Breast Cancer Treatment

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• QWhat happens during follow-up care for breast cancer patients?

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  A Dr. Renee L. Quarterman, MD , Surgery, answered on behalf of St. Mary Medical Center

  They're under surveillance. So women with breast cancer, after they've completed their treatment, they need to be followed for every 4 to 6 months for a while, and so they're going to see me and possibly some other specialists on a regular basis forever, really.

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• QWhat doctors and specialists treat breast cancer?

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  A Aurora Health Care answered

  Breast cancer treatment requires a team effort by doctors, nurses and other healthcare professionals. Once your primary doctor has all the information about your breast cancer, you'll talk with your team about the treatments you'll need. Your treatment team may include:

  • Anesthesiologist
  • Cancer Nurse Navigator
  • Genetic counselor
  • Health psychologist
  • Medical oncologist
  • Pathologist
  • Physical therapist/occupational therapist
  • Plastic surgeon
  • Radiation oncologist
  • Radiologist
  • Surgeon
  • Nationally accredited breast care centers

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• QHow is breast cancer treated?

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  A Univ. of Nev. School of Medicine, Family Medicine answered

  The treatment techniques available for breast cancer include surgery, radiation, chemotherapy, hormone therapy, and targeted therapy. Most women with breast cancer have surgery to treat the main breast tumor. The primary purpose is to remove as much cancer as possible, determine whether the cancer has invaded local tissue, spread to the lymph nodes under the arm or relieve symptoms of advanced cancer. Because surgery may remove only a portion of the breast tissue and cancer can metastasize from the primary tumor and spread through the bloodstream. There are many different types of breast cancer surgery including the following:

  • Breast-conserving surgery or partial mastectomy, segmental mastectomy, lumpectomy, quandrantectomy
  • Total mastectomy without axillary lymph node dissection or sentinel lymph node biopsy
  • Modified radical mastectomy with axillary lymph node dissection or with sentinel lymph node biopsy
  • Radical mastectomy with chest wall excision with axillary lymph node dissection or sentinel lymph node biopsy

  Many surgeries may need to be preceded (neoadjuvant therapy) or followed (adjuvant therapy) by radiation treatments, rounds of chemotherapy, hormonal suppression or targeted therapy. For instance, when chemotherapy is given after surgery to patients it is called adjuvant chemotherapy and it aims to lower the chance of recurrence at a later date. However, chemotherapy that is given before surgery is called neoadjuvant chemotherapy and it aims to treat, reduce or minimize the cancer. Radiation therapy for breast cancer consists of either “external beam radiation” with series of targeted exposures to high-energy rays or “brachytherapy” with placement of radioactive pellets strategically positioned to kill rapidly dividing cancer cells. Less often, radiation therapy may be used to debulk or shrink a tumor before surgery. Radiation to the breast is often needed after breast-conserving surgery. It is usually given after any chemotherapy.

  Chemotherapy for breast cancer is the use of anti-cancer drugs via oral medications, intramuscular injection or intravenous infusions. Because they enter the bloodstream and reach distant parts of the body, chemotherapy is important treatment for cancers that have spread to distant organs or lymphatics. Hormone therapy for breast cancer targets hormone receptors, blocks the effects of estrogen and progesterone that promote cancer cell growth, and thereby reduces the risk of the cancer recurrence after surgery. 

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• QWhat is prone breast radiation treatment?

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  A Dr. Michael S. Porrazzo, MD , Radiation Oncology, answered on behalf of Spotsylvania Regional Medical Center

  

  Michael Porrazzo, MD from Spotsylvania Regional Medical Center explains prone breast radiation treatment and how this development benefits many patients. Watch this video to learn more.

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• QIs only breast tissue removed during a lumpectomy?

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  A Columbia University Department of Surgery answered

  In a breast lumpectomy, the operation focuses on the breast and possibly the lymph nodes under the arm in the setting of invasive cancer. During the operation, the surgeon usually removes some of the lymph nodes under the arm to check for cancer. This approach is termed a sentinel lymph node biopsy, in which the first few nodes that drain the breast are removed and checked under the microscope. A lumpectomy is also called a partial mastectomy or segmental mastectomy. These are all types of breast conservation surgery, in which the cancer is removed with a margin of normal tissue around it. An excisional biopsy is a surgery for a noncancerous lesion that involves removing an area of breast tissue for diagnostic purposes. This involves removing the lesion in question without a margin of healthy tissue around it in order to make a definitive diagnosis (usually done to rule out a cancer).  
• QWhat can I expect after a lumpectomy in the long term?

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  A Columbia University Department of Surgery answered

  After the lumpectomy, the breast tissue will be analyzed fully by the pathologist. When a pathology report is available (usually about a week after surgery), the doctor will discuss the results and formulate a treatment plan. Usually, this involves a multidisciplinary treatment team, including a medical oncologist (who administers chemotherapy or an antiestrogen pill), as well as a radiation oncologist. 
• QWhat can I expect after a mastectomy in the long term?

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  A Laurie Rudolph, RN , Nursing, answered on behalf of Reston Hospital Center

  

  Following a mastectomy, patients need to take extra care of themselves until they're fully healed. They may also need physical therapy. Learn more from Laurie Rudolph from Reston Hospital Center in this video.

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• QHow does targeted drug therapy help treat breast cancer?

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  A Cancer Treatment Centers of America (CTCA) answered

  In addition to chemotherapy drugs, doctors use a variety of targeted drugs to fight breast cancer. Targeted drug therapy uses drugs that interfere with specific molecules involved in tumor growth to block the growth and spread of the disease.
  
  Biological response modifiers, such as Herceptin, are drugs that bind with specific proteins on breast cancer cells to prevent their growth. Your care team may recommend this form of breast cancer targeted therapy to treat tumors that produce too much of, or overexpress, a protein called HER2. If laboratory testing reveals the HER2 gene in the cancer cells, the medications can help shut down the HER2 gene, thus cutting the cancer cells off from their energy supply.
  
  Your care team will likely combine breast cancer targeted drug therapy with other treatments, such as chemotherapy, to help control cancer that has spread or to prevent breast cancer recurrence.
• QWhat are the side effects of radiation therapy for breast cancer?

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  A Cancer Treatment Centers of America (CTCA) answered

  When radiation passes through the skin, the skin cells in the treatment area become damaged. If you receive frequent radiation, your skin cells often do not have enough time to repair and regenerate in between treatments.
  
  Thus, common breast cancer radiation side effects may include redness, dryness or irritation of the skin in the treated area. Another common side effect is fatigue, especially in the later weeks of treatment and for some time afterward.
  
  By employing innovative radiation techniques, radiation oncologists are able to deliver higher radiation doses to breast cancer cells while limiting damage to healthy tissue. Your radiation oncologist may also recommend radioprotective drugs, such as amifostine, to help guard healthy tissue from exposure to radiation.
  
  If skin irritation occurs, your doctors will provide various comfort measures. For example, you may receive topical drugs in the form of therapeutic creams or ointments. You may also receive antibiotics to fight infection or pain medications to relieve discomfort. 

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• QWhat is the treatment for ductal carcinoma in situ (DCIS)?

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  A Cancer Treatment Centers of America (CTCA) answered

  Current treatments for ductal carcinoma in situ (DCIS) can eliminate the disease completely and lower the risk of recurrence. Your ductal carcinoma in situ treatment options may include:

  • Surgery: Women may undergo a lumpectomy (removal of the lump and some surrounding tissue) or a mastectomy (complete removal of the breast).
  • Radiation therapy: A course of radiation treatment following surgery may help ensure that all cancer cells are eliminated from the body.
  • Hormone therapy: Women may also undergo hormone therapy with drugs such as tamoxifen to help reduce the risk of recurrence, particularly following a lumpectomy with or without radiation.

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