Treatment Options
Breast Cancer: Understanding Treatment 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.
Why Me?
Right now you are probably asking yourself, “Why me?” Cancer has suddenly intruded on your life and threatened your health and well-being. You have not lost control of your personal health. You will continue to take care of yourself by working in a partnership with the health care professionals responsible for your treatment and safe recovery. By becoming informed, asking questions, and participating in treatment decisions, you will have a positive influence on your own well-being.
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 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.
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.
Skin Sparing Mastectomy
The mastectomy is performed through a small keyhose 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. It is followed by approximately six weeks of radiation therapy.
Sentinel Lymph Node Biopsy
This procedure allows for the evaluation of the axillary (underarm) lymph nodes. The sentinel (first line of defense) lymph node(s) are identified by this technique. If no cancer is identified in this node(s), no additional nodes will need to be removed as they will not contain cancer. The procedure involves with an injection of radioactive tracer called technetium sulfur colloid and a vital blue dye near the nipple while you are under anesthesia at the start of the breast cancer procedure that has been chosen. These two modalities allow us to identify the sentinel lymph node in 90% of patients. Once the sentinel node is identified, your surgeon will manually check your axilla for other nodes that may have tumor in them. Lymph nodes filled completely with cancer cells may not have the ability to pick up the radioactive tracer and blue dye; therefore this is also an important part of the process. At your postoperative visit, you will discuss your final pathology, which will include the results of your margins of tumor resection and the findings of complete examination of your sentinel lymph node(s). Decision may be made at that time regarding your need for axillary dissection.
Axillary Node Dissection
Axillary node dissection refers to the staging procedure performed in conjunction with lumpectomy for breast conservation or mastectomy. The procedure involves an axillary incision below the hairline when performed with a lumpectomy and is performed through the mastectomy incision with removal of the breast.
Removal of level I and II lymph nodes includes the tissue between the axillary portion of the breast and the area above the axillary vein underlying the pectoral muscles. The axillary nodes (level III nodes) lying superior to the pectoral major muscle are preserved to decrease the incidence of arm edema. It may also remove a small nerve in the process resulting in numbness to the posterior aspect of the arm. Determining whether the lymph nodes are involved with the tumor will stage the cancer to determine if chemotherapy will be needed. One of the debilitating side effects of axillary dissection has been lymphedema (arm swelling). This occurs in approximately 8-10% of patients. The arm may also become numb above the elbow at the level of the triceps muscle. You must protect your arm from cuts and scrapes for the rest of your life to prevent lymphangitis (an infection in the lymphatics of the arm).
The Breast Cancer Treatment Team
During your treatment you are likely to meet several health professionals who will perform the various tests and treatments your doctor recommends. It may be difficult at first to talk with them about your illness and your feelings about treatment, but each of them can offer information to help you feel more at ease. By talking with the professionals who care for you, you will come to understand more about cancer and its’ treatment and be better able to cope. In addition to the surgical and medical treatment of your cancer, you may also want to consider integrating holistic therapies into your treatment plan to enhance and promote your healing process.
These are some of the specialists you may meet and hear about:
Anesthesiologist – A doctor who administers drugs or gases to put you to sleep before surgery.
Clinical nurse specialist – A nurse with special knowledge in a particular area, such as postoperative care or radiation therapy.
Medical Oncologist – The doctor who administers anti cancer drugs or chemotherapy.
Pathologist – Doctor who examines tissue removed by biopsy to see if it is cancerous.
Personal physician – Your doctor, who will be responsible for coordinating your treatment and working with you to ensure that treatment is satisfactory. Your personal physician may be a surgeon, radiation oncologist, medical oncologist or family physician.
Physical Therapist – A specialist who helps in rehabilitation after surgery by using exercise, heat, light and massage.
Radiation Oncologist – Doctor who supervises radiation therapy.
Radiation therapy technologist – A specially trained technician who helps the radiation oncologist give external radiation treatments.
Surgeon – A doctor who performs surgery, such as biopsy and mastectomy and axillary node dissections.
Making Important Decisions about Treatment
Important decisions are always hard to make, particularly when they concern your health. However, there are a number of things you can do to make decisions about breast cancer treatment easier. One is gathering information. You can:
Talk with your doctor. There are a number of treatments that may be used for breast cancer. To make sure you will be comfortable with your decision to have a particular treatment, you may want to get a second medical opinion. Obtaining a second opinion does not mean you do not trust your doctor; it means you are insuring that you are receiving the best possible care and treatment that exists.
Discuss treatment options with friends and relatives. Although you and your doctor are in the best position to evaluate treatment options, it sometimes helps to discuss your feelings with others whose judgment you respect. Often, close friends and relatives can provide insight that can help your own thinking.
Talk with other women who have had breast cancer. Many women who have been treated for breast cancer are willing to share their experiences. Your local American Cancer Society (ACS) office may be able to direct you to such women through its Reach to Recovery program. This program, which works through volunteers who have had breast cancer, helps women meet the physical, emotional and cosmetic needs of their disease and its treatment. Some ACS offices have volunteer visitors who have had a mastectomy, breast reconstruction, radiation or chemotherapy. Sometimes they are able to meet with women before surgery. Contact your local ACS office for additional information.
Take the Time to Make and Informed Decision
Remember that you have time to consider options. Except in rare cases, breast cancer patients do not need to be rushed to the hospital for treatment as soon as the disease is diagnosed. Most women have time to learn more about available options, make arrangements at medical facilities where treatments will be given, and organize home and work lives prior to treatment. A long delay however, is not advisable because it may interfere with the success of your treatment.
