Breast cancer can be treated with local or systemic therapy. Some patients receive both kinds of treatment. Local therapy, which includes surgery and radiation therapy, is used to remove or destroy breast cancer in a specific area.
Systemic treatments, which include chemotherapy and hormonal therapy, are used to destroy or control cancer throughout the body. Some patients have systemic therapy to shrink the tumor before local therapy. Others have systemic therapy to prevent the cancer from coming back or to treat cancer that has spread.
Surgery is the most common treatment for breast cancer. There are two main objectives for surgery. The first is to remove the tumor. The second is to evaluate the lymph nodes to determine if the cancer has spread.
There are two types of surgery to remove the cancer – partial mastectomy and mastectomy:
- Partial Mastectomy – an operation that 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 partial mastectomy, to reduce the risk of the cancer reoccurring.
- Mastectomy – an operation where your surgeon will remove all of the breast tissue — the lobules, ducts, fatty tissue and a strip of skin with the nipple and aureola.
- 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 mastectomy bra that contains a prosthetic breast for visual uniformity, or you can have delayed reconstruction.
- Reconstructive surgery – if reconstruction is an option, your surgeon will refer you to a plastic surgeon. Your options will include reconstruction with a synthetic breast implant or reconstruction using your own tissue.
- Skin-sparing mastectomy is removal of the breast tissue through a small incision around the areola, leaving the skin behind. This procedure creates an envelope of skin inside which a plastic surgeon can reconstruct the breast. The cosmetic results are very good; however this is an add-day procedure that requires a hospital stay of several days.
Evaluating the Lymph Nodes
Three of the most important factors in the treatment of cancer are tumor size, nodal status and presence or absence of cancer outside of the breast and lymph nodes. This information combined will help classify the cancer and determine the most effective treatment.
This evaluation is called staging. The surgeon will evaluate the lymph nodes at the time of surgery.
Radiation therapy, or “radiotherapy,” uses high-energy x-rays or particles to destroy cancer cells. This treatment is used to kill any cancer cells remaining in the breast, chest wall or underarm area after breast-conserving surgery. It may also be needed after mastectomy in certain cases. Before you undergo radiation, a radiation oncologist and physicist plan the precise delivery of the radiation to minimize radiation to your vital organs and maximize the radiation to the affected area.
There are two types of radiation therapy – external beam radiation and brachytherapy:
External beam radiation uses a machine called a linear accelerator to treat the entire breast from the outside. In some cases, surrounding tissue is also treated. External beam radiation therapy is painless. Each treatment lasts only a few minutes and is similar to getting an x-ray. The therapy is typically given 5 days a week for 3-6 weeks.
Brachytherapy, also called internal or partial-breast radiation, uses a balloon-tipped catheter to insert radioactive pellets into the cavity that was created during surgery. This method treats only the tissue surrounding the tumor site and can usually be completed in 5 days. New brachytherapy devices use a multi-channel catheter to facilitate better control over the dosage and direction of the radiation, making this option available to women with smaller breasts or more complicated tumor sites. The James Graham Brown Cancer Center has the most experienced physicians in the region in the science and application of brachytherapy, and is has the first nationally accredited radiation oncology program in Louisville.
Chemotherapy uses drugs to destroy cancer cells. The drugs enter the bloodstream and travel throughout the body. Chemotherapy may be recommended to kill any remaining cancer cells following surgery, or to control cancer growth and relieve symptoms. Most chemotherapy drugs are given intravenously or in pill form.
Hormonal therapy keeps cancer cells from getting the hormones they need to grow. It is used to treat cancers that are fed by estrogen – known as hormone receptor positive tumors. Like chemotherapy, hormonal therapy can affect cancer cells throughout the body.
The immune system is your body’s way of fighting disease. Immunotherapy helps this system control or kill cancer cells.
Clinical Trials and Research
In addition to using the most advanced methods of diagnosis and treatment, the Brown Cancer Center is constantly examining new approaches to cancer treatment. Brown Cancer Center physicians participate in and initiate a wide range of ongoing clinical trials and research, giving you access to new therapies that may not yet be available in other parts of the country or even the world.
If you have general questions about your condition, the Brown Cancer Center, or free services available to you and your loved ones, please contact the M. Krista Loyd Resource Center at 502-562-4158 or 866-530-5516.