Treatment Options

It’s normal to feel overwhelmed when planning your treatment with your doctors. There is no single plan that works for everyone, so your care team will carefully choose the most effective treatment or combination of treatments that fit your unique diagnosis.

Before you begin any treatment, your doctor will review your pathology report and discuss the breast cancer treatment options available. The type of breast cancer treatment or treatments that are recommended will be based on the following factors:

• How small or large is the tumor
• Where the tumor is found in the breast
• If the tumor is invasive or in situ
• If cancer is present in the lymph nodes
• If cancer is found in other parts of the body

Be sure to ask your doctor if you have any questions or concerns about the breast cancer treatment option that is being recommended. It is a decision you and your doctor will make together, and it is important to know exactly what to expect with a procedure before you begin any form of treatment.

Surgery

Most breast cancer patients will have surgery to remove the cancerous area. There are several surgical options available to patients depending on the extent of their disease.

Lumpectomy

A lumpectomy is also known as breast-conserving surgery. In a lumpectomy, the surgeon removes the breast cancer and some normal tissue around it. Often, some of the lymph nodes under the arm are removed as well. The lumpectomy breast cancer treatment procedure is usually followed by radiation therapy to destroy any cancer cells that may remain in the area.

Partial Mastectomy

In a partial mastectomy [MAS-TEC-toe-mee], the surgeon removes the breast cancer and a larger area of normal breast tissue around it. In many cases, the lymph nodes under the arm are also removed. Occasionally, some of the lining over the chest muscles below the tumor is removed as well. This breast cancer treatment procedure is usually followed by radiation therapy to destroy any cancer cells that may remain in the area. A partial mastectomy is also referred to as segmental mastectomy or quadrantectomy.

Total Mastectomy

This type of breast surgery actually removes the breast. Some of the lymph nodes under the arm may also be removed. A total mastectomy is sometimes referred to as a simple mastectomy.

Modified Radical Mastectomy

In a modified radical mastectomy, the surgeon removes the breast, most of the lymph nodes under the arm and often the lining over the chest muscles.

Radiation Therapy

In most cases, breast sparing surgery is followed by radiation therapy. Some patients undergoing mastectomy may also require radiation therapy. High-energy radiation is used to kill cancer cells that may be present in the remaining breast tissue. The radiation may come from outside the body (external radiation) or from radioactive materials placed directly in the tumor (implant radiation).

Chemotherapy and Hormone Therapy

Depending on the particular clinical factors of breast cancer patients, chemotherapy may be recommended. Chemotherapy drugs are designed to travel throughout the body and kill or slow the growth of cancer cells. For women who have cancer that has spread beyond the breast, hormone therapy is often recommended. In the case of a large breast tumor, some patients will undergo neoadjuvant therapy, or treatment prior to surgery, in order to shrink the tumor. This allows for breast conservation surgery for some patients. Source: NCCN.org

Sentinel Node Biopsy

Sentinel node biopsy is a technique used to determine the status of the axillary lymph nodes without performing a full axillary dissection. The tumor site is injected with a radio isotope and/or blue dye. This is tracked into the sentinel node, which is the first lymph node in the body to come in contact with cancer cells as they leave the primary tumor. The sentinel node is then removed.

If there is no breast cancer found in the sentinel node, no further nodes may need to be removed. If breast cancer is found, then more lymph nodes will need to be removed. Minimal node removal can save a woman from a condition known as lymphedema, a painful swelling of the arm.

Magtrace is a new, advanced technology for identifying the sentinel lymph node. Magtrace can replace the blue dye and radioactive particles that have been in use for sentinel lymph node location since the 1990s. The new technique eliminates the risk of side effects related to the dye and decreases the regulations involved with injecting the radioactive particles that were used with the older technique. This allows the injection to occur in any location and, for some patients, days ahead of their surgery.

Breast Reconstruction

After a mastectomy, some women decide to have breast reconstruction. This is done either at the same time as the mastectomy or in a later surgery. It is best to consult with a plastic surgeon before the mastectomy, even if breast reconstruction will be considered at a later date.

Either implants or tissue flaps can be used to rebuild the breast. Tissue flaps involve using muscle, fat and skin from another part of the body to reconstruct the breast. The tissue is shaped and inserted in the chest to form a breast.

Treatment timeline

There are many factors that determine an individual’s treatment plan and timeline. There are usually additional tests performed with a cancer diagnosis, and those results will have to be considered as well. Your care team will take into consideration your health condition, personal preferences, and national guidelines when determining your course of treatment.

Generally, a patient diagnosed with breast cancer will meet with a breast surgeon or surgical oncologist who will go over imaging and pathology results. He or she will order additional tests you may need and place any referrals for other physicians like medical and radiation oncologists. Some patients will have additional imaging procedures like breast MRI (magnetic resonance imaging) or PET (positron emission tomography) scans in addition to blood tests, physical therapy consults, and other examinations.

Each individual will follow a timeline based on many personal and outside factors. Ask your doctor what to expect.