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'One stop shop' for cancer
Breast tumour
Advances could help breast cancer patients
One of the founding fathers of breast surgery says that a combination of newer treatments could allow some breast cancer patients to receive all their treatment in just one day.

Potentially, hundreds of thousands of women with small breast tumours might be able to benefit.

Breast-conserving surgery, pioneered in the late 1960s by Professor Umberto Veronesi, has prevented hundreds of thousands of women losing one or both breasts following a cancer diagnosis.


If this new procedure proves effective then I think we can present a whole new image of breast cancer to the women

Professor Umberto Veronesi
Now he wants to see more doctors using a subtler-still operation called sentinel node biopsy, and thinks it that combined with a novel form of radiotherapy could be a "breakthrough" for surgery.

Presently, only an estimated half of suitable UK women are offered sentinel node biopsy, and "intra-operative radiotherapy" is still under development.

Professor Veronesi described the potential of the combination to the European Cancer Conference in Lisbon after being awarded a prize for his work on breast cancer surgery.

Many patients diagnosed with a small breast tumour are given the standard "lumpectomy", but often a large clump of lymph nodes around the armpit are also removed to try to prevent the disease spreading to other parts of the body.

This is not only more painful for the woman at the time, but increases the chances of lymphodema, a highly-uncomfortable condition which causes swelling.

Some doctors fear that removing so many nodes - which play a role in the immune defences of the body, may even remove some protection against disease recurrence.

Spotting the sentries

Sentinel node biopsy works on the principle that a few of the underarm nodes are first in line to host the spreading cancer cells. If they are not here, they are highly unlikely to have spread to other, more distant nodes and beyond.

If doctors can test just these nodes, then this should present enough evidence of spread, or lack of it.

Professor Veronesi's research over the past decade has provided strong evidence that only a handful of spreading cancers will be missed if sentinel node biopsy is carried out instead of the full node removal.

His results on thousands of women suggest that the technique is just as successful, but with far fewer side-effects.

Conventionally, after cancer treatment, women often have to return for several sessions of radiotherapy.

Professor Veronesi says that these visits could be eliminated by combining the complete operation with all the radiotherapy in one package.

While the patient is still on the operating table, a lead disc is slipped behind the breast tissue to protect the chest cavity, and an eight inch wide electron beam focused directly on the area surrounding the tumour.

Because the beam is being so precisely targeted, a bigger dose can be given, equivalent to several sessions all at once.

No nausea

Preliminary results suggest that the technique might be as effective as separate radiotherapy, and with far fewer side-effects such as skin discomfort and nausea, although safety and efficacy trials over a longer period have yet to be completed.

Professor Veronesi told the conference: "If this new procedure proves effective then I think we can present a whole new image of breast cancer to the women.

"We can treat a patient with a single operation - one or two hours - in which the tumour is removed, a sentinel node biopsy carried out, and radiotherapy delivered.

"It might stimulate women to participate more and more in early detection programmes around the world - which may save their lives."

The European Cancer Conference - full coverage

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See also:

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