For patients who have been diagnosed with breast cancer, the simplest way to rid the body of cancer is by literally removing it from the body through surgery. Chemotherapy and radiation are useful medical procedures to manage the size of a cancerous tumor before surgery or to ensure the death of cancer cells that have spread from the tumor prior to surgery. However, physically removing the tumor through surgery and testing the surrounding tissue for clear margins of removal gives the clearest indication that the cancer has been successfully eliminated. There are multiple forms of surgery that a patient may undergo depending on the size of the tumor when it is detected or after therapy.
Sentinel Node Biopsy
Cancer cells have the ability to metastasize, or spread, to other parts of the body. One of the first places that they spread to is the lymph nodes, which are receptacles for lymph fluid as it cycles throughout the body. There are a number of lymph nodes located near the breasts that are potential first sites of cancer cells that have spread from a breast tumor. If this is the case, then it is important to either begin chemotherapy or remove the lymph nodes to combat further spreading of the cancer cells. In order to determine if cancer has spread to the lymph system, a sentinel node biopsy can be conducted to analyze the nodes next to the breast to which the cancer cells are likely to spread first. A surgeon may use radioactive or colored dyes to locate these sentinel nodes and then remove them. These nodes are sent to a pathologist so that they may be analyzed for the presence of cancer cells. Depending on whether or not they are found, then the pathologist knows if the cancer has spread from the breast and a more aggressive treatment plan is required.
There are two major types of tumor removal for patients with breast cancer, and each has its benefits and drawbacks. The first type of surgery is known as mastectomy, in which the entire breast containing the cancerous lump is removed. Some benefits of this procedure include a high likelihood that the cancer will be completely removed, as the entire breast represents more than enough clear margins around the tumor. Additionally, mastectomy may be able to circumvent the need for supplementary chemotherapy or radiation therapy procedures, as there is less of a need to shrink the tumor before attempting to remove it. There are multiple types of mastectomy, which differ in the amount and type of tissue removed from the patient.
The first, simple mastectomy, removes only breast tissue and no other types of nearby tissue. This procedure is appropriate for patients with Ductal Carcinoma in Situ, or DCIS, and those that are at high risk for breast cancer and wish to remove their breast as a preventative measure.
Modified Radical Mastectomy
The second type of mastectomy, modified radical mastectomy, removes the entire breast and the first two levels of the lymph nodes that are adjacent to the breast tissue. This procedure is useful for patients with invasive breast cancer which may have spread beyond the breast tissue. Only part of the lymph nodes are removed to maintain the system’s functionality in that part of the body, but the removed segment of the lymph system may be tested to see if the cancer has indeed spread beyond the breast and further medical action must be taken.
If a sentinel node biopsy reveals that the lymph nodes have been affected by cancer’s spread, then it may be necessary to remove the rest of the nearby lymph nodes in order to further ensure that the cancer has been removed from the body. Unfortunately, this presents a few other potential side effects of surgery that may develop after the procedure. The most common side effect from this procedure is lymphedema, in which the lymph fluid is unable to drain properly out of the arm that is on the side of the body where the lymph nodes were removed. Instead, the fluid pools in the arm, causing a swelling of the patient’s arm and potential discomfort or stiffness. While this is does not occur for all patients who have undergone lymph node removal, it is important for those experiencing this problem to contact their specialist immediately to seek help in alleviating the pressure and draining the fluid. Physical therapy is the preferred method for those patients, and WNY Breast Health is proud to offer on-site physical therapy to assist its patients in their recovery. Learn more about the physical therapy services we offer here, and about our on site physical therapist and lymphedema specialist here.
The other type of tumor removal surgery is known as lumpectomy. Lumpectomy targets a smaller portion of the breast overall, specifically the region containing the tumor along with some surrounding healthy tissue, to remove the cancer while maintaining the natural appearance of the breast. This procedure is less physically altering than mastectomy, but because the entire breast is not removed, there is the possibility that not all of the cancerous tissue will be removed on the first attempt and subsequent surgeries or medical treatments will be necessary. Keeping this in mind, surgeons will often order multiple weeks of radiation following lumpectomy in an effort to reduce the likelihood that the cancer will return in the breast. Studies have shown that lumpectomy of small breast tumors combined with four or more weeks of radiation have proven equally effective in patients as those that have had total mastectomies. For many patients, the choice between lumpectomy and mastectomy rests in their hands, and it becomes a choice between aesthetics, treatment time, and peace of mind to determine by which pathway they would like to proceed.
New advances in mastectomy have allowed surgeons to remove the breast tissue while preserving most of the overlying skin and nipple area for those women that are interested in undergoing breast reconstruction surgery. This procedure in no way increases the chance that cancer will or will not return, and is purely a cosmetic offering for patients that would like to maintain an appearance as similar as possible from before their surgery. There are many options for breast reconstruction surgery, and no time frame by which they must be completed. A patient may have their breast reconstructed in the same surgery session as it was removed, or up to years following their mastectomy or lumpectomy. If they choose to proceed by this route, the breast may be rebuilt using either a saline bag or tissue transplanted from another part of the body, such as the back or buttocks. If the nipple was unable to be preserved during surgery, then a new one may be either tattooed onto the breast or reconstructed from transplanted tissue. On the other hand, if the patient is unwilling or unable to undergo more surgery to reconstruct their breast, then there are many prosthetic options available such as swimwear and lingerie that are equally effective in restoring their appearance as it was prior to surgery. WNY Breast Health offers the largest selection of such prosthetic apparel in New York State in their in-house store, AuNaturel. Learn more about AuNaturel and the products and services they offer here.
Oncotype DX is a useful gene evaluation test, which can be conducted on women who have recently been diagnosed with breast cancer. This test examines a tissue sample of the breast tumor to give the specialist a better understanding of the relative activity of the cancerous cells. During surgery, a small amount of removed tumor tissue can be saved and used as the sample tissue. The test results will indicate, among other things, how effective chemotherapy or radiation therapy may be if used as a supplemental treatment option and the type of cancer cells present in the tumor and some of the specific cellular receptors they may have. The primary specialist receives a report from the Genomic Health laboratory, which tests the sample, with a recurrence score value. This score is somewhere between 0 and 100, and if the value is low, it means that the cancer is not likely to return, and the patient will receive little benefit from undergoing additional chemotherapy treatments. On the other hand, if the score is higher, the cancer does have some chance of coming back, but chemotherapy will help to greatly reduce that risk.