Surgical Treatment of Breast Cancer
I have just
been diagnosed with breast cancer, what information
do I need to know regarding my cancer and follow-up
Here is a review of some of the basic information
you will need to know, and that your doctor will
use to plan your follow-up treatment. Getting
a diagnosis of cancer can be overwhelming. We
work as a team. Your surgeon will be giving you
a lot of information, and the nurse practitioner
is also available to answer and review information
with you, and provide information about resources
and support services. We are available at 847-797-9000.
There are several tests done on your cancer tissue
to help determine what your follow-up treatment
Type of breast cancer. The tissue removed is examined
under the microscope to see whether the cancer
is in situ, which means noninvasive, or if it
is invasive. Also, the biopsy is used to determine
the cell type. The most common types of breast
cancer are ductal cancer which arises in the ducts,
and lobular which is found in the lobules.
Tumor Size: The size of the tumor is important
in determining the prognosis, or probable future
outcome of the disease. In general, patients with
smaller tumors of 2 centimeters or less have a
better prognosis than those with larger tumors.
Grades of breast cancer: The pathologist assigns
a grade to the cancer indicating how fast the
cells are growing. Cells that resemble normal
tissue grow more slowly, and tend to spread more
slowly. Higher-grade cells tend to be more aggressive.
A higher grade indicates a faster growing cancer.
The system of grading cancers is used for invasive
but not in situ cancers. Typically, grading is
from Grade I, a well-differentiated tumor, to
Grade III, a poorly differentiated tumor. Individuals
with a well-differentiated tumor tend to have
a better prognosis.
Margins: The pathologist will look at the tumor
to determine whether or not the margins, or edges,
of the specimen are free of tumor. Sometimes there
are microscopic cells that your surgeon cannot
see or the disease is more extensive than originally
appreciated by current imaging techniques. If
the tumor is at the edge or close to the edge
of the specimen, your surgeon will take you back
to the operating room to remove more tissue. The
goal is to get the entire tumor removed with a
normal ridge of tissue around it.
Lymph Nodes: Your lymph nodes will be evaluated
by your surgeon by either using a sentinel node
procedure or an axillary dissection. Your lymph
node status will be reported to indicate whether
the cancer has spread to the lymph nodes in the
underarm. The number of positive lymph nodes can
help predict the risk of cancer recurrence.
Estrogen and Progesterone Receptors: Your tumor
will be tested for these receptors. Receptors
are parts of cells that can attach to substances
such as hormones that circulate in the blood.
Women who are hormone receptor positive tend to
have a better prognosis and respond better to
HER2/neu testing: Your tumor will be tested for
a growth promoting protein called HER2/neu. Tumors
that over express this protein tend to grow faster
and be more aggressive than other breast cancers.
HER2/neu positive tumors can now be treated with
a drug called Herceptin.
Staging of cancer: Staging is determined with
three key pieces of information from the surgery.
The size of the tumor, whether the lymph nodes
are involved, and whether there is any evidence
that the tumor has spread to distant organs. Once
the stage is determined, this helps the physicians
involved in your care select the best treatments
for your care and also help predict your future
to Detect Cancer Spread
Depending on the stage of your cancer, some of
these additional tests may be required.
Chest X-ray: This test may be done to see whether
the breast cancer has spread to your lungs.
MRI: A breast MRI (Magnetic Resonance Imaging)
uses strong magnets and radio waves to create
clear detailed pictures of the insides of your
breast. It does not use x-ray. The energy from
the radio waves is absorbed and released in a
pattern. A computer translates this information
into a detailed image for the radiologist. You
will have an IV inserted. A contrast material
called gadolinium is injected by IV to better
differentiate the details. MRI is now being used
in some cases when a new diagnosis of breast cancer
has been made in order to assist your physician
in treatment planning.
Bone Scan: This test helps evaluate whether cancer
has spread to any of your bones. You will receive
a radioactive material for this test. The dose
is very low and causes no long-term side effects.
The radioactive substance is attracted to diseased
bone throughout the entire skeleton. Areas that
take up the substance are called hot spots. Arthritis,
infections, or other bone diseases can also cause
a similar pattern. To distinguish among these
conditions, you may require additional x-rays
or a biopsy. A bone scan can usually find metastases
earlier than regular x-rays.
Computed Tomography (CT) Scan: The CT scan is
an x-ray procedure that produces a detailed cross-sectional
image of your body. This test can help tell if
cancer has spread to your liver or other organs.
Often pictures are taken with and without contrast
dye. The contrast dye helps to better outline
structures in your body.
PET Scan: A PET Scan, or Positron Emission Tomography,
is new imaging technology that detects cancerous
tumors earlier and more accurately. The scan creates
computerized images of chemical changes that take
place in tissue. The PET Scan is used in breast
cancer patients to see if there is any evidence
of cancer in other areas of their body, and to
determine the effectiveness of treatment.
Radiation Therapy: High-energy x-rays are used
to kill any cancer cells that remain in your breast
or lymph nodes after surgery. Most women who have
lumpectomy (breast conserving surgery) receive
radiation after surgery to help ensure that any
remaining cancer cells are destroyed and to help
prevent the chance of cancer recurrence. Some
women with tumors larger than 4 centimeters who
have had mastectomies will require radiation therapy
as well. You will have a consultation with a radiation
oncologist prior to beginning any treatment to
discuss your case thoroughly.
Chemotherapy: Chemotherapy involves the use of
drugs that can kill cancer cells or stop them
from multiplying. After your surgery, you will
have a consultation with a medical oncologist
to determine whether chemotherapy is recommended
as treatment for your breast cancer. Chemotherapy
usually begins within 6 weeks after surgery.
Hormone Therapy: All normal breast cells have
receptors that are designed to bind them to the
hormones estrogen and progesterone. Receptors
are protein molecules found on the surface of
the cells. Your tumor will be tested to see whether
or not these receptors are present in the cancer
cells. If they are present or positive, you will
be advised to take hormone therapy. This hormone
therapy uses drugs that block the ability of the
cancer cells from binding to the estrogen and
progesterone. This inhibits their ability to grow.
Drugs such as Tamoxifen and Arimidex fall into
Biological Therapy: Biologic therapy or immunotherapy
involves the use of drugs or substances that enhance
the body’s ability to detect and destroy
foreign invaders like cancer cells. For breast
cancer treatment, the primary biological therapy
being used is a drug called Herceptin. Herceptin
targets cancer cells that over express or make
too much of a protein called Her-2. Herceptin
slows or stops the growth of these cells.
If you have additional questions
or concerns, please call us at