Breast Cancer Health Article

Treatment

Early detection is associated with the best clinical outcomes. Treatment options include surgery with or without chemotherapy, or surgery with or without radiation. Sometimes, all treatment modalities may be used in the same patient. Breast cancer is treated locally to eliminate tumor cells from the breast by surgery and radiation, and systemically to destroy cancer cells that have traveled to other parts of the body. Systemic therapy includes the use of chemotherapy and hormonal treatments to reduce the amount of estrogen circulating in the blood.

Lumpectomy is a surgical treatment for newly diagnosed patients with breast cancer. Lumpectomy is considered breast-conserving surgery because only the malignant tumor and a surrounding margin of normal breast tissue are removed. Lymph nodes in the armpit (axilla) may also be removed. This procedure is called lymph node dissection.

It is estimated that at least 50% of women with breast cancer are good candidates for a lymph node dis- section. The location, size, and type of tumor are of primary importance when considering breast cancer surgery options. The size of the breast is another factor the surgeon considers when recommending surgery. The patient's psychological outlook, as well as her lifestyle and preferences, should also be taken into account when treatment decisions are made. If the tumor is less than about 1.5 in (4 cm) or there is little risk of recurrence, the patient and physician may opt for lumpectomy, followed by radiation therapy.

Many studies have compared the survival rates of women who have had mastectomy (removal of a breast) with those who have undergone lumpectomy and radiation therapy. The data clearly demonstrate that for women with comparable stages of breast cancer, survival rates are equal between the two groups.

In some instances, women with later stage breast cancer may be able to have lumpectomy. Chemotherapy may be administered before surgery to decrease tumor size and the chance of metastasis in selected cases.

If the tumor is larger, a total (or simple) mastectomy may be recommended. If the cancer has spread to the chest muscles, a radical mastectomy may be the best treatment option.

In a lumpectomy, the surgeon removes:

• the lump
• a margin of the tissue around the lump or mass
• some of the lymph nodes under the arm (to determine whether the cancer has metastasized)

A new technique that may eliminate the need for removing many axillary lymph nodes is being tested. The term sentinel node biopsy is most frequently used to refer to this method. It is based on the idea that the condition of the first lymph node in the network, which drains the affected area, can predict whether the cancer may have spread to the rest of the nodes. If this first, or sentinel, node is cancer-free, it is thought there is no need to look further. Many patients with early-stage breast cancers may be spared the risks and complications of axillary node dissection as the use of the sentinel node biopsy continues to increase.

Even if no cancer is found in the nodes, radiation always follows lumpectomy, and treatment may include chemotherapy. Some studies suggest that following lumpectomy, a combination of chemotherapy and radiation offers the best chance of long-term survival.

In a modified radical mastectomy, the doctor removes:

• the entire breast
• axillary lymph nodes
• the lining over the chest muscle, but not the muscles themselves

Today, radical mastectomy is rarely performed, but when necessary, the surgeon removes:

• the entire breast
• the chest muscles
• all of the lymph nodes under the arm

Mastectomy may be combined with breast reconstruction, either during the surgical procedure, postoperatively

or months later. During surgery, if cancer cells are detected in the lymph nodes, more extensive surgery may be indicated. If the cancer has spread to the nodes, then radiation, chemotherapy, hormone therapy, or a combination of all three will be recommended after surgery. These post-surgical treatments are referred to as adjuvant therapy.