Cancer

Breast Cancer: Treatments

Jessica Evert, MD, edited by Benjamin McDonald, MD

There are two general approaches to treating cancers: local treatment and systemic (whole body) treatment. Local treatment involves treating just the small areas of the body containing tumors while affecting the rest of the body as little as possible. Systemic treatment approaches, on the other hand, are used to treat cancer that has spread throughout the body. Local treatment approaches alone may be all that is required for treatment of early stage breast cancer (e.g., before metastasis - the spreading of cancerous tissues through the body -- has occurred). Combined local and systemic approaches may be necessary for treatment of more advanced cancers. Surgical approaches tend to fall into the local treatment category, while chemotherapy approaches fall into the systemic category. Radiation therapy approaches can be local or systemic depending on how they are administered.

The majority of women who are afflicted by breast cancer will require some type of surgery. The goal of the surgical procedure is to remove the cancerous tumor while preserving as much of the healthy breast tissue as possible. Later stage breast cancers often require more extensive surgeries as more tissues get involved in the disease process. Some of the surgical procedures used to treat breast cancer are:

  • Lumpectomy. Lumpectomy is a surgical procedure in which the breast tumor is removed while sparing as much healthy surrounding tissue as possible. The benefit of lumpectomy is that in most circumstances the mass and form of the breast can be retained. Radiation treatment and chemotherapy are often given in conjunction with lumpectomy. Recovery time from a lumpectomy is very short.

  • Partial Mastectomy. This surgical procedure is similar in principle to a lumpectomy but involves removing more of the tissue surrounding the cancerous tumor. Partial mastectomy can also be followed by radiation therapy or chemotherapy.

  • Modified Radical Mastectomy. This surgical procedure involves removing the entire breast mass and involved lymph nodes from under the arm (while preserving as many of the lymph nodes as possible). Understandably, removal of the entire breast and the disfigurement this creates can be traumatic and depressing for many women. Reconstructive surgery may be desirable.

  • Radical Mastectomy. During this surgical procedure the entire breast is removed as well as the lymph nodes under the arm and the pectoral (chest) muscles under the breast. This most extreme surgical method is rarely performed today since studies have shown that survival rates with modified radical mastectomy are often just as high. Most mastectomy patients stay in the hospital anywhere from four to ten days after surgery.

Surgical removal of the tumor causing a cancer is often not sufficient for a full recovery, particularly when metastasis has occurred. It is common to see systemic chemotherapy or radiation therapies applied in conjunction with surgery. Chemotherapy and radiation therapies offer doctors a way to destroy any cancer cells in the surrounding area of the main tumor that they might have missed during surgery. For more information on chemotherapy and radiation therapy refer to the above topic heading "Overview: Treatments".

  • Hormonal therapy. Now that tumor biopsy specimens can be tested for specific hormone receptors it has allowed scientists to develop drugs which can block those receptors and slow a tumor's growth. The main type of drug used blocks the effects of a hormone called estrogen and is usually given over a five year period and then discontinued.

Having been diagnosed with breast cancer, many women feel an extreme sense of urgency to begin treatment. While understandable given the gravity of the diagnosis, a rush towards treatment can commit patients to a treatment plan they are not comfortable with or fully educated about. Further, although treatment of some sort is almost always necessary to prevent a negative outcome, there is sometimes some flexibility with regard to what forms treatment might take and how rapidly they must be applied. For these reasons it is important that patients express any questions or concerns they may have to their doctors so as to become as well informed and comfortable with treatment options and decisions as possible. Patients may wish to consult with a second doctor to obtain an independent treatment recommendation. Another specialist may provide additional information and options, or confirm that a recommended course of treatment is best.

 




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