Treatment options are
- WLE (1 cm margin) + axillary clearance + radiotherapy
- Total mastectomy + axillary clearance
All surgical patients get LFT, CXR. If any abnormality then full staging
(MIBI scintigram, liver US). Full staging is always carried out before chemotherapy.
Tamoxifen is given to all women with ER or PR positive tumours.
(Some controversy over using Tamoxifen on those in the best prognostic group:
tumour <10 mm, no vascular invasion, grade 1, tubular carcinoma,
node negative, ER positive. Tamoxifen only confers 3% survival advantage, but
reduces risk of cancer in contralateral breast by 1/3.)
- Lump <2 cm: WLE
- Lump >5 cm: mastectomy
- Lump 2–5 cm: clinical judgement based on position of lump, size of breast
- > 6 palpable fixed lymph nodes: chemotherapy or total mastectomy.
- Huge or inflammatory: chemotherapy.