MANILA, Philippines - For Stage I and II (those with small tumors and positive axillary nodes: The treatment of choice seem to be modified radical mastectomy versus some form of local excision combined with radiation.
The more extensive surgeries are not concurrently being performed more often and results are similar no matter which form of local treatment.
Axillary node dissection should be done for prognostic purpose and to determine if further therapy is needed. The addition of adjuvant chemotherapy has produced a nedian survival and overall survival advantage for premenopausal women with Stage II cancer. The results are also promising for premenopausal women with Stage I cancer and poor prognostic sign (unfavorable histology, lack of estrogen receptor proteins and expression of certain oncogenes. Postmenopausal women with positive ERs and Stage II disease benefit from adjuvant Tamoxifen. The optimal duration of Tamoxifen therapy is yet to be defined.
Locally, advanced breast cancer patients includes patients who may be unresectable technically, inoperable or those with inflammatory changes. They may not have distal metastases but local disease control by surgery alone has proven to be unlikely. These patients are now given chemotherapy first. If they have a complete clinical response, radiation alone or with a mastectomy is then given. If a partial response occurs, radiation is then used. If the tumor is respectable, surgery is done. If not resectable, more chemotherapy is given.