We like to think of the treatment in divisions of the stage. All cancers are staged by how big the tumor is in the breast, whether or not there is involvement of the lymph nodes underneath the arm on the involved side, and whether or not there is any sign of spread beyond these areas. The area of the lymph nodes under the arm is also known as the axilla. Sometimes this staging will require blood tests and some radiology tests. After the patient has been discussed her surgical options and sometimes requiring consultation with other physicians she will return to the office for her decision.
The two main types of surgeries of the breast involve either a mastectomy (removal of the breast) or lumpectomy which is removal of the cancer with a rim of normal tissue. If lumpectomy is chosen the patient requires post operative radiation therapy to decrease the risk of cancer recurrence. This decision is often patient preference but can also be determined by the size of tumor versus the size of the breast so the patient can have the best cosmetic outcome.
The lymph nodes are dealt with depending on whether or nor there is felt to be cancer in them. If there is no cancer on physical exam a procedure called sentinel lymph node biopsy is performed. This is done by injecting the breast with radioactive (but non toxic) and blue dye to find the area that the portion of the breast drains. If there is no cancer in this node or nodes then the procedure is complete with little risk to the patient. If there is cancer in the sentinel node then all the lymph nodes are removed. The procedure removing all the lymph nodes is called an axillary dissection. If the breast and all the lymph nodes are removed the term is modified radical mastectomy. If the lymph nodes harbor cancer prior to surgery all the lymph nodes are removed. There are risk and benefits associated with all surgical procedures and they would be discussed further with the patient at her appointment.
There are different forms of radiation therapy now that can best be discussed with the radiation oncologist as well as different types of breast reconstruction that is best discussed with the plastic and reconstructive surgeon.
The final arm of breast cancer treatment involves the medical oncologist. There is chemotherapy and hormonal therapy to treat the entire body. Chemotherapy has traditionally been offered post surgery but sometimes is now offered preoperatively. This depends on many factors including size of the cancer in the breast, lymph node involvement, as well as genetic profiling of the cancer itself. This is best discussed with the medical oncologist.
Our office is very attune to the fact that breast cancer outcomes are improved with a team approach to cancer treatment and oftentimes involve multiple modalities to provide the best care to the patient. We offer organized, quality care by a staff dedicated to breast health.