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Tremendous strides have been made in the treatment of breast cancer. The treatment
choice is guided primarily by the stage of the cancer, but there are also personal
considerations for each patient. In addition to reading about the procedures,
you may want to seek a second medical opinion or contact a breast cancer support
group to talk to women who have already undergone these treatments.
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
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.