Breast Cancer Treatment

Treatment for breast cancer includes surgery, radiation and medicine. Not all women require all three. The standard is to start with surgery, which includes the following options:

Breast conservation -Lumpectomy

This procedure removes the cancer with a surrounding narrow rim of normal breast tissue but preserves the breast itself. This option is available to most women whose breast cancer involves only one area of the breast. The procedure is performed in the hospital and many women go home the same day or the next day. Recovery is straightforward and takes approximately 2 -3 weeks. After recovery, radiation treatments to the remaining breast tissue on that side are required.

Mastectomy - involves removing the entire breast.

This is performed for women who can not (because of other medical conditions) receive, or who choose not to receive, radiation. Mastectomy patients usually stay overnight at the hospital, but recover very quickly, in about the same time as a lumpectomy patient (2-3 weeks).

Reconstruction - when mastectomy is chosen, recreation of the breast can be done at the same time.

Reconstruction involves a plastic surgeon, who will join your general surgeon in the surgery suite, and begin immediate rebuilding of the breast. This lengthens overall surgical time and increases recovery time as well. Reconstruction can also be done at any point in the future-which is known as “delayed reconstruction”. At the time of mastectomy, it is helpful for the general surgeon to know that you are considering future reconstruction.

Sentinel Lymph Node Biopsy -This procedure assists in limiting the total number of lymph nodes removed at the time of surgery.

A special staining or nuclear dye is injected into the breast before surgery and given time to travel to the lymph nodes. The first lymph node it comes to change is the “sentinel” lymph node. This node is removed and sent to the laboratory for testing. If cancer cell are found in the sentinel node, then an axillary lymph node dissection (removing most of the lymph nodes under the arm) may be done. If cancer cells are not found, it is most likely that the cancer has not spread to the remaining lymph nodes and they can be spared. When performing sentinel lymph node biopsy with lumpectomy, a separate incision is needed to remove the lymph nodes under the arm. For mastectomy, the same incision is used.

Breast Radiation –uses x-rays to kill breast cancer cells.

Radiation therapy is often used in combination with breast conserving lumpectomy for early breast cancer. It may also be used to eliminate any tumor cells that may remain after surgery. If cancer cells have spread to the lymph nodes, radiation can be used to those areas as well.

Medicine - Many medications are available to treat breast cancer.

Medicine therapy is given AFTER surgery. While surgery and radiation are LOCAL therapy (treatment affects only the breast). Medication is SYSTEMIC therapy (travels in the bloodstream to affect or treat cancer cells ) and includes chemotherapy, given intravenously, which is typically after surgery but before radiation. Adjuvant hormonal therapy is medicine given by mouth (pill form) that is "added on" after surgery, radiation and chemotherapy. It is aimed at lowering estrogen levels or blocking estrogen uptake and is used in breast cancers that are found to be "estrogen positive". Estrogen positive breast cancers (the cancer cells use estrogen as a fuel source to grow) include the majority of all breast cancers (about 70%).

Neoadjuvant Chemotherapy

In some cases, when the tumor is very large or attached to the chest wall, or the lymph nodes (on biopsy) contains cancer cells, chemotherapy is given BEFORE surgery to shrink the tumor and allows for a more successful surgery.