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NCCN Guidelines for Patients


Breast Cancer - Early-Stage


, Version 1.2016


Breast cancer surgery

Breast tumor surgery

whom breast-conserving therapy would be unlikely to

fully treat the cancer in the breast.

Tissue from a lumpectomy will be tested by a

pathologist for cancer cells at or near the surgical

margin. You also may be given another mammogram

to look for any cancer that wasn’t removed. If it

appears that cancer remains in your breast, more

surgery is needed. The second surgery is often

another lumpectomy but sometimes a mastectomy is


Neoadjuvant treatment

You may be able to have breast-conserving therapy

even if you have a large stage II breast tumor. In

this case, a breast tumor is large if it is bigger than

2 cm. Your doctors may decide that you can receive

neoadjuvant (or preoperative) treatment to shrink the


If neoadjuvant treatment is planned, a core needle

biopsy of the breast tumor is advised. A biopsy can

confirm if there’s cancer and what type. Your doctors

will also assess for cancer in your axillary lymph

nodes. Imaging tests and a biopsy of your lymph

nodes may be done as described in Part 2.

Neoadjuvant treatment can cause the cancer to

shrink a lot. Thus, the tumor sites in your breast and

lymph nodes should be marked with small clips.

Imaging tests, such as a mammogram or ultrasound,

should be used to help place the clips. The clips will

help your surgeon to find the tumor sites and remove

tissue after neoadjuvant treatment.

Chemotherapy is the class of drugs most often

used to shrink large breast tumors before surgery.

Chemotherapy is discussed in Part 4. Endocrine

therapy alone may be used for neoadjuvant treatment

but only for some women with hormone receptor–

positive cancer. Endocrine therapy is discussed in

Part 6.

If you have HER2-positive breast cancer, you should

be treated with chemotherapy and HER2 inhibitors for

at least 9 weeks before surgery. For all neoadjuvant

treatment, it is ideal that the full dose be given before

surgery. If not completed, the remaining dose should

be received after surgery.

During treatment you will be given tests to assess if

the cancer is shrinking. Such tests include a physical

exam and maybe imaging tests. If the cancer doesn’t

shrink much or grows, your doctor may give you a

different type of chemotherapy. If the tumor shrinks

enough, a lumpectomy can be done.

Total mastectomy

Some women with stage I or II breast cancer can’t

have or don’t want a lumpectomy. A lumpectomy

may not be an option because of your health, the

tumor size, cancer in the surgical margins, and your

chances of having another breast tumor.

You may refuse to have a lumpectomy. Some women

refuse because of how they want their breast to

look after treatment. Others refuse because they

won’t have to worry about the cancer returning in the

removed breast.

If a lumpectomy isn’t an option, a total mastectomy

is advised. This surgery is also called a simple

mastectomy. Your whole breast will be removed but

not any chest muscle. Following the mastectomy, or

in some cases at the same time as the mastectomy,

you may want to have breast reconstruction. Breast

reconstruction is described in more detail later in this