Surgical Oncology Breast cancer is the most common cancer diagnosed in women, but is highly treatable in the vast majority of patients. As with most cancers, early detection is the key to survival, and nearly 100 percent of patients diagnosed with the earliest stage of breast cancer can be effectively cured of their disease. It should also be mentioned that approximately 1 percent of breast cancers actually occur in men, and for whom the treatment of this disease is very similar as for women. As with most other types of cancer, breast cancer is best managed utilizing a multidisciplinary approach, involving the expertise of surgical, medical and radiation oncologists, as well as other oncology specialists. Recent and exciting innovations in the surgical management of breast cancer have revolutionized the management of this disease in recent years, and new advances are constantly being made in all areas of breast cancer diagnosis and treatment. It is estimated that there are currently more than 2 million people who are alive with breast cancer in the United States, and based upon recent trends, nearly 1 out of every 8 women in this country will ultimately be diagnosed with this disease at some point in their lives. Fortunately, for the first time in several decades, the number of patients newly diagnosed with breast cancer has actually started to decline, and the number of patients dying from breast cancer is starting to drop as well. Choose an item below to learn more:
Types of Breast Cancer Non-invasive breast cancers represent the accumulation of abnormal cells within the milk ducts and milk glands of the breast. Invasive breast cancers, on the other hand, arise when abnormal cells begin to invade tissues outside of the milk ducts and glands. Once cancer cells break out of the milk ducts and glands, then they are free to spread to other regions of the body by entering the lymphatic vessels or blood vessels within the breast. As is true of most cancers, diagnosis of breast cancer at an early stage is associated with the best chance of cure.
[ top ] Screening & Diagnosis Women who have significant risk factors for developing breast cancer should consider obtaining baseline mammograms, as well as breast ultrasound, earlier than the recommendations listed above, based upon the nature of their risk factors. (High-risk women include those who, themselves, have a history of breast cancer; or a previous biopsy demonstrating DCIS, LCIS, or atypical ductal or lobular hyperplasia; and women with one or more first degree relatives with a history of breast cancer.) Recently, the American Cancer Society has recommended that women with a strong family history of breast cancer, or with a personal history of breast cancer, should also consider undergoing annual MRI scans of the breast as well (at this time, however, not all health insurance companies are covering screening MRI scans of the breast). Women should never ignore a new breast lump, or changes in the shape or size of their breast. Dimpling of the breast skin, new retraction or inversion of the nipple, crusting or ulceration of the nipple, or the onset of nipple discharge (and bloody nipple discharge in particular) should also be thoroughly evaluated by a physician who is experienced in diagnosing and treating breast diseases.
[ top ] Treatment of Breast Cancer Although “lumpectomy” has replaced mastectomy for most patients with breast cancer, in 20 to 50 percent of cases, a second (and, occasionally, a third) small surgery may be required to remove remaining microscopic traces of breast cancer when the pathologist finds otherwise invisible traces of cancer on the edges of the “lumpectomy” specimen. In addition to removing the primary cancer in the breast, the surgeon also samples the axillary lymph nodes in order to further “stage” the patients with invasive breast cancer. In the past, this staging procedure involved the removal of the majority of the lymph nodes (axillary lymph node dissection) in the armpit area, which can result in short term complications such as fluid collections or blood clots under the incision, or longer term complications like numbness or tingling of the arm, chronic swelling of the arm and hand (lymphedema), and reduced mobility or/and weakness of the shoulder or arm. However, recent innovations in mapping and removing only those axillary lymph node(s) at greatest risk for cancer involvement (sentinel lymph node mapping) can reduce the risk of these complications to one-tenth of the levels associated with complete axillary lymph node dissection. Sentinel lymph node biopsy allows the surgeon to find the 1 or 2 lymph nodes (on average) most likely to contain cancer cells, while leaving the remaining 20 to 30 axillary lymph nodes relatively undisturbed. The majority of patients who are diagnosed with invasive breast cancer today will be advised to undergo additional treatment (adjuvant therapies) beyond surgery. For patients who undergo breast-conserving breast cancer surgery, most will be advised to undergo postoperative radiation therapy to the affected breast, to reduce the likelihood of cancer recurrence in that breast. For most patients, this amounts to a daily 45-minute outpatient visit, where painless radiation treatments are applied to the breast over a period of 5 to 6 weeks. Currently, several other approaches to breast radiation therapy are being investigated, and some of these treatments may lead to shorter durations of radiation therapy with equivalent results. Your Radiation Oncologist will thoroughly evaluate you, and will work closely with you, to tailor your radiation therapy to best treat your breast cancer. Surgery and radiation therapy are considered “local” and “regional” cancer therapies. That is to say, these types of therapy are designed to eliminate the primary breast tumor and any tumor cells lurking in the adjacent surrounding tissues. As already mentioned, surgical biopsy of axillary lymph nodes adds further and important cancer staging information and may, in some cases, be therapeutically beneficial as well. However, neither of these treatment methods address tumor cells that may have already spread outside of the breast and axillary lymph nodes. In order to treat the whole body, therefore, systemic adjuvant therapy is also often recommended. For most otherwise healthy patients with primary breast cancers that are 1 centimeter or greater in size, and for almost all patients with either positive lymph nodes or with evidence that the cancer has already spread to other areas of the body, chemotherapy is generally recommended. There are several different chemotherapy regimens available to treat breast cancer, and your Medical Oncologist will work closely with you to tailor a treatment plan that is optimal for you. For some patients, medications that block the effects of the female sex hormone estrogen in your body may also be recommended, usually following the completion of surgery, radiation therapy and chemotherapy. However, in some patients, hormonal therapy may be recommended instead of chemotherapy. This may be the case for older patients with very small estrogen-sensitive cancers and negative lymph nodes, or in patients with severe coexisting illnesses, such as heart failure, who may not be able to safely tolerate chemotherapy. Additionally, other specialized systemic adjuvant therapies may be recommended for individual patients with adverse tumor factors, such as those patients who have breast cancers with abnormalities related to the gene HER-2/neu. Once again, your Medical Oncologist will carefully evaluate all aspects of your health, to include the specifics of your breast cancer diagnosis, and will then work with you to develop a highly individualized plan for systemic adjuvant therapy. In some cases, he/she may also advise you to consider participating in a clinical research trial that may involve new treatment regimens for breast cancer.
[ top ] Survival and Cure Rates The stage of an individual patient’s breast cancer is based upon the size of the primary tumor, the status of the axillary lymph nodes, and the presence or absence of metastatic disease. Early stages of breast cancer are associated with excellent survival rates, while advanced stages of breast cancer are associated with a greater risk of cancer recurrence or progression, and death due to cancer. Therefore, until a method of effectively preventing the development of breast cancer is discovered, detection of breast cancer at the earliest possible stage is critically important, as the cure rates associated with Stage I breast cancer currently approach 100 percent.
[ top ] Family History and Genetics [ top ] Prevention [ top ] |
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