the fact that the sequential treatment with an AI and tamoxifen is superior to the treatment with tamoxifen alone.
Trastuzumab is a humanised monoclonal antibody that binds to the extracellular domain of the HER2 transmembrane protein, trastuzumab in combination with chemotherapy has demonstrated a high improvement of survival in HER2-positive patients with breast cancer.
Despite of the small increase in local recurrence after conservative surgery for early breast cancer , yet most center still recommend it . They aim at lowering this recurrence by better selection of patient and improving -ve resection margin and proper use of adjuvant &Systemic therapy .