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38

NCCN Guidelines for Patients

®

:

Breast Cancer – Locally Advanced (STAGE III)

Version 1.2017

4

Surgery

Treatment guide

Treatment guide

Breast surgery

Guide 5

lists the deciding factors for breast

surgeries. If you had preoperative treatment, your

surgical options are based on how well treatment

worked. Another deciding factor is the amount of

breast tissue that needs to be removed.

For any stage III cancer that shrank enough, a

lumpectomy may be an option. However, there

are other factors to consider. The other option is a

mastectomy.

Lumpectomy

A lumpectomy may be an option if only some of

your breast needs to be removed. Removing a

large part may cause your breast to look deformed.

A lumpectomy is not advised when more than one

cut is needed to remove all the cancer. Is it also not

advised if worrisome spots throughout the breast

should be removed with the cancer.

Some deciding factors clearly rule out a lumpectomy.

It isn’t an option if you should not or cannot have

radiation. Do not receive radiation therapy during

pregnancy. Lumpectomy may not be an option if

you’ve had radiation near the tumor site. Some

connective tissue diseases may also exclude

lumpectomy. Examples include scleroderma and

lupus.

Being likely to get new breast tumors due to your

genes may exclude lumpectomy. Talk with your

doctor about genetic mutations that may affect your

options. Some are discussed next.

Lumpectomy is not advised if both

ATM

genes are

mutated. Normal ATM protects the body from cells

with damaged DNA. It fixes, shuts down, or kills the

damaged cells. When mutated,

ATM

genes can lead

to breast cancer.

ATM

mutations also make the side effects of

radiation therapy much worse. New tumors may form

because of the radiation. Thus, breast-conserving

therapy is not advised.

A lumpectomy may not be an option if you have Li-

Fraumeni syndrome. It increases the risk for breast

cancer. Like having an

ATM

mutation, radiation

therapy should also be avoided.

Guide 5. Breast surgery

Surgery options

Deciding factors

Lumpectomy

with radiation therapy

(AKA breast-conserving therapy)

may be an option if all these factors

describe you:

ª

• Don’t need a large part of your breast removed,

• Aren’t genetically predisposed to breast cancer, AND

• Can have radiation therapy.

Mastectomy

may be an option if

any of these factors describe you:

ª

• Are not approved for a lumpectomy,

• A lumpectomy would not remove all the cancer, OR

• Are approved for a lumpectomy but declined.