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Invasive ductal carcinoma is the most common type of breast cancer, it begins in the cells that line the milk duct in the breast, then the cancer penetrates the channel wall and grows into nearby breast tissue, at this stage it can spread to other parts of the body through the lymphatic system and the bloodstream. Given in this case, the patient has invasive ductal carcinoma through the biopsy taken, and since the solid mass is immobile with a diameter of 2-3 cm, 5 cm from the nipple, is felt in the upper outer quadrant of the right breast, the lymph node in the armpit is imperceptible, and there is no spread In the body, according to the TNM staging system, the system that describes the amount and spread of cancer in a patients body. T describes the size of the tumor and any spread of cancer into nearby tissue; N describes the spread of cancer to nearby lymph nodes; and M describes metastasis. Accordingly, the patient in this case is in Stage 2A: T2, N0, M0.

In this case, we will start with a topical treatment.

Stage 2 cancers are treated with either breast preservation surgery (BCS; sometimes called lumpectomy or partial mastectomy) or mastectomy. Proximal lymph nodes will also be examined, either by sentinel lymph node biopsy (SLNB) or axillary lymph node dissection (ALND). Women with BCS are treated with radiotherapy after surgery as radiation is discussed as a treatment option after surgery. In this case, we will start with a lumpectomy and then dissect the axillary lymph node.

The goal of lumpectomy is to remove cancer or other abnormal tissue while maintaining the appearance of your breast. Studies indicate that lumpectomy followed by radiation therapy is as effective in preventing a recurrence of breast cancer as the removal of the entire breast (mastectomy) for early-stage breast cancer. here we recommend lumpectomy because the biopsy has shown that the cancer is believed to be small and early stage. A lumpectomy may also be used to remove certain noncancerous or precancerous breast abnormalities.

we do not recommend lumpectomy for breast cancer if you: Have a history of scleroderma, have a history of systemic lupus erythematosus, have two or more tumors in different quadrants of your breast that cannot be removed with a single incision, which could affect the appearance of your breast, have previously had radiation treatment to the breast region, have cancer that has spread throughout your breast and overlying skin since lumpectomy would be unlikely to remove cancer completely, have a large tumor and small breasts, which may cause a poor cosmetic result, and don’t have access to radiation therapy. But in this case, all of these barriers are not present, so a lumpectomy is a correct and proper option.

The goal of axillary lymph node which is a surgical procedure that incises the axilla to identify, examine, or remove lymph nodes. Axillary dissection has been the standard technique used in the staging and treatment of the axilla in breast cancer. Patients presenting with symptomatic early breast cancer have a 30-40% chance of having positive axillary nodes and a 20-25% chance if presenting through a screening program. Staging of the axilla is an important step in the treatment of breast carcinoma. Axillary lymph node status is a significant prognostic pathologic variable in patients with operable primary breast cancer, and it remains the most powerful predictor of recurrence and survival.

starting with a Lumpectomy to remove cancerous breast tissue along with a rim of normal tissue surrounding it called a surgical margin. The procedure preserves the rest of the breast as well as the sensation in the breast. If you have invasive breast cancer and are younger than 70 years of age, a lumpectomy is always followed by radiation treatments to the breast the patient is 42 years old so we will start with radiation therapy, External beam radiation therapy is offered after breast-conserving surgery for stage 2 breast cancer. All of the breast and the lymph nodes under the arm and near the collarbone are treated. Radiation after lumpectomy is to kill any cancer cells that might remain. Adding radiation after a lumpectomy reduces the risk that cancer will return to the affected breast. Lumpectomy combined with radiation therapy is often referred to as breast conservation therapy. This type of treatment is as effective as having all the breast tissue removed (mastectomy). In special situations where the risk of recurrence is very low.

After lumpectomy, radiation treatment options might include:

Radiation to the entire breast. One of the most common types of radiation therapy after a lumpectomy is external beam radiation of the whole breast (whole-breast irradiation).

Radiation to part of the breast. Radiation therapy to part of the breast (partial-breast irradiation) may be an option for some early-stage breast cancers. This technique directs internal or external radiation to the area around where the cancer was removed.

Complementary and Alternative Medicine (CAM) is becoming increasingly popular among cancer patients, in particular those with breast cancer. It represents one of the fastest-growing treatment modalities in the United States. CAM encompasses a wide range of modalities including special diet and nutrition, mind-body approaches, and traditional Chinese medicine.

CAM treatment 1: Special diet

A healthy diet is an important part of cancer treatment. However, some people with breast cancer may start on a special diet in place of taking anticancer drugs. You should avoid foods that are:high-fat, salt-cured, smoked, or pickled. You should also double up on fruits, vegetables, and plant-based foods.

CAM treatment 2: Antioxidant supplements

Antioxidants lower your risk of cancer by helping protect your body from damage caused by free radicals. Certain grains, fruits, and vegetables are rich in dietary antioxidants, including:

beta carotene, lycopene, vitamin A, vitamin C, vitamin E. These antioxidants may be found in the following foods: goji berries, wild blueberries, dark chocolate, pecans, and kidney beans. Theyre also available through dietary supplements. However, research is mixed on whether antioxidant supplements are safe to use during cancer treatment.

CAM treatment 3: Mind, body, and soul therapies

Mind-body practices are meant to improve your minds positive impact on the rest of your body. Each therapy targets your mind, body, and soul using meditative techniques and creative activities that help enhance your quality of life.

CAM treatment 4: Massage therapy

Massage therapy is known to boost immunity and ease anxiety, pain, and fatigue. One 2003 study by Trusted Source found that in women who had breast cancer, massage therapy helped reduce not only anxiety and pain but also the need for pain medication. Another study Trusted Source released around that time found that massage therapy and progressive muscle relaxation helped increase protective white blood cells in women with stage 1 and stage 2 breast cancer.

CAM treatment 5: Acupuncture

Acupuncture is a central part of traditional Chinese medicine that may help relieve symptoms of breast cancer and the side effects of treatment. Acupuncture requires a practitioner to place sterile, hair-thin needles into acupuncture points specific points on your skin and then gently move them to stimulate your nervous system.

Research Trusted Source has shown that acupuncture can help: relieve fatigue, control hot flashes, reduce vomiting, reduce pain, and help decrease nausea.

Fighting cancer typically involves more than one treatment. Most of the time, the disease requires a multidisciplinary approach or a combination of therapies. Treatment plans often involve a primary therapygenerally surgery or radiation therapyin addition to an adjuvant or neoadjuvant therapy. In a nutshell, these are therapies, like chemotherapy or hormone therapy, delivered before or after the primary treatment, to help increase the treatments chance of success and decrease the risk of recurrence.

Neoadjuvant and adjuvant therapies are often used to treat breast, colon, and lung cancers, and may include chemotherapy, hormone therapy, radiation therapy, immunotherapy, and targeted therapy. The two therapies differ largely in when they are given and why. Neoadjuvant therapies are delivered before the main treatment, to help reduce the size of a tumor or kill cancer cells that have spread. Adjuvant therapies are delivered after the primary treatment, to destroy remaining cancer cells.

Most often, neoadjuvant and adjuvant therapies are recommended when a patient with early-stage cancer undergoes surgery or radiation therapy and we believe that in this condition she may benefit from additional systemic treatments, In this condition we have localized breast cancer, and the first-line treatment in this case is surgery, but to improve the chances that the surgery works as well as it can, we give chemotherapy three or four months before surgery, or three to four months after surgery, then there is a significant improvement in prognosis and a decreased risk of recurrence with doing either an adjuvant or neoadjuvant approach.

Neoadjuvant and adjuvant therapies benefit many, but not all, cancer patients. The type and stage of a patients cancer often dictate whether she is a candidate for additional treatment. Neoadjuvant therapy may also serve as a tool for determining the patients response to treatment. If the tumor responds to chemotherapy before surgery, you know that the patient is more than likely to do well.

Its important to know, though, that neoadjuvant and adjuvant therapies may cause side effects, such as the nausea and fatigue that often accompany chemotherapy. Thats why theyre commonly recommended for otherwise healthy cancer patients when the expected benefits outweigh the potential risks.

What types of adjuvant therapies are used for breast cancer?

Most adjuvant therapies are systemic: they use substances that travel through the bloodstream, reaching and affecting cancer cells all over the body. Adjuvant therapy for breast cancer can include chemotherapy, hormonal therapy, the targeted drug trastuzumab (Herceptin), radiation therapy, or a combination of treatments.

Adjuvant chemotherapy uses drugs to kill cancer cells. Research has shown that adjuvant chemotherapy for early-stage breast cancer helps to prevent the cancer from returning.

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