Treatment Options

Treatment Guidelines

The treatment of breast cancer is a very complex issue. There are a number of treatment options and combinations of treatments that can be used. The appropriate treatment program will be different for every woman, based on a number of factors including the type and stage of the cancer, the age and overall condition of the woman, and past medical history. Treatment decisions should be made by a team of physicians and healthcare professionals who are familiar with the patient and with her overall medical status. In addition, the patient and her family should be involved in treatment decisions.

Treatment programs for breast cancer patients must be developed on an individual basis, with input from the physician, other health care professionals, and the patients and their families. Treatment guidelines are available to assist physicians in planning the most appropriate treatment programs for their patients and to provide patients and their families with information about different treatment options. These guidelines are intended to provide general information for healthcare professionals to use to plan customized treatment programs tailored to individual patient needs. Individual treatment programs may differ from these guidelines, as the physician will base the treatment program on specific information about the patient.

The American Cancer Society and the National Comprehensive Cancer Network (NCCN) have collaborated since 1995 to develop cancer treatment guidelines for healthcare professionals.

The American Cancer Society has prepared a version of treatment guidelines tailored to patients and their families. A written version can be obtained by calling 1-800-ACS-2345.

The National Cancer Institute also provides treatment guidelines through its telephone information center at 1-800-4-CANCER.

Surgery

Most breast cancers are treated surgically, with removal of all or a portion of the breast containing the cancerous lesion. Breast conservation therapy refers to surgery to remove a breast cancer and a small amount of benign tissue around the cancer, without removing any other part of the breast. Mastectomy refers to surgery to remove the entire breast and sometimes other tissue around the breast. When a woman undergoes a mastectomy, breast reconstruction surgery can be performed during the same operation, or at a later time.

Breast conservation therapies include lumpectomy and quadrantectomy, which is also referred to as partial or segmental mastectomy. This type of surgery has been shown to be as effective as mastectomy in most women with Stage I or II breast cancer; however, it is not recommended for some women with special health issues. Women considering breast conservation therapy should discus the risks and benefits with their physician before making a decision. Breast conserving surgery is usually followed by radiation therapy. If chemotherapy is also part of the treatment plan, radiation therapy will be administered after the chemotherapy program is complete.

In a lumpectomy, stereotactic imaging is frequently needed to provide a roadmap for the physician to use to determine the precise location of the mass. Aided by this technology, the physician makes an incision and the breast mass and a portion of normal tissue surrounding the mass is removed (excised). The excised tissue is examined and if cancer cells are noted in the outer edge of the excised tissue, additional tissue may need to be removed.

Side effects of breast conserving surgery may include temporary swelling and tenderness. In some instances, scar tissue formation in the surgical site results in a hardness in the breast and makes follow-up screening examinations more difficult. Women who have had lymph nodes removed as part of breast conservation surgery may experience swelling and/or numbness of the arm and difficulty with movement of the arm and shoulder.

Mastectomy procedures involve removal of the entire breast and, depending on the specific procedure, a portion of tissue surrounding the breasts. There are three types of mastectomy procedures:

• Simple or total mastectomy removes only the breast, but not the lymph nodes from underneath the arm or muscle tissue from beneath the breast.
• Modified radical mastectomy involves the removal of the entire breast and some of the underarm lymph nodes. This is the most common mastectomy procedure.
• Radical mastectomy involves removal of the entire breast, underarm lymph nodes, and the pectoral (chest wall) muscles under the breast. This procedure is rarely performed today because most physicians believe that modified radical mastectomy has proven to be as effective.

Possible side effects of mastectomy include: wound infection, hematoma (accumulation of blood in the wound) and seroma (accumulation of clear fluid in the wound). If the surgery involves removal of lymph nodes, additional side effects may include swelling and/or numbness of the arm and difficulty with movement of the arm and shoulder.

Breast surgeries are frequently accompanied by a procedure to determine whether the cancer has spread to lymph nodes. There are two procedures used to perform this assessment:

• Axillary dissection involves the removal of a portion of the underarm (axillary) lymph nodes for examination under a microscope to assess the spread of cancer to lymph nodes. This assessment is an important part of determining whether adjuvant (additional) therapy is needed. A separate incision is required for this procedure.
• Sentinel lymph node biopsy involves the injection of blue dye or a radioisotope tracer into the tumor site at the time of surgery. The first (sentinel) node that picks up the dye is removed and examined for the presence of cancer cells. If the node is cancer- free, additional surgery for lymph node removal may not be needed.

Breast Reconstruction Surgery

Breast reconstruction surgery is not a treatment for cancer. It is a procedure that restores a normal appearance after a mastectomy. Reconstruction is an important option offered to any woman who has lost a breast because of cancer. A reconstructed breast will not have natural feelings; however, it can boost a woman's feeling of attractiveness. It will also help to maintain a sense of balance and relieve the asymmetrical stress on posture that may occur after a mastectomy.

Breast reconstruction may be done at the time of the mastectomy (immediate reconstruction) or performed months to years after the mastectomy (delayed reconstruction). In some cases, breast reconstruction surgery may need to be delayed if other treatments, such as chemotherapy or radiation therapy, are ongoing.

Some women prefer immediate reconstruction because only one operative session is involved, which generally results in fewer problems from anesthesia and surgery, less recovery time, and lower costs. In addition, the psychological trauma of awakening from surgery without a breast is reduced. Other women prefer delayed reconstruction because it allows more time to consider reconstructive choices and can be easier to coordinate.

The breast may be reconstructed with tissue flaps from one's own body or a synthetic implant.

Implants

Synthetic implants or temporary tissue expanders are tear drop-shaped pouches filled with liquid silicone, or with saline (salt water) that are inserted under the skin to create the form of a breast. The implants are placed under the skin behind the chest muscle. Implant surgery generally requires the least surgery time, has a shorter recovery period, and is less expensive than surgery with tissue flaps. However, implants may rupture or for some other reason need to be replaced.

Patrice, Flagstaff, AZ

“I'm an attorney, and I'm used to doing research. I looked at all the options.”

Click here to see Patrice's Story.

To hear more stories, visit www.VoicesofMammoSite.com

Joan, Philadelphia, PA

“When my surgeon told me I had breast cancer, I didn’t hear much else after that. I did hear him say, ‘You have options’.”

Click here to see Joan’s Story.

To hear more stories, visit www.VoicesofMammoSite.com

To download information on Breast Cancer Treatment Options click here.