الفهرس 
Introduction and Aim of the workOnly 14 pages are availabe for public view
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Abstract
Summary and Conclusion
Breast cancer is one of the most common cancers in
women. Many studies have shown that early detection of breast
cancer and improved diagnosis of the extent of disease enable
more appropriate treatment and treatment at an earlier stage,
and help minimize the morbidity and mortality of this disease.
Many risk factors increase the chance of a woman to
developing breast cancer. The common is the effect of the level
and duration of exposure to endogenous estrogen. Early
menarche, nulliparity, and late menopause increase lifetime
exposure to estrogen in premenopausal women, while obesity
and hormone replacement therapy increase estrogen levels in
postmenopausal women.
Both breast self-examination and clinical breast
examination involve inexpensive and noninvasive procedures
for the regular examination of breasts.
Breast imaging is largely indicated for detection,
diagnosis, and clinical management of breast cancer and for
evaluation of the integrity of breast implants.
Mammography is currently the gold standard for early
breast cancer detection and several analyses have shown that
regular breast screening with mammography can significantly
reduce the mortality rate due to breast cancer.
MRI and ultrasonography have an increasingly important
adjunctive role for imaging high-risk patients and women with
dense breasts. Breast CT has demonstrated high-resolution
three-dimensional imaging capabilities.
Radionuclide based imaging techniques and x-ray
imaging with intravenously injected contrast offer substantial
potential as a diagnostic tool and for evaluation of suspicious
lesions.
Breast conservation surgery (BCS) combined with
postoperative radiotherapy has become the preferred
locoregional treatment for the majority of patients with earlystage
breast cancer, with equivalent survival to that of
mastectomy and improved body image and lifestyle scores.
The success of BCS for breast cancer is based on the tenet of
complete removal of the cancer with adequate surgical
margins, while preserving the natural shape and appearance of
the breast. Achieving both goals together in the same operation
can be challenging, and BCS has not always produced good
cosmetic results in all patients.
One of the limiting factors is the amount of tissue
removed, not only in terms of absolute volume but also in
relation to tumor location and relative size of breast. If either of
these two goals is not obtainable, mastectomy is often proposed
to the patient. An alternative is to downsize the tumor
preoperatively with either chemotherapy or hormone therapy.
However, not all tumors respond to neoadjuvant treatment. The
failure of classical BCS techniques to offer solutions for
challenging scenarios has stimulated the growth and
advancement of new techniques in breast surgery during the
past decade.
Oncoplastic surgery allows for wide resections with
favorable cosmesis and integrates into a standard
multidisciplinary approach for BCS. The ultimate goal is to
allow large-volume resections with free margins and fewer reexcisions
and mastectomies than is obtainable with standard
BCS.
OPS divided into two levels based on excision volume
and the complexity of the reshaping technique. For resections
less than 20% of the breast volume (level I OPS), a step-by
step approach allows easy reshaping of the breast. For larger
resections (level II OPS), a mammoplasty technique is
required.
Staging of the axilla in breast carcinoma is the single
most important prognostic factor for selection of appropriate
adjuvant therapy, loco-regional recurrence and long-term
survival. Exact staging of axillary lymph nodes can be
obtained in two ways, directly by axillary lymph node
dissection (ALND) or indirectly by sentinel lymph node biopsy
(SLNB).
The purpose of radiation therapy following breastconserving
surgery is to eradicate local subclinical residual
disease while reducing local recurrence rates. radiation to the
intact breast is considered standard of care even in the lowest
risk disease with the most favorable prognostic features.
Neoadjuvant Systemic Therapy or Administration of
systemic chemotherapy or hormonal therapy before surgery can
result in a significant reduction in tumor size in 50% to 80% of
patients with locally advanced breast cancer.
Adjuvant treatment of breast cancer is designed to treat
micro-metastatic disease, or breast cancer cells that have
escaped the breast and regional lymph nodes but have not yet
established an identifiable metastasis.
In estrogen-receptor positive early stage breast cancer,
hormonal therapy plays a main role in adjuvant treatment,
either alone or in combination with chemotherapy.