Editing Breast cancer (section)

=== '''Local control''' ===

** Breast-conserving surgery is defined as WLE and whole-breast radiotherapy 
** Indications:
*** Single or multiple lesions that can be excised to leave a satisfactory cosmetic outcome
*** Most T1 and T2 cancers (consider neoadjuvant therapy first for 4-5cm cancers)
*** T3 cancers in larger breasts
** Relative contraindications (none are absolute):
*** T4, N2 or M1
*** Patient preference for mastectomy
*** Collagen vascular disease (especially scleroderma - increased complications from radiotherapy)
*** Large or central tumours in small breasts (that cannot be excised to leave a satisfactory cosmetic outcome - although consider neoadjuvant first)
*** Strong family history of breast cancer, or BRCA1/BRCA2 positive
*** ''Unable or unwilling to have the radiotherapy that should be part of BCS''
*** ''High nuclear grade, presence of lymphovascular invasion and negative steroid hormone receptor status are linked to higher recurrence rates, but are not contraindications to breast conservation''
** Margins
*** Invasive breast cancer: any negative margin is acceptable, i.e., 'no ink on tumour'
*** An involved posterior or anterior margin may not be fixable with surgery, if the original excision extended from right under breast skin back to pectoralis fascia. More often, radiotherapy is the answer.
** Alternative therapies to WLE (remains investigative)
*** Cryoablation
**** Can potentially replace WLE for patients with high surgical risk
**** Argon gas and multiple freeze-thaw cycles
*** RFA
**** RFA alone
**** Excision followed by RFA
***** Under investigation currently
*** Laser ablation
*** High-intensity focused US
*** Microwave ablation
*** Stereotactic radio-ablation