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Your treatment plan will depend on the stage of the breast cancer, as well as the type of breast cancer, your current condition, and your medical history. Treatment plans will consist of at least one of the options below, and many times it’s a combination of 2 or more treatments.
Most patients who have breast cancer will undergo some type of surgery to determine the stage of the cancer and to remove the cancer. Surgery may include:
Sentinel Lymph Node Biopsy: the sentinel lymph node is the first lymph node(s) that the cancer would have spread to. A blue dye, or radioactive substance is injected into the tissue near the tumor. The dye is observed to see which lymph node receives the dye first. This lymph node(s) is then removed and biopsied to check for the presence of cancer cells. If cancer cells were not found in the sentinel lymph node, then it may not be necessary to biopsy additional lymph nodes. If cancer was found, then more lymph nodes will be removed to check for cancer in a process called a lymph node dissection (also known as an ‘axillary node dissection’).
Lumpectomy: also known as ‘breast-conserving surgery’, this surgical procedure removes the breast tumor (or ‘lump’) and a small amount of normal tissue surrounding it. It is the least invasive breast cancer surgery when compared to any type of mastectomy. It is technically considered to be a partial mastectomy, but less breast tissue is removed. Depending on the location of the cancer, some of the chest wall (i.e. chest lining or muscles) may need to be removed as well.
Partial Mastectomy: this is similar to the lumpectomy, but requires a larger portion of the breast to be removed. An entire section of the breast tissue may need to be removed to eliminate the cancer. In a quadrantectomy, for example, a whole ‘quadrant’, or quarter of the breast will be removed. Depending on the location of the cancer, some of the chest wall may need to be removed as well.
‘Total’ or ‘Simple’ Mastectomy: this is the most common type of mastectomy to treat breast cancer. It is the removal of the entire breast, including the nipple and areola, as well as any lymph nodes that are located within the breast tissue. No axillary lymph nodes (lymph nodes under the arm) or any part of the chest wall is removed; however, axillary lymph nodes may be removed during the surgery so that they can be checked for the presence of cancer cells. Modified Radical Mastectomy: this surgery removes the entire breast. It also removes many of the axillary lymph nodes (lymph nodes under the arm), and sometimes parts of the chest wall. Double Mastectomy: this procedure removes both breasts. It is usually performed as a preventative measure for women with a very high risk for developing breast cancer.
Did You Know?
If you’re having a mastectomy and are considering immediate breast reconstructive surgery, ask your doctor about a skin-sparing mastectomy. The surgeon removes all of the breast tissue and nipple, but leaves the breast skin to be used as a pouch around the breast implant. If you’re not having immediate breast reconstruction or if cancer cells are too close to the skin, then this may not be an option for you.
Chemotherapy, or ‘chemo’ is the use of drugs to kill cancer cells or to stop their growth. Chemo is administered by mouth or injected into a vein or muscle. Chemotherapy is a systematic approach to therapy because the drugs enter the bloodstream, reaching the cancer cells throughout the body. The combination of drugs used in chemotherapy is tailored to each cancer patient.
Some hormones, such as estrogen and progesterone, can cause cancers to grow. Hormone therapy removes the hormones or blocks them so that the cancer cells are ‘starved’ and can no longer grow or survive. This is a treatment option if the cancer cells from your lab tests show that they are ‘estrogen receptor positive’ or ‘progesterone receptor positive’. This means that the cancer cells have receptors (places in the cell that allow hormones to attach), which allows the cancer cells to feed on the hormones, causing them to grow. Common hormone therapy drugs include: tamoxifen, an LHRH agonist, or aromatase inhibitors.
Radiation therapy uses high-energy radiation (i.e. x-rays) to destroy cancer cells or to keep them from growing. It also helps to prevent cancer from recurring in the future. There are two types of radiation therapy. External radiation therapy is a traditional therapy in which radiation is directed toward the cancer through a machine that is outside of the body. Internal radiation therapy is when a radioactive liquid put inside the body, directly into or near the cancer through needles, wires, pellets, or a catheter. A radiation oncologist will determine the type of radiation needed based on the size and location of the tumor.
Targeted therapy uses drugs to specifically target and attack cancer cells, while minimizing harm on the normal cells in the body. These drugs identify specific markers, or characteristics of the cancer cells that cause the cells to grow and multiply. One type of targeted therapy is monoclonal antibody therapy. This uses a laboratory-made protein, or antibody drug (i.e. Herceptin; Trastuzumab) that will bind to the cancer cells and kill them or block their growth. Tyrosine kinase inhibitors are another type of targeted therapy. These drugs (i.e. Lapatinib) block signals in the cancer cells, which would normally allow them to receive certain proteins that cause them to grow.
There are various targeted therapies that doctors can use based on your specific cancer type. Targeted therapy is typically done in combination with another treatment option, such as chemotherapy.
Clinical trials are research studies involving people, and are available to patients with all stages of cancer. The purpose is to test new ways to treat cancer, prevent cancer, manage symptoms of cancer, and/or find and diagnose cancer.
Once you’ve been diagnosed, your doctor may suggest a clinical trial, if it’s right for you. Often times, a standard treatment option will be recommended, but discuss your options with your doctor. Standard treatment options include surgery, chemotherapy, radiation therapy, hormone therapy, and targeted therapy.
Interested in learning more? Go to the National Cancer Institute at www.cancer.gov and search for ‘clinical trials’ to download a comprehensive guide and to search for clinical trials near you.