Surgical Options for treatment of breast cancer Also known as breast-conversing surgery Removal of breast cancer with clear surgical margins. Preservation of most of the breast tissue i.e. wide local excision of breast cancer. Total Mastectomy Removal of the entire breast, nipple-areolar complex, underlying pectorals fascia. Other structures such as lymph nodes and pectorals muscle may or may not remove. Define sentinel node and discuss the rationale of sentinel node biopsy. Mapping out lymph nodes that are most likely to get affected it the cancer has spread. This is done by injecting a radioactive substance e.g. blue dye. These travel through the lymphatic systems. Once the sentinel node is located, the surgeon will make a small incision and remove it. Information obtained from it is important for staging. For example, if the sentinel node is positive for cancer cells -> additional lymph nodes need to be tested. May need further surgery and/or systemic treatment such as chemotherapy. Axillary dissection Involves the removal of several or all axillary lymph nodes. Used when: Invasive breast cancer. Sentinel lymph node biopsy. Biopsy to identify the first lymph nodes to which cancer cells are likely to spread to. Nipple Discharge Types and causes Note: breast cancer rarely causes discharge -> when it does wither bloody or clear Evaluation History Physical examination Lab tests Prolactin levels -> to rule out hyperprolactemia . Thyroid function tests -> in cases of suspected hormonal imabance . WBC Imaging Mammogram Ultrasound Ductography / glactograohy Evaluates specific ducts involved in discharge Uses contrast material to highlight the ducts. Biopsy Fine needle Core needle Ductal lavage or cytology Discharge collection for cytologic examination -> helps identify malignant cells or infection.