Breast Cancer

Treatment Options

Surgery

Surgery is the primary local treatment used to physically remove cancer from the breast. The goal of surgery is local control of the cancer by removing all cancer cells to prevent return of cancer at that same location. The surgery may be a lumpectomy, where part of the breast is removed, or a mastectomy, where the entire breast is removed. The removed breast tissue is sent to pathology for examination and testing. Your doctor or breast care coordinator will discuss your pathology report with you, as soon as it is available. The pathology report will provide more information about your cancer and will guide further treatment. It may take 1 – 2 weeks to get the results.

+ Lumpectomy

Lumpectomy is a surgical procedure to remove the cancer and some normal tissue surrounding the cancer, called the margin. It is also referred to as breast conservation surgery. Lumpectomy leaves the breast largely intact. On the day of surgery, if the cancer cannot be located by touch, the radiologist uses mammogram or ultrasound imaging and a needle to insert a wire into the breast at the site of the cancer. This is called wire or needle localization. Alternatively, a specialized marker or clip may be placed at the site of the tissue, replacing the need for a wire. The wire or marker then guides the surgeon to the targeted tissue. At the time of surgery, the surgeon uses the wire or marker to locate the cancer tissue for lumpectomy. The patient is normally provided with sedation and local anesthesia or general anesthesia. Most patients go home the same day. Patients often receive radiation therapy after the incision from surgery has healed. The combination of lumpectomy and radiation therapy lowers the risk of local cancer recurrence.

+ Sentinel Lymph Node Biopsy

Almost every patient with invasive breast cancer will have a sentinel lymph node biopsy (SLNB). The SLNB is often done at the same time as a lumpectomy or a mastectomy. The biopsy is a way to see if cancer has spread from breast tissue to nearby lymph nodes. During this procedure a small amount of radioactive substance, or dye (often both) is injected into the breast close to the nipple. The radioactive substance and dye travel to and collect in the lymph nodes associated with the breast. These are called sentinel lymph nodes (SLNs). For some people there may be just one SLN, and for others there may be several. A probe is used to sense the location of the radioactive substance under the skin. A small incision is made in the skin and the lymph nodes containing the radioactive substance are removed. The SLNs are examined by the pathologist. If cancer cells are found in the SLNs it means the cancer cells have spread outside of the breast, at least to the SLNs. This information is critical to determine further treatment plans.

+ Axillary Lymph Node Dissection

If cancer cells are found in the sentinel lymph nodes, then cancer cells have traveled into the lymph system and possibly to other parts of the body. More lymph nodes may need to be removed to assess how many lymph nodes are involved. To do this, the surgeon may remove most of the lymph nodes in the axilla. This is called an axillary lymph node dissection (ALND). Not everyone with positive sentinel lymph nodes will need an ALND. This procedure is sometimes done in connection with a lumpectomy or mastectomy. The procedure is done under general anesthesia and most patients will leave the hospital the same day with a drain in place for removing fluid that gathers in the surgical wound following surgery.

+ Mastectomy

Mastectomy, also referred to as total or simple mastectomy, is a surgical procedure that removes nearly all of the breast tissue. A mastectomy is the surgical alternative to a lumpectomy. Both are done to achieve local control of the cancer. Most of the skin is left in place but the nipple is often removed. Mastectomy may be recommended for the patient when a tumor is very large, or if there are multiple tumors in a breast, or if the cancer involves a large portion of the breast. Some patients may choose mastectomy after considering all of the treatment options. The mastectomy procedure requires general anesthesia. Many patients leave the hospital the following day with a drain in place to collect normal post-surgery fluid.

+ Modified Radical Mastectomy

A modified radical mastectomy removes the entire breast and some amount of associated lymph nodes. The procedure consists of a simple mastectomy plus an axillary lymph node dissection. This is different from what used to be called a radical mastectomy, which included removing chest wall muscle. A radical mastectomy is now considered excessive and unnecessary surgery, and therefore is no longer done.

+ Prophylactic Mastectomy

Prophylactic mastectomy is surgery to remove one or both breasts even if there is no information showing the presence of cancer. Removing tissue of one or both breasts reduces the chances of developing breast cancer in the future. It is not a guarantee that cancer will not occur. We encourage you to fully understand the potential benefits and consequences of this procedure.

Survivorship

For many people, cancer survivorship means having no signs of cancer after finishing treatment. Another common meaning of survivorship is living with, through, and beyond cancer. This means that cancer survivorship begins at diagnosis and continues through treatment and beyond. It can be useful to think of survivorship in three phases. Survivorship that begins at diagnosis and ends with the completion of initial cancer treatment is referred to as acute survivorship. Extended survivorship follows initial cancer treatment and focuses on the effects of the cancer and treatment, including efforts to decrease the risk of recurrence. Finally, permanent survivorship is the period when years have passed since the initial cancer treatment and the risk of recurrence is much lower. The focus during this time is on long-term effects of cancer and treatment. The number of breast cancer survivors has steadily increased over the last 45 years. Breast cancer survivors have created strong networks for mutual support.

Local community programs and services provide places where people with breast cancer meet and find solutions. We encourage you to take advantage of these services. Your care team will help you to locate them. After completing initial treatment, some patients feel a new-found freedom following weeks, or months, of appointments, tests, and treatments. Some people will continue with their lives much as they did before treatment, while others may have difficulty adjusting to treatment side effects that can continue for months or years. Concerns about breast cancer recurrence are very common, even when treatments have been successful. You may have lost some upper body strength and it will take time to regain it. Changes in your physical appearance may feel uncomfortable. Clothes and breast forms can cover the areas affected by treatment and may help to increase your comfort and self-confidence. If you had not previously received breast reconstruction surgery, you can still choose this procedure at any time.

+ Family, Friends, and Emotional Support

It is normal to seek support from those closest to you. At times they may not notice if you are having side effects from treatment or if you need support. They may not understand your emotional and psychological experiences. We encourage you to talk with your family and friends about your feelings and needs. This can help them to better understand your experience. You might find new friends by attending support groups with others who have breast cancer.

+ Intimacy and Sexuality

Rarely are so many intimate aspects of a person’s life affected by a single circumstance. At times you may feel frustration, anger, loneliness, or sadness. Remember your care team is here to support you. Physical changes brought on by breast cancer and its treatment often cause symptoms of menopause. These can include vaginal dryness, sensations of itching or burning, problems with urination and pain with sexual intercourse. These symptoms are referred to as genitourinary syndrome, or vaginal atrophy. There are treatment options, though not all of them are suitable for breast cancer patients. In addition, your personal journey may change your understanding about your self-identity, your sexuality, and physical intimacy. An intimate partner may also have difficulty coping with physical and emotional changes. We are here to support them as well. We encourage you to be patient with yourself. Express your feelings and be open to learning new things about yourself and others. These pages offer a few suggestions for meeting people who are in similar situations and may be experiencing the same things. You may find new friends. You may gain deeper relationships with existing friends. Your care team is always available to help you manage physical symptoms as well as locate emotional support.