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Welcome message from Donald M. Miller, M.D., Ph.D., Director of the James Graham Brown Cancer Center.

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Breast Cancer Treatment Options

Local Therapy Treatment

Removing the Tumor

There are two types of surgery to remove the cancer:

Lumpectomy
This operation saves as much of your breast as possible by removing only the lump plus a surrounding area of normal tissue. This is an outpatient procedure so you are home the same day. Radiation is critical after a lumpectomy. You will have radiation five days a week for six weeks. In general, each treatment is short (about 15 minutes), but you must commit to having radiation therapy if you want to have a lumpectomy.

Mastectomy
Mastectomy means your surgeon will remove all your breast tissue — the lobules, ducts, fatty tissue and a strip of skin with the nipple and areola. There are two types of mastectomy:

• Conventional mastectomy means your surgeon will remove your entire breast. You usually are in the hospital overnight. You will be flat-chested after this procedure but can wear a prosthesis or have delayed reconstruction.
• Skin-sparing mastectomy is a mastectomy where your surgeon carves out the breast tissue through a small incision around the areola, leaving the skin behind. This creates an envelope for the plastic surgeon to then “stuff.” The envelope retains the same shape as your breast. The cosmetic results of this operation are very good, however this is an all-day procedure. You are in the hospital about four days, and it takes a couple of weeks to recover.

Evaluating the Nodes

The second main objective of surgery (after removing the tumor) is to evaluate the lymph nodes. The surgeon does this for two reasons. The first is that knowing whether the cancer has spread to the lymph nodes tells us about how aggressive the cancer is and will affect the treatment you receive. This is called staging. The other reason is that if there is cancer in the lymph nodes, we need to treat that cancer to prevent it from growing. Your nodes are evaluated using a procedure called sentinel lymph node biopsy, which concentrates on locating the sentinel nodes — the first nodes to that the cancer will spread if it spreads.

Reconstructive surgery

If reconstruction is an option, your surgeon will refer you to a plastic surgeon who will describe the procedures to you and show you photos of women who have had different types of reconstruction. Your options will include reconstruction with a synthetic breast implant or reconstruction using your own tissue to rebuild your breast. These operations can be performed at the time of your mastectomy or later.

Radiation Therapy

Radiation therapy uses high-energy rays to kill any breast cancer cells that may remain in the area following surgery. Usually, radiation is delivered by a technique called external beam, where the entire breast is treated with x-rays. Before you undergo radiation, a radiation oncologist and physicist plan the precise delivery of the radiation to minimize radiation to your heart and lungs and maximize the radiation to your breast.

For external radiation therapy, you will go to the Brown Cancer Center, generally five days a week for six weeks. Each treatment takes 15 minutes, and many patients continue to work while they undergo radiation.

Radiation is recommended if had a lumpectomy. If you had a mastectomy, you may need radiation if your tumor was larger than 5 cm or you had four or more lymph nodes with cancer.

Systemic Therapy Treatment

Chemotherapy

Chemotherapy uses drugs to destroy cancer cells. Chemotherapy may be recommended following surgery to kill any cancer cells that may have spread outside your breast. Chemotherapy for breast cancer is usually a combination of two or more drugs. The drugs enter the bloodstream and travel throughout the body. You may have between four and eight treatments spread over three to six months.

In some cases, your physician may suggest neoadjuvant therapy, which means taking chemotherapy drugs before surgery to shrink a breast tumor before an operation. This may make it possible for you to have a lumpectomy rather than a mastectomy.
Chemotherapy side effects may include hair loss, nausea, vomiting and fatigue. These occur because in addition to attacking cancerous cells, chemotherapy affects healthy cells — especially fast-growing cells in your digestive tract, hair and bone marrow. Not everyone has side effects; today there are better ways to control them if you do.

Hormonal therapy

Hormonal therapy keeps cancer cells from getting the hormones they need to grow. It is used to treat women with cancers that are fed by estrogen. Like chemotherapy, hormonal therapy can affect cancer cells throughout the body. However, with hormonal therapy, your hair will not fall out, and you will not get sick. But there is an increased chance of getting blood clots in your legs, and you may experience menopausal symptoms.

Clinical trials and research

In addition to using the most advanced methods of diagnosis and treatment, the James Graham Brown Cancer Center participates and initiates a wide range of ongoing clinical trials and research, including new therapies that may not yet be available in other parts of the region. To learn more about available clinical trials, ask your physician.