For most patients, surgery is the first step in their breast cancer treatment. A surgical procedure to take out the tumor, (the medical term is “resection”), is the only way to completely remove it from the body. Other forms of cancer treatment are designed to destroy or stop the growth of cancer cells, but do not actually remove the tumor from your body. There are two main categories of breast cancer surgeries: Lumpectomy (also known as breast conservation surgery or breast conservation therapy) and mastectomy:
- Lumpectomy, or Breast Conservation Therapy, is the removal of the specific cancerous tissues or tumor, while leaving the rest of the breast intact. This procedure is almost always followed by radiation therapy to the breast. To learn more about lumpectomy, see Breast Cancer: Treatment.
- Mastectomy is the removal of the breast and some surrounding tissue. There are several types of mastectomy, and vary based on how much of the breast tissue is removed.
- Sentinel Lymph Node Mapping is often done before surgery. This procedure helps the surgeon know which lymph nodes are the primary ones that receive drainage from the breast tissue, an indication of which ones would probably be the first to have cancerous cells in them. By doing the mapping ahead of time, your surgeon can take out fewer overall lymph nodes, which helps your healing time while decreasing the severity of complications like lymphedema.
Lymphedema Prevention & Treatment
Lymphedema is a condition where excess lymph fluid collects in the tissue instead of draining through the lymphatic system. The result can be swelling, discomfort and numbness. Breast cancer patients are at risk for developing lymphedema because once the lymph nodes are removed during surgery it is more difficult for fluid to drain from the area.
Fortunately, most patients don’t experience lymphedema and there are exercises that can help prevent it. If you develop lymphedema talk with your physician or the patient navigator about the best course of action and be sure to take advantage of Riverside’s Lymphedema Program. Our certified lymphedema therapists can help teach you exercises, as well as perform the necessary massage and wrapping techniques to help decrease the swelling. To learn more about lymphedema prevention and treatment, see Lymphedema.
In this type of treatment, beams of radiation are targeted on the tumor site to destroy the cancer cells while preserving the healthy surrounding tissue. The two main kinds of radiation therapy are external beam radiation and internal beam radiation, both of which can be used to treat breast cancer. With external beam radiation, the radiation is generated by equipment outside of your body. With internal beam radiation, known as brachytherapy, the radiation source is placed inside the body. Patients with breast cancer who are treated at Riverside can receive internal radiation in the form of Mammosite® technology, a relatively new but well established therapy that reduces the duration of treatment time when compared to conventional radiotherapy. You and your physician will discuss what type of radiation, if any, is right for your treatment. To learn more about radiation therapy in cancer treatment, see Radiation Therapy: Using radioactivity to kill cancer cells.
Medical oncology uses cancer-fighting drugs (including chemotherapy medications) to treat tumors through a systemic approach – meaning that the medicine travels throughout the body, unlike radiation and surgery which are directed to a single site. Depending on the particular type of medication, the drug may be taken by mouth in pill form or delivered directly into the bloodstream through an IV. These medications are often very strong, and can have unpleasant side effects. You and your medical oncologist will decide what combination, or regimen, of medications is right for you. Be sure to mention any side effects you experience, as there are sometimes other medications that can help ease the side effects. To learn more about systemic treatment of cancer, see Breast Cancer: Treatment.
Another common treatment is anti-hormonal therapy. Like other medical treatments, hormone therapy is a systemic treatment. It is most often used to help prevent a recurrence of breast cancer, but it can also be used to treat more aggressive cancers. Anti-hormonal therapy works by blocking naturally occurring hormones that can enhance some tumor cells. Depending on the diagnosis, you and your physician may discuss anti-hormonal treatment as a possible therapy. For more information on anti-hormonal therapies in cancer treatment, see Hormone Therapy: Cancer Treatment for Certain Hormone-Sensitive Cancers.
Breast reconstruction is surgery performed by a plastic surgeon to restore the appearance of the breast following surgery. Most women who have a mastectomy can have reconstructive surgery, while most women who have had a lumpectomy do not need reconstructive surgery. Depending on the treatment plan, immediate reconstruction may be able to be performed at the same time as the mastectomy. However, this is often not advised for women who will be receiving radiation therapy, as it could increase complication rates after surgery. It is important to discuss your desire for reconstructive surgery with your surgeon, as well as your plastic surgeon. If you elect immediate reconstruction, the scheduling of the surgery will be done to allow both surgeons to be present. There are several types of reconstructive procedures, including approximating the nipple-areola area through a tattooing technique that can take place after the initial procedure. To learn more about breast reconstruction, see Breast Reconstruction After Mastectomy.
Research and Clinical Trials
Ongoing research and access to clinical trials (new and sometimes experimental treatment programs in which women can volunteer to participate) are important components of any cancer program, and housed within the Peninsula Cancer Institute.
National Comprehensive Cancer Network (NCCN) Guidelines
The NCCN develops the nationally accepted gold standard guidelines for cancer treatment depending on the type and stage of the cancer. Riverside is proud to be one of the few institutions in the nation whose Cancer Registry checks 100 percent of our cancer cases against NCCN guidelines.
Case Conferences / Tumor Board
A case conference or tumor board is a unique opportunity to have an interdisciplinary team of physicians and other health care specialists come together to discuss your case and treatment plan. As an accredited Comprehensive Community Cancer Program by the American College of Surgeons’ Commission on Cancer, Riverside’s cancer program reviews a minimum of 10 percent of all cancer cases in a case conference or tumor board setting. Pathologists, radiologists, surgeons, medical oncologists, radiation oncologists, patient navigators, nurses and other specialists discuss the specifics of the case, and often review the latest research that may apply to the situation. The benefit to the patient is the opportunity to have more physicians reviewing the case – like getting a second, third and fourth opinion all at once.