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MULTIDISCIPLINARY APPROACH WITH SURGICAL ONCOPLASTY OF A 46 YO WOMAN WITH BREAST CANCER

Mohamed Swamad, Yanislav Mitkov, Aygulya Akisheva, Dobromir Dimitrov, Chavdar Bachvarov

Abstract

Introduction: Modern treatment applications in breast cancer patients require multidisciplinary approach, combined with oncoplasty and reconstructive surgery in some cases. The term multidisciplinary treatment (MDT) encompasses various diagnostic and treatment approaches in the management of patients with breast cancer. The oncoplastic approach is the best current solution, creating a fine balance between radical surgical treatment and preservation of the breast.

Materials and Methods: We looked at the patient’s case file from September 10, 2015 until 7 months ago. All the medical documentation was collected upon request from the Department of General Surgery at MHAT Saint Marina, Pleven. The patient, without a history of other pathology, was hospitalized at MHAT Saint Marina, Pleven presenting with a painless, palpable tumour mass in the left breast.

Results: The patient underwent clinical examinations, echomammography, mammography, fine-needle aspiration cytology (FNAC), tru-cut needle biopsy (TCB), enhanced body CT and CA 15-3 test. Invasive ductal cancer with axillary lymph node involvement was proven on September 30, 2015 with a clinical stage T2 N2 M0. An MDT meeting recommended neoadjuvant chemotherapy with FEC. After 4 cycles of chemotherapy and 3 cycles of Docetaxel, and a good response on clinical examinations and mammograms, on February 17, 2016, the patient underwent simultaneous left skin-sparing mastectomy and right nipple-sparing mastectomy. Dissection of left axillary lymph nodes was done. Histology showed micropapillary breast cancer and no invasive ductal cancer. Two of the resection margins were positive. MDT meeting recommended staging PET – CT, adjuvant chemotherapy, radiotherapy, hysterectomy with adnexectomy.

After chemotherapy and radiotherapy, 7 months after surgery, new PET-CT scans showed no recurrence of the disease or distant metastases. The breasts of the patient were reconstructed 9 months after radical surgery with implants.

Conclusion: The MDT approach to treatment is the best current solution as collective decision making from multiple disciplined specialists is far better than one specialist making the sole decision.

In cases of heterogeneous cancers, TCB is insufficient.


Keywords

breast cancer, MDT, oncoplasty, tru-cut biopsy, skin-sparing mastectomy.


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