Surgical treatment of breast cancer has made great advances over the past few decades. The most significant has been the replacement of the once common and only surgical option available, radical mastectomy, with less disfiguring, yet highly effective surgeries and other therapies. Today the total removal of chest muscles, breast tissue, and lymph nodes is likely to be done only when a tumor has invaded the muscle beneath the breast. There are three other types of mastectomy, which may be offered by your surgeon — modified radical mastectomy, simple mastectomy, and subcutaneous mastectomy. In the modified radical mastectomy, the chest muscles are spared and the breast and lymph nodes are removed. Over the years it became clear that survival was not increased by the removal of the chest wall muscles, so modified radical mastectomies replaced the radical mastectomy. Prosthetic reconstruction is easier than in a radical mastectomy and problems with the arm are not as likely to occur. In a simple mastectomy, the surgeon removes only the breast. A subcutaneous mastectomy removes only the breast tissue, leaving the skin and some superficial tissue.
Breast conservation therapy, or lumpectomy, is the removal of the malignant lump and the lymph nodes under the arm, leaving the remainder of the breast intact. A lumpectomy is a viable choice for breast cancer treatment when the tumor is small. The procedure is almost always followed by five to six weeks of radiation therapy to destroy any remaining cancer cells. Studies have revealed that in early stage breast cancer, the combination of lumpectomy and radiation therapy has the same success rate as modified radical mastectomy. Some women prefer a lumpectomy because it allows them to keep their breast. However, it should be noted that lumpectomy may not be an option for pregnant women; those whose tumor is large relative to the size of the breast; those who have had previous radiation therapy to the breast; and those who are unwilling or unable to have radiation therapy.
Early studies demonstrated that lumpectomy alone may not eradicate the presence of breast cancer. In fact, breast cancer will recur in approximately 20 percent of lumpectomy patients who do not also receive radiation therapy. Radiation treatment to decrease risk of local reoccurrence almost always follows a lumpectomy and is recommended whenever the cancer has reached the lymph nodes. Before treatment, the patient’s skin is marked to identify the area where radiation must be targeted. The painless treatment usually involves five to six weeks of x-rays to the chest and/or underarm area for a few minutes at a time. When cancer metastasizes to the bone, radiation is often used to ease the pain. The specialist who administers this treatment is a radiation oncologist or radiotherapist. There are several side effects to radiation. Fatigue is commonly experienced toward the end of the radiation series. The skin in the treated area will look and feel slightly sunburned. This problem fades about a month or more after the treatments end. Care should be taken when exposing the treated area to the sun. Protective clothing and sunscreen are advised.
Surgery and radiation therapy are intended to treat a localized area of the body. If the breast cancer cells migrate or metastasize to other parts of the body, medicine is needed that can be distributed throughout the body. Chemotherapy is that medicine. Chemotherapy drugs — chemicals that destroy tumor cells — are given either intravenously, in pill form, or through a combination of the two methods. The course of treatment may be over a four to six month period in three or four week cycles. A medical oncologist provides the chemotherapy. Because chemotherapy can also injure healthy cells, a medical oncologist must adjust the dosage and combination of drugs for each breast cancer patient. Chemotherapy works best for women who have not yet gone through menopause. Several side effects are associated with chemotherapy. They are nausea, vomiting, hair loss, mouth sores, vaginal sores, and fatigue. Certain chemotherapies also cause infertility and premature menopause.
In treating breast cancer, hormone therapy may be used on its own, in conjunction with chemotherapy or following chemotherapy. The most commonly used hormone drug is an anti-estrogen agent called tamoxifen. The role of estrogen in causing breast cancer is still debated, but scientists have found that the hormone can be used to block the production of cancer cells. In order to determine whether anti-estrogen treatment will be effective, a pathologist will study the biopsied breast tissue. If the tissue is found to be estrogen-receptor positive, hormone therapy may be able to fight the cancer. The side effects of hormone therapy can include weight gain, mood swings and hot flashes. One serious side effect of using tamoxifen is an increase in the risk of endometrial cancer, or cancer of the uterus. Many physicians believe that the benefits of using tamoxifen outweigh that potential risk.
Reconstructive surgery and cosmetic prosthesis are two options for breast cancer patients who have had surgery to remove part or all of their breast tissue. Those who prefer to have breast reconstruction may choose an implant or an autologous reconstruction. The latter uses a woman’s own fatty tissue, muscle, and skin from her back or belly to create a breast shape. In either case, it is also possible to have the nipple and the areola reconstructed. Responding to reports that implants were making women ill, the United States Food and Drug Administration now regulates the use of breast implants. Implants are made of either saline or silicone. Silicone-filled implants may only be used by women who have had a mastectomy, and then only if they agree to participate in a clinical trial. Mastectomy patients may also use saline-filled implants, and they are encouraged to participate in a clinical study. By participating in a study, a woman will receive close follow-up for five years and may also get some financial assistance..