Breast cancer (non-metastatic)


This review examines the effects of treatment for non-metastatic, primary breast cancer. Ductal carcinoma in situ is a non-invasive tumour characterised by the presence of malignant cells in the breast ducts, but with no evidence that they breach the basement membrane and invade into periductal connective tissues. Invasive breast cancer occurs when cancer cells spread beyond the basement membrane, which covers the underlying connective tissue in the breast. This tissue is rich in blood vessels and lymphatic channels capable of carrying cancer cells beyond the breast. Invasive breast cancer can be separated into three main groups: early invasive breast cancer, locally advanced breast cancer, and metastatic breast cancer (see review on breast cancer [metastatic]). more. Operable breast cancer is disease apparently restricted to the breast and/or local lymph nodes in the absence of metastatic disease, and can be removed surgically. Although women do not have overt metastases at the time of staging, they remain at risk of local recurrence, and of metastatic spread. They can be divided into those with tumours greater than 4 to 5 cm, or multifocal cancers, or widespread malignant micro-calcifications that are usually treated by mastectomy, and those with tumours less than 4 to 5 cm that can be treated by breast-conserving surgery. Locally advanced breast cancer is defined according to the TNM staging system of the UICC[1] as stage 3B (includes T4 a–d; N2 disease, but absence of metastases [see table 1]). It is a disease presentation with clinical or histopathological evidence of skin and/or chest-wall involvement, and/or axillary nodes matted together by tumour extension. Metastatic breast cancer is presented in a separate review (see review on breast cancer [metastatic]).