Breast Cancer

Each type of cancer has unique characteristics and responds differently when treated. Our highly trained staff and physicians combine their skills with the latest equipment and techniques to treat all forms of cancer. The webpages below contain detailed information about specific types of cancer, related issues and the treatment options available.

Breast Cancer

TREATMENT OPTIONS

Surgery

Appropriate management of breast cancer will include some form of surgery. Traditionally, a mastectomy, which is the removal of the entire breast and surrounding structures, has been the standard surgical approach to breast cancer. However, over the past 20 years, it has become increasingly clear that simply removing the tumor itself while leaving the remaining breast intact and then followed by radiation therapy to the remaining breast offers disease control as good as mastectomy. The greatest advantage of this surgical approach, called lumpectomy, is that it offers definitive treatment of breast cancer while allowing preservation of the breast itself. Following mastectomy, a new breast can be reconstructed using skin and muscle from the woman’s abdomen, but the cosmetic result is often not nearly as good as that which follows a lumpectomy and radiation treatment.

It should be stated, however, that for women with large and advanced breast tumors that mastectomy remains the treatment of choice.

Surgery is usually necessary not only for management of the breast tumor, but also for management of the nearby lymph nodes. The lymph nodes most commonly associated with breast cancer are located within the axilla which is a space underneath the arm. These lymph nodes receive draining fluid from the breast and therefore represent a site where disease may spread. In the event that an invasive tumor has been diagnosed, a surgical procedure of the axilla called an axillary dissection is commonly performed. This axillary dissection commonly removes approximately 10-15 lymph nodes from underneath the arm of the effected breast. These lymph nodes are then evaluated pathologically for evidence of spread of malignancy. The reason for an axillary dissection is mult­ifold: to provide prognostic information regarding breast cancer, to help determine the need for chemotherapy, to help determine the need for radiation therapy to the local lymph nodes, and to help attain better disease control within the local lymph nodes. In the event of a non-invasive tumor, an axillary dissection is not performed due to the very low risk of disease having spread to these lymph nodes.

Radiation Therapy

The most common use of radiation therapy for breast cancer today is in the setting of postoperative treatment following a lumpectomy as described above. The purpose of radiation treatment to the entire breast following lumpectomy is to sterilize any residual malignancy in the breast following surgery. Breast cancer is generally a multifocal disease process. This means that even though there is one tumor that is present within the breast, that there is a high chance of further tumors developing within that same breast over time. In fact, the chance of a second breast tumor arising within a breast that has been treated with lumpectomy alone approaches 50%. The addition of radiation therapy following lumpectomy reduces this risk to roughly 5%. Radiation therapy is therefore very effective in sterilizing any residual tumor that may be present in the breast following a lumpectomy. For early stage breast cancer, lumpectomy followed by radiation therapy is quickly becoming the standard of care if not already.

Chemotherapy

Chemotherapy for breast cancer is evolving constantly, but the common chemotherapeutic drugs used today include Adriamycin, Cytoxan, and Taxol. Typically, chemotherapy is given over a period of three to six months during which time administration of the chemotherapeutic drugs occurs every three to four weeks. The side effects from chemotherapy may include but are not limited to the following: loss of hair, poor appetite, decreased blood counts, and fatigue. Chemotherapy is usually given following surgery, but may also be given prior to any surgical treatment in the event of a large, unresectable cancer.

There exist some controversies regarding the use and benefit of chemotherapy. Chemotherapy appears to offer the greatest benefit to premenopausal women with node-positive breast cancer. Other patient groups appear to benefit less from chemotherapy. However, a medical oncologist is best qualified to determine the need for chemotherapy in a given patient.

Although not chemotherapy, Tamoxifen is a drug that has been used increasingly for women with breast cancer. Tamoxifen is a drug which prevents a woman’s estrogen from acting on estrogen sensitive tissue. The use of Tamoxifen is particularly applicable to women with estrogen receptor positive disease as previously discussed. The idea is that Tamoxifen will prevent any residual cancer cells that are hormone sensitive from being exposed to hormone and then being stimulated to multiply. The administration of Tamoxifen is by mouth and is given daily for a period of five years. The side effects of Tamoxifen may include but are not limited to the following: menopausal-type symptoms, gastrointestinal upset, and weight gain or loss. Overall, Tamoxifen is clearly recommended in women with estrogen receptor positive disease. Also, Tamoxifen has been increasingly found to be of benefit in women who are at high risk of developing, but have not yet developed, breast cancer. These studies are ongoing.