Breast Cancer Treatment Choices

Breast cancer can be treated with a mastectomy or breast preservation surgery, lumpectomy, followed by radiation and sometimes chemotherapy. Some types of tumors are stimulated by normal hormones found in a woman's body, such as progesterone, estrogen, and HER-2. By knowing this information, a plan of treatment can be offered that will improve a woman's chances of cancer free survival.The pathology from the surgery, done to remove the cancer tumor, will tell if the entire tumor was removed and if cancer was found in the lymph nodes. During surgery the surgeon can see the cancer tumor, but not all of the cancer cells can be visualized. This way cancer cells that might be outside the main tumor can be seen. This dye is injected before surgery and will show which node is the main node that drains fluid from the cancer tumor site. If lymph nodes are found to have cancer cells within them the cancer has moved from the tumor site to other areas in the body. This movement of cancer cells away from the tumor indicates metastasis, or stray cancer cells that are traveling in the body. The final pathology will offer much information about the type of cancer, the location of the cancer and how best to treat the cancer to provide a cancer free life for the woman.A woman who has been diagnosed with cancer, from a biopsy, then will see a surgeon who specializes in breast cancer. Surgery to remove the tumor is always needed, as long as the tumor is in the breast it will grow and chances are the cancer cells will travel away from the main tumor and spread throughout the body. The surgeon will ask questions about the woman's health and ask about the woman's family. If a woman has family members that have, or have had breast cancer, this information will be included in treatment decisions. The surgeon then will discuss ways to treat the cancer. A lumpectomy which is removal of the cancer tumor and a small amount of tissue surrounding the tumor is another choice. If the tumor is large a lumpectomy may not be a good choice. The smaller the tumor, the better the chances of survival for the woman. Sometimes chemotherapy is needed before surgery; the chemotherapy will hopefully shrink the tumor and kill cancer cells that may have moved away from the main tumor (metastasized). Chemotherapy may be needed after surgery depending on the type and stage of the cancer.Often the surgeon will ask a woman to see a radiation oncologist before her surgery. This consultation will allow the radiation oncologist, another cancer doctor who specializes in radiation, to review the woman's case and to offer choices of treatment. The options this doctor may offer are whole breast radiation after surgery, or partial breast radiation after surgery, or no radiation if a woman has a mastectomy and no cancer cells are found outside the breast that was removed in surgery.One type of partial breast radiation is brachytherapy. Brachytherapy of the breast is a good choice for some women. The size of the tumor and the location of the tumor are two of the determinations if this is a good choice. If the cancer is found out side of the breast, brachytherapy is not a choice for a woman. Brachytherapy is radiation given to the area where the cancer tumor was. When a woman chooses breast brachytherapy the applicator that will allow radiation to go right into the space where the cancer was; is placed at the time of surgery. Only the tissue around where the cancer tumor was is radiated; the normal tissue is exposed either not at all or to such a low level of radiation it is not affected by the radiation.The brachytherapy treatments are given two times a day, at least 6 hours between treatments, for a total of ten treatments. This type of radiation requires special equipment and knowledge, many cancer centers now have both the equipment and the radiation oncologists that are specialized in this treatment.The other type of partial breast radiation is accelerated partial breast radiation. This type of treatment also requires that the tumor is small and no cancer has been found outside the breast. The equipment to give these treatments is IMRT, which most if not all cancer centers have. This type of radiation involves one treatment a day Monday through Friday for 6 weeks, a total of 30 treatments. It is external beam radiation that goes from the outside of the breast to the inside of the breast and radiates all of the tissue in the breast and surrounding area, not just the area where the tumor was. This type of treatment is favored when the tumor is larger or the cancer cells were found outside of the breast, such as in one or more lymph nodes. The lymph nodes can be included in the whole breast radiation. Some women will choose whole breast radiation because it has been used for so very long. Partial breast radiation has shown the same effectiveness in studies, when the woman is a candidate for brachytherapy.

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