The treatment of breast cancer requires a multidisciplinary care team. No single clinician can manage all the care for a person with breast cancer. The team is composed of surgeons, medical oncologists, radiation oncologists, radiologists, plastic surgeons, pathologists, genetic counselors, social workers and care coordinators. It’s important that these people be in the same place to develop a game plan for treating a person with breast cancer.
Breast Cancer Treatment
After a breast cancer diagnosis, there are many decisions to make. A multidisciplinary team of doctors and specialists can help get a treatment plan started and you can choose a treatment facility. In the past, breast cancer treatment involved a radical mastectomy, but today procedures are less invasive. Treatment will depend on the stage of breast cancer. It may include surgery, such as lumpectomy, radiation or chemotherapy to shrink and kill cancer cells. Learn more about breast cancer treatment options with expert advice from Sharecare.
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Fawcett Memorial Hospital answeredIf some breast cancer cells remain after chemotherapy, a different treatment may be used. Often different drugs are used to combat a problem in women with breast cancer called “clonality.” Say a person has a relatively small breast cancer, but it has spread to a lymph node under the arm. Presumably it may be somewhere else as well and because of this, chemotherapy is recommended. The treatment kills 98% of the cells. The remaining 2% however, are resistant.
This is similar to the well-known phenomenon of antibiotic resistance seen when treating some bacterial infections. The 2% of cancer cells that survived the chemo become the next epicenter of cancer (a “recurrence”). Fortunately some of these will be sensitive to another form of chemo. Some may be surgically removed (in selective cases) and some will be sensitive to radiation. If the “clonality” problem arises again (98% of the 2% cell population), these cells may be susceptible to yet another agent. The genetic basis of cancer will continue to guide treatment decisions and increasingly individualize the choice of therapies used, many of which have fewer side effects.
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Penn Medicine answeredRadiation therapy as part of breast-conserving therapy traditionally involves treatment of the whole breast, a process that takes six weeks. A boost to the primary site may be given at the end. Radiation starts 2 to 4 weeks following surgery. However, if chemotherapy is needed, that comes first after surgery, and radiation would follow 2 to 4 weeks after completion of chemotherapy.
In selected cases, partial breast radiotherapy can be given. These are usually early, favorable tumors that have a low risk of being multifocal and a low risk of recurrence. Partial breast radiotherapy can be delivered by placement of a Mammosite balloon. This device is placed into the lumpectomy site in the operating room or the surgeon’s office. The device has two exiting ports, one for inflation and deflation of the balloon, and one that attaches to the radiation unit. Radiation is delivered through the catheter in two sessions daily six hours apart for one week. Once radiation is completed, the catheter and balloon are removed. This type of radiotherapy would be given shortly after the lumpectomy, before chemotherapy, as opposed to external beam whole breast radiation, which is generally given after chemotherapy.
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Partial breast radiation therapy is when the whole breast is not treated with radiation for breast cancer; rather, doctors focus their efforts on the area they think may be most at risk for breast cancer occurrence. The rationale for partial breast radiation is that the majority of recurrence in carefully selected women may be right at the lumpectomy site where the tumor was removed. The advantage of partial breast radiation is that it is convenient and can be completed in about a week’s time. In addition, less normal tissue is exposed to radiation. -
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Dr. Preya Ananthakrishnan, MD , Surgery, answered on behalf of Columbia University Department of SurgeryAfter undergoing a lumpectomy to remove the part of the breast affected by breast cancer, most women must undergo radiation therapy treatments to eliminate microscopic cancer cells that might remain undetected by clinical examination or breast imaging in order to decrease the risk of local recurrence. The standard course of breast irradiation delivers radiation to the entire breast, and consists of six to seven weeks of therapy given five days a week. Some patients may be candidates for shorter courses of radiation or partial breast radiation.
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St. Petersburg General Hospital answeredA double mastectomy is removing both breasts. This can be done by removing all skin and breast tissue, and leaving the chest wall flat, or by removing the breast tissue, while leaving the nipple and areola, and an envelope of skin. By leaving the nipple and areola, and the skin of the breast, a plastic surgeon can come in at the same operation and do immediate reconstruction of the breast.
Immediate reconstruction can be done by placement of implants under the chest wall muscle or by rotating muscle and skin from another area of the body. When immediate reconstruction is performed, studies have shown that it is psychologically a benefit to the woman. Of course, reconstruction is a personal choice, and every woman makes a choice based on her own personal feelings.
One of the most common reasons that a woman has a double mastectomy is when she is found to be carrying a gene mutation that gives a very high lifetime risk of breast cancer. For example, the BRCA 1 and 2 gene mutation (like the mutation Angelina Jolie carries) gives a high risk of breast cancer by age 70 (from 50-80% risk). We know that by removing the breast tissue it decreases this risk by 98%.
In other cases, a woman with breast cancer or “pre-cancer” changes in one breast may choose to have a double mastectomy. They may make this decision so both breasts look the same.
In America, unlike Europe or other parts of the world, more women are choosing to remove both breasts, when they have cancer in only one breast. There are several thoughts as to why women are making this choice, but these are only speculative, as the exact reasons for increased double mastectomy in the United States are unknown.
- Increased awareness of genetic mutations for breast cancer that gives a woman a very high risk of breast cancer in either breast over her lifetime. Double mastectomy in women with a genetic mutation decreases her risk of breast cancer in either breast.
- Symmetry: Women who are having a mastectomy on one side may choose to have the same operation on the other breast so the breasts look the same.
- Improvement in techniques for double mastectomy: It is now common to leave the nipple and areola, and the skin envelope of the breast, so that the breast retains a more natural appearance after mastectomy.
- Improvement in techniques for immediate reconstruction, including implants and skin and muscle rotation into the area to recreate a breast.
- Overestimation of risk of breast cancer coming back in the opposite breast. With the advances in treatment of breast cancer over the past 20 years, this risk is actually much lower than many people may think (5% after 10 years of treatment).
Overall, most women who do make the decision to have a double mastectomy are satisfied with that decision even 10 years later.
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St. Petersburg General Hospital answeredSee All 2 Answers
How long a woman has to stay in the hospital after breast surgery depends on what type of surgery has been performed.
70 to 80 percent of breast cancers can be treated with a “lumpectomy,” meaning removal of the cancer and a surrounding area of normal breast tissue. With this type of surgery, most women can go home the same day if they choose, or leave the next day.
If the cancer is treated with mastectomy (removal of the entire breast, leaving the chest flat), women typically stay in the hospital overnight and go home the next day.
If the cancer is treated with mastectomy and reconstruction (reforming a breast mound with an implant or other means at the same time of mastectomy), a woman typically stays in the hospital two days.
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St. Petersburg General Hospital answeredSee All 2 Answers
There are many very good and improved breast cancer treatments compared to even 20 years ago. The best cure for breast cancer is when the cancer has been found at an early stage, before it has a chance to spread. Most often, breast cancers today are diagnosed at an early stage due to screening with yearly mammograms, and in most cases women will have a low risk of getting breast cancer again. Breast cancer advances that have helped give a better survival are:
- Earlier diagnosis with mammograms and increased awareness of breast cancer.
- Better surgical treatment with fewer side effects—for example, rather than removing many of the lymph nodes under the arm, we now remove the “sentinel” lymph nodes, meaning the first lymph nodes that the breast drains to, usually 1 to 3 nodes. This gives a very low risk of arm swelling down the road.
- Better and more targeted chemotherapy. The tumor itself can be looked at with gene tests to determine if chemotherapy will be needed.
- Hormonal therapy with a pill that is taken for 5 to 10 years, which decreases recurrence of breast cancer in half.
- Improved radiation therapy with fewer side effects.
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Blake Medical Center answeredMinimally invasive surgery can be used to biopsy breast tissue.
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About 25% of women who have a lymph node dissection have side effects, so it’s an operation to be avoided for some women. In a study of women with small breast cancers who underwent lumpectomy and lymph node dissection, it was found that their survival rate was the same as for women who did not have the axillary dissection, so for some women it’s okay to omit this step. One of the reasons is that women who have lumpectomies also have radiation therapy, which may kill the cancer in the lymph nodes. Another reason is that it’s not true for every woman that the cancer will spread to other organs. The bottom line is that for some women lymph node dissection can be omitted.