유방암을 치료하는 외과의사 한원식 교수 | #지켜보다

Breast cancer diagnosis and treatment principles

• Breast cancer surgery as standard care (early-stage)

  • Most breast cancers require surgery, especially when localized or early-stage.
  • Surgery may offer limited benefit in late-stage cases with metastasis.

• Disease staging details

  • “Early stage” examples include tumors that are still small or nascent, and may be difficult to palpate.
  • Recurrence is common: subtitles indicate ~2–3 out of every 10 patients experience recurrence (depending on stage/subtype).

• Biopsy and pathological evaluation

  • Needle localization can be used when tumors are not palpable on the skin surface.
  • Frozen-section biopsy is used intraoperatively to check whether cancer cells are present near the nipple, which determines whether nipple-sparing approaches/reconstruction are possible.

Treatment selection and sequencing (personalized oncology)

• Breast cancer is described as having multiple types/subtypes, requiring different approaches.

• Potential treatment modalities mentioned:

  • Surgery (e.g., partial mastectomy vs total mastectomy variants)
  • Radiation therapy (when needed)
  • Chemotherapy (anticancer chemotherapy)
  • Targeted therapy for HER2-positive breast cancer (noted as “HART-positive” in subtitles)
  • Hormone therapy for hormone-positive breast cancer

• Neoadjuvant drug treatment (drug-first strategy)

  • A strategy described as giving drug treatment before surgery to reduce tumor size.
  • Subtitles note a risk of overtreatment, since cancer biology may not be fully understood before complete workup.

Surgical innovations aimed at preserving form and quality of life

• Oncoplastic surgery / symmetry preservation

  • Techniques intended to prevent breast collapse and maintain symmetry while removing cancer.

• “Seongsu method” (as referenced in subtitles)

  • A tailored approach considering segmental vs total mastectomy, alongside reconstructive strategies to address expected outcomes.

• Breast “preservation total mastectomy” (simultaneous oncologic + reconstructive approach)

  • Perform total mastectomy while leaving most skin intact, then reconstruct using implants.
  • Simultaneous procedure coordination
    • Breast surgeon removes cancer tissue.
    • Plastic surgeon performs reconstruction (“crafting the treasure” for breast restoration).
  • If nipple-area cancer is found
    • Use a skin expander for months, then later insert implants and reconstruct the nipple.
  • If nipple-area cancer is absent
    • Proceed directly with plastic reconstruction.

• Future augmentation

  • Possibility of later augmentation/repair surgery is mentioned.

Translational and computational/biomarker research

• Breast Cancer Research Laboratory (Seoul National University Hospital)

  • Conducts basic research to support advances alongside or before clinical work:
    • Development of diagnostic markers and prognostic markers
    • Development of new drugs
  • Notes that some marker-related outputs have been commercialized.

• Neutrophils and CT scans

  • Subtitles claim that, along with recruitment of neutrophils, CT scans induce network formation, suggesting a mechanistic link between imaging/biological response and microenvironmental formation (presented as an active research topic).

• “HIT” prognosis prediction tool

  • A breast cancer prognosis prediction tool using next-generation sequencing (NGS).
  • Purpose:
    • Identify patients more likely to need chemotherapy after surgery versus those who may avoid it.
  • Clinical decision impact:
    • Support recommending chemotherapy for patients predicted to have a poor prognosis.
    • Support advising against chemotherapy for patients predicted not to benefit.
  • Next step goal:
    • Conduct more multi-center clinical trials to potentially change breast cancer treatment guidelines.
  • Broader objective:
    • Find therapeutic targets and improved diagnostic/prognostic markers for more personalized diagnosis and treatment.

Methodology / workflow outlined

• When tumors are not palpable

  • Place a needle localization marker prior to surgery.
  • Perform partial mastectomy to remove the marked area.

• Intraoperative decision workflow for reconstruction

  • Remove tumor(s) during mastectomy.
  • Send tissue to pathology for frozen-section biopsy of the nipple base area.
  • If no cancer near nipple
    • Proceed immediately with plastic reconstructive surgery.
  • If cancer near nipple
    • Use a skin expander over several months.
    • Insert implants later and reconstruct the nipple.

• Prognosis-guided treatment selection (HIT tool)

  • Use NGS-based genetic analysis.
  • Predict prognosis category.
  • Recommend:
    • Chemotherapy if predicted poor prognosis
    • Avoid chemotherapy if predicted not to require it

• Research-to-clinic strategy

  • Basic research → develop diagnostic/prognostic markers.
  • Translational/clinical validation → expand with multi-center trials.

Featured researchers / sources (named at end)

• Han Won-sik (Professor, Department of Breast and Endocrinology, Seoul National University Hospital)
• Jin Woong-sik (Professor, Department of Plastic Surgery)
• Seoul National University Hospital Breast Research Laboratory (institutional research group)
• “HIT” (next-generation sequencing-based prognosis prediction tool developed by Professor Han Won-sik)