If we see the localized disease in detail, it includes cases till T3, that is tumor more than 5 cm but not infiltrating the skin or chest wall, or N1, that is presence of mobile axillary lymph nodes.
In early-stage disease, the decision to move ahead with BCS depends on patient as well as oncologist.
The patient has to be willing for it and give consent for the same, and oncologist has to look for any contraindications for the procedure.
If everything is in favor, and the tumor size is small, breast conservation surgery may be was done correctly.
Whereas if the tumor is large, we first have to give neo-adjuvant chemotherapy to shrink the tumor, and then reassess for breast conservation surgery, depending upon the response to chemotherapy.
So, the decision to add chemotherapy in the neoadjuvant or adjuvant setting is taken on an individual patient basis, after discussion in a tumor board.
Also, the decision to add hormonal therapy and targeted therapy is taken depending upon the ER, PR, and her-2 receptor status and along with other factors.
After Breast Conservation Surgery, radiation therapy is given in all the cases.
Whereas after modified radical mastectomy, the decision to add radiation therapy is taken by the radio oncologist depending upon the T-status, N-status, margins of resection along with other factors.
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