The first step in any breast cancer treatment is usually surgery. The type of surgery will vary depending on the type and extent of the breast cancer, and can range from the removal of a single lump to the removal of the entire breast and adjoining lymph nodes. Like most surgeries, breast cancer surgery will likely require some preoperative tests such as an x-rays, a blood test, a urine test, and possibly an EKG or CAT scan to determine how fit your body is for the anesthesia and the operation, and how best for the surgeon to proceed.
There are two main types of breast cancer surgery, each with their own variations:
Lumpectomy – The surgical removal of just the lump itself, and a small amount of surrounding tissue. A lumpectomy is often referred to as “breast conserving” surgery. The amount of tissue removed will vary greatly depending on the individual patient. If your surgery is referred to as a quadrantectomy, then about one-quarter of your breast will be removed.
Lumpectomies without lymph node removal are usually a day surgery procedure, and are often performed with just a local anesthetic. A lumpectomy is usually followed with 5 to 7 weeks of radiation therapy, and occasionally chemotherapy. On occasion, the surgeon will elect to conduct a lumpectomy in place of a biopsy, and biopsy the lump after it is removed.
Mastectomy – Mastectomy is the total removal of the breast. There are varying degrees of mastectomy:
A partial mastectomy involves just the removal of the lump and slightly more surrounding tissue than a lumpectomy.
A simple or total mastectomy involves removal of the breast, but not the lymph nodes or underlying muscle.
In a modified radical mastectomy, the breast and some lymph nodes are removed.
In a radical mastectomy, the breast, lymph nodes and underlying chest wall muscle are removed. Radical mastectomies are being performed less frequently as breast cancer treatment evolves.
Nipple sparing or subcutaneous mastectomy involves the removal of the entire breast, with the exception of the nipple. Nipple-sparing surgeries are intended to assist in future breast reconstruction. Some surgeons prefer not to perform nipple sparing surgery in order to not risk any of the cancer cells being left behind in the nipple tissue.
Lymph Node Removal
Lymph nodes are small bean-shaped organs that are distributed throughout the body. They are part of the lymphatic system, which circulates a plasma-like liquid called lymph throughout the body. The number of lymph nodes in the body varies from individual to individual.
Surgeons remove between five and thirty of the underarm lymph nodes when they remove a tumor from the breast, which the biopsy to help determine if the cancer has spread. Lymph node strap bacteria and foreign particles from the lymph, and are full of germ-killing white blood cells. On occasion, the lymph nodes located in the armpits trap breast cancer cells that entered the lymphatic system from the nearby breast.
Surgery to remove some or all of the lymph nodes under your arm is called axillary lymph node dissection. A new, less extensive type of surgery called sentinel lymph node dissection is now being used for some women with a low risk of lymph node involvement. In a sentinel lymph node dissection, only the first “sentinel” cluster of the two or three lymph nodes nearest the breast are removed, as they are the ones most likely to contain cancer.
Lympedema is a possible side effect of lymph node removal in which the lymph accumulates under the arm, causing swelling. Lymphedema can affect the breast area, the whole arm, or just part of the arm (usually the lower part and the hand). Severe lympedema will require treatment for the pain and swelling.
Lumpectomy vs. Mastectomy
Until the mid-1980s, mastectomy was the standard surgery for any stage of breast cancer. Now, many women are given the choice between removing the entire breast (mastectomy), ore just removing the lump and surrounding tissue (lumpectomy), followed by radiation. Recent research that followed 11,000 women for ten years showed that adding radiation therapy to a breast-conserving lumpectomy halves the chance that cancer will come back and reduces the risk of dying from breast cancer, compared to surgery alone.
The combination of lumpectomy and radiation has proved to be as effective to treat breast cancer as a complete mastectomy for women with small intact cancers. When making a decision between a mastectomy and a lumpectomy and radiation, women must take into consideration factors such as:
How important it is for them to keep their breast.
How much a lumpectomy will change the appearance of their breast.
How concerned they are about a possible cancer reoccurrence.
The impact of five to seven weeks of radiation following a lumpectomy.
The fact that a radiated breast can’t receive radiation again should cancer recur.
The advice of their doctor(s).
Hormone Therapy for Breast Cancer
About two thirds of cancers test positive for hormone receptors. Hormone receptors are cell proteins that stimulate the growth of cells, including cancer cells. Patients with hormone receptor positive breast cancer will have hormone therapy (oral breast cancer medications such as Femara) added to their treatment plan following surgery.
A second and more aggressive type of breast cancer with receptors for a protein called HER2 is often treated with a breast cancer drug called Herceptin following surgery.
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