Breast Cancer: What to Expect?

James Piephoff, M.D., Radiation OncologistBy James Piephoff, M.D.
Board Certified Radiation Oncologist
Saint Anthony's Physician Group

When asked to name their greatest fears, a good number of women would put breast cancer at or near the top of the list. And there’s good reason: more than 200,000 American women are diagnosed with breast cancer each year and nearly 40,000 die. Breast cancer is the leading cause of cancer deaths for women aged 35 to 54, and, after lung cancer, the second leading cause, overall.

The first worry, of course, once the diagnosis is confirmed, is one of life or death. With early detection, thanks to breast self-examination and regular mammography, the mortality risk has been declining steadily over the past decade. Of women diagnosed with breast cancer, 70 percent do not die from it. The patient also has more and better treatment options, with less disfigurement and fewer side effects.

SURGERY: The first step is to remove or destroy the cancer cells from the breast tissue. In the not-so-distant past, the primary option for doing this was radical mastectomy, which involves removal of the breast and the underlying chest muscles plus lymph nodes in the arm pit. Today, this procedure is no longer done because less disfiguring options are available.  These include:

• modified radical mastectomy – removal of the breast and lymph nodes but without the underlying muscles of the chest wall,
• simple mastectomy – removal of the breast but no other structures and
• lumpectomy – removal of the cancerous tissue along with lymph nodes from the arm pit. 

A landmark study from the National Surgical Adjuvant Breast and Bowel Project (NSABP) in 1985 found that women with small early-stage breast cancers who underwent breast-conserving surgery followed by radiation did better after five years than those who had mastectomies. A 20-year follow-up published in 2002 confirmed the results.     

Lumpectomy can be performed for tumors that can be felt as lumps as well as smaller ones detectable only by mammography. The tumor itself plus a margin of normal tissue is removed, usually along with some lymph nodes to determine if the cancer has spread. If a pathology report shows only normal tissue at the edges of the tissue, no additional surgery is needed.

With sentinel node biopsy, only the first one to three lymph nodes that drain the breast are removed surgically. If these are free of cancer, the others are left undisturbed.

In some cases, mastectomy is still necessary. Using breast implants or muscle flaps, doctors now have increasingly effective methods of breast reconstruction.

RADIATION is normally a crucial follow-up for women choosing lumpectomy and may also be used on the chest wall and on lymph nodes following mastectomy. The goal is to kill any microscopic cancer cells that have escaped the scalpel and prevent recurrence.     
The entire breast is treated daily for five to seven weeks with high-energy x-rays. The treatment is painless and lasts only a few minutes. It can irritate the skin or cause a burn similar to a sunburn. 

CHEMOTHERAPY, given either intravenously or orally, is the use of drugs to kill cancer cells. It’s used both to treat cancer that has spread to other parts of the body and to reduce the risk of recurrence in persons thought to have localized cancer. It may also be used before surgery to shrink a tumor or kill stray cells.

Because of the well-known side effects – hair loss, nausea, vomiting, fatigue – chemotherapy is usually delivered in cycles–a few days or weeks of intensive treatment followed by a few weeks of recovery. Many of these side effects have been reduced with newer medications.

HORMONE THERAPY: Not all breast cancers need estrogen to grow, but more than half do. For these hormone-sensitive cases, medications are used to deprive cancer cells of estrogen. This may be instead of chemotherapy, if the tumor is small and slow growing, or in addition to the other drugs.

SUPPORT: In spite of all the positive signs in terms of early detection and life-saving treatment, breast cancer is still bound to invoke more than a little fear, anger, anxiety and depression. Treatment itself takes a toll on the body, emotions and family and social relationships.

To deal with such issues, it’s important that supportive care be available as part of treatment. Some need therapy; nearly all benefit from talking to others with similar experiences. Women with advanced cancer participating in support groups, according to one study, lived twice as long as women with the same prognosis but no support. 
Saint Anthony’s Caring Circle Education and Support Group meets monthly and offers women with breast cancer a chance to connect with other women about their experiences. For more information about the support group or breast cancer treatment options at Saint Anthony’s, please call 618-463-5623

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