Breast Cancer:

Understanding Treatment and Options 

The treatment options available to you will depend on a number of factors, including the type of tumor, the extent of the disease at the time of diagnosis, your age, and your medical history. However, your personal feelings about the treatment, your self-image and your lifestyle will also be important considerations in your doctor’s assessment and recommendations. You and your doctor should discuss these treatment methods and how they apply to your situation. Understanding all of your options from the beginning of your diagnosis allows you to have all of the information you need to make an informed and rational decision about your care.

TWO-STEP TREATMENT

The two step treatment method involves having a biopsy one day; then, if the lump is cancerous, the treatment takes place within the next few weeks. In many cases, the biopsy can be done on an outpatient basis-often in the doctor’s office or mammography suite. Most biopsies can be performed under local anesthesia. Your surgeon will discuss the specific type of biopsy with you.

The short time between biopsy and treatment (which will not reduce the chances for success) allows time to examine the permanent section slides, to perform additional tests to determine the extent of the disease, to discuss treatment options, to gain another medical opinion, to make home and work arrangements, and to prepare emotionally for the treatment.

STAGING

Once a diagnosis of invasive cancer is made, you may go through a staging process to determine if the tumor has spread to any other organs in the body. This usually includes a chest x-ray, liver function tests, and bone scan. In certain instances your physician may request a PET scan, MRI, or CAT scan. An abnormality in these does not mean the tumor has spread, but that further testing is needed.

BREAST SURGERY

Mastectomy is the medical term for surgical removal of the breast. It refers to a number of different operations, ranging from those that remove the breast, chest muscles and underarm lymph nodes, to those that remove only the breast lump.

The different types of breast surgery are described below. Based on the size and location of the lump, your doctor will recommend the type of surgery that offers you the best chance of successful treatment.

Most medical and surgical procedures carry some risk. The risks are categorized small or serious, frequent or rare. Because there is such a wide range of potential risks and benefits from various treatments for the different stages and kinds of breast cancer, you should discuss with your doctor the particular benefits and risks of treatment methods suitable for you.

MODIFIED RADICAL MASTECTOMY OR TOTAL MASTECTOMY WITH AXILLARY NODE DISSECTION

This procedure removes the breast, the underarm lymph nodes, and the lining over the chest muscles. It is also called “total mastectomy with axillary (or underarm) dissection.”

ADVANTAGES

Keeps the chest muscle and the muscle strength of the arm. Swelling is less likely, and when it occurs, it is milder than the swelling that can occur after a radical mastectomy. Survival rates are the same as for the radical mastectomy when cancer is treated in early stages. Breast reconstruction is easier and can be planned before surgery.

DISADVANTAGES

The breast is removed. In some cases, there may be swelling of the arm because of the removal of the lymph nodes. (8%-10% risk of lymph edema).


TOTAL OR SIMPLE MASTECTOMY

This type of surgery removes only the breast. Ideally a few of the underarm lymph nodes closest to the breast are removed to assure complete removal of the axillary tail of the breast. This is most often used to treat noninvasive breast cancers or in prophylactic mastectomies.

ADVANTAGES

Most or all of the underarm lymph nodes remain, so the risk of swelling of the arm is greatly reduced. Breast reconstruction is easier.

DISADVANTAGES

The breast is removed. If cancer has spread to the underarm lymph nodes, it may remain undiscovered.


SKIN SPARING MASTECTOMY

The mastectomy is performed through a small keyhole using the nipple/areolar complex as the only skin that is removed.


LUMPECTOMY

This procedure removes the tumor plus a wedge of normal tissue surrounding the cancer. Occasionally the skin and the lining of the chest muscle below the tumor will need to be removed to obtain clear margins. A margin of normal tissue must be removed to insure the tumor has been completely removed. (A 5 mm margin of normal tissue is optimal, but a 2 mm margin is mandatory to decrease the risk of local recurrence after radiation therapy). It is followed by approximately six weeks of radiation therapy.

ADVANTAGES

If a woman is large breasted, most of the breast is preserved. There is little possibility of loss of muscle strength or arm swelling.

DISADVANTAGES

If a woman has small or medium-sized breasts, the procedure may noticeably change the breast’s shape. There is a possibility of arm swelling if an axillary lymph node dissection is performed.