Multi-Criteria Assessment Problems in
Breast Cancer Surgery

Cornel RESTEANU¹, Romica TRANDAFIR², Xenia BACINSKI³

¹I C I Bucharest
(National Institute for R & D in Informatics)
8-10 Averescu Blvd.
011455 Bucharest 1, Romania
resteanu@ici.ro

²Technical University of Civil Engineering
24 Lacul Tei Avenue, 020396, Bucharest 2, Romania
romica@utcb.ro
³Institute of Oncology
52 Fundeni Avenue, 022338, Bucharest 2, Romania
xenia_bacinschi@yahoo.com

Abstract: It is well known that in the breast cancer surgery, of paramount importance is to choose the best surgery type according to the patient’s disease stage. The best choice is possible to be made by computing, in the Multiple Attribute Decision Making paradigm, the merits of all types of surgery that can be applied. The main issues are the diverse assessment problems with conflicting criteria and different measure units. Therefore both the physician and the patient have a good scientific tool in their practical decision process.

Keywords: Cancer, Surgery schema, Merits’ Assessment, Multiple Attribute Decision Making, Decision Analysis.

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CITE THIS PAPER AS:
Cornel RESTEANU, Romica TRANDAFIR, Xenia BACINSKI, Multi-Criteria Assessment Problems in Breast Cancer Surgery, Studies in Informatics and Control, ISSN 1220-1766, vol. 19 (1), pp. 45-54, 2010.

1. Introduction

By definition, ‘Neoplasm or tumor represents the abnormal cells excessive proliferation that resembles more or less the tissue in which they are growing and they end up obtaining a biological autonomy’. Neoplasm has miscellaneous causes: hereditary, chemical (tabacosis), physique (sun radiations), biologic (a virus action). These causes can join together. Sometimes, a tumor can have an unknown cause. Tumor cells lost the sensibility to organic structure that normally discourages any excessive proliferation. Immune system’s white cells inhibit or destroy all isolate tumor cells that appear in the case of a healthy individual. Therefore, a real tumor could grow only if its cells became resistant to immune system.

There are two kinds of tumor, benign tumor and malignant (cancerous) tumor:

Benign tumors usually have a limited volume. They repress to neighbor tissues without invading them, they do not produce metastases and, in most of the cases, their consequences are not serious;
Malignant tumors, i.e. cancerous tumors, have opposite characteristics to benign tumors. They often become bulky and ill bounded. They infiltrate the surrounding tissues, relapse after the ablation and, especially, they have the tendency to expand and form metastases.

Breast neoplasm [1] is the most frequently woman cancer type, representing about 29% of new annual diagnosed cancer. It represents the first cause of death among women younger than age 55.

The breast neoplasm incidence has significantly increased in the last decades, but mortality decreased because the disease early detection and modern treatments. The disease stages are the following:

Stage I is known as precocious stage, early stage;
Stages IIA and IIB are considered advanced loco regional stages; the tumor is smaller than 5 centimeters and can not include the breast adjacent tissues;

Stages IIIA and IIIB are considered advanced loco regional stages; the tumor is bigger than 5 centimeters and can include the breast adjacent tissues;
Stage IV, metastasis, the cancer cells go and proliferate in different organs situated at a distance from the primary tumor.

The treatment depends on disease stage. It is limited to surgery associated with radio-therapy and hormonal-therapy in early stages and can become more complex and aggressive in late stages by using, beside surgery, cytostatics, monoclonal antibodies, radio-therapy, hormonal-therapy, an entire arsenal of symptomatic therapies in order to ensure a better life quality.

In this paper, the focus is on surgical treatments’ assessment, computing merits of the surgery schema. It is possible to use techniques like in [2] but they have some limitations. In this paper, merits are computed using the Multi-Attribute Decision Making (MADM) paradigm. In the following, there are some theoretical considerations on mathematical instruments.

For objects in a given set, the MADM methods [3, 4] compute, in the assessment process, its merits, values between 0 and 1, used for objects’ ranking or / and optimal choice. The objects’ set are finite and explicit done. The assessment is made upon a set of objects’ attributes.

The second section of the paper presents the breast cancer surgery model and its instance in conformity with the experiment made. Some general methods to solve the assessment generated problems, based on the previously mentioned model, are given in the third section. These methods are presented in the natural language, but one of them is presented in mathematical language. Also, the general procedure, for solving multi-attributes-states_of_nature-experts problems, is done in the same section. Model’s consistency analysis and assessment numerical results with comments on their significance are given in the fourth section. Some conclusions, given in the fifth section, end this paper.

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https://doi.org/10.24846/v19i1y201005