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July 18, 2008 - by Gina Andrews
Breast Cancer Treatments
Faced with a diagnosis of breast cancer can bring on many
questions, but first and foremost is likely to be, "What's
next?"
In general, the first step of your treatment will be surgery to
remove the tumor and any other cancerous tissue. There are two
types of breast surgery: lumpectomy and mastectomy. Either
procedure may include an axillary lymph node dissection, which
will remove some or all of the lymph nodes under the arm next
to the affected breast. Since the lymph nodes act as filters to
the lymph system, cancer in the lymph nodes is associated with
an increased risk of cancer having spread to other parts of the
body (metastasis).
In a lumpectomy, only the tumor (or lump) is removed. Since the
rest of the breast tissue is retained, this is also called
breast-conserving surgery. Other names for lumpectomy are
biopsy, partial mastectomy, wedge resection, or quadrantectomy.
All the tissue removed will be sent to the lab to determine if
the cancer was contained in the excised tissue. This is
referred to as the "margins" or edges of the excised tissue.
How close to the margins cancer cells are found will determine
further treatment. If cancer cells are found in the margins,
most likely further surgery will be performed in an effort to
remove any remaining cancer (this is often called
re-excision).
Lumpectomy is usually followed by radiation
therapy. Research has shown that lumpectomy followed by
radiation can be as effective as mastectomy for those patients
with only one tumor less then 4 centimeters which is removed
with clear margins.
There are three types of mastectomy: simple,
modified, and radical. Which type your doctor selects has to do
with several factors, including type and stage of your
cancer.
In a simple mastectomy, the entire breast is removed, but not
the lymph nodes or chest muscles. This is usually done for
non-invasive cancers, or for those patients that elect to have
prophylactic mastectomy due to a family history of the
disease.
Most women today who have mastectomy surgery have a modified
radical mastectomy. In this surgery, the entire breast is
removed as well as the axillary lymph nodes under the arm next
to the affected breast.
Radical mastectomy used be the norm, but now is generally only
done if the cancer has spread to the chest wall. The entire
breast is removed as well as all the underarm lymph nodes and
the chest wall muscles under the breast.
In almost all cases, breast surgery will be followed up with
either radiation or chemotherapy, or a combination of both.
This is to eradicate any cancer cells that might have been
missed, or that have broken away from the original site, and to
reduce the recurrence of the cancer.
Radiation is directed at the area where the cancer occurred and
any areas where the cancer has spread. When you start radiation
therapy depends on what type you'll be getting. Intraoperative
radiation is given in the operating room during your breast
surgery. Partial breast radiation is generally started right
after surgery. External beam radiation is usually started 3-6
weeks after your breast surgery.
Radiation treatment is usually given 5 days a week for up to
seven weeks, in sessions lasting about 30 minutes each. The
main side effects of radiation are skin reactions, fatigue, and
pain in the chest wall.
Chemotherapy is a systemic therapy that affects the whole body.
Administered through the bloodstream, the chemotherapeutic
agents target fast growing, rapidly dividing cells like the
cancer cells. Side effects are often due to the
chemotherapeutic agent targeting normal cells that also rapidly
grow and divide, such as those in the mouth, nose, vagina,
intestinal tract and those in the hair and nails.
A medical oncologist will meet with you to prescribe a
chemotherapy regimen that is tailored to your specific needs,
such as the stage of your cancer, your age and general health,
and tumor location. You will probably be prescribed a
combination of therapies, and your chemotherapy may be
administered intravenously or by pill.
Before receiving chemotherapy, you will have blood drawn for a
complete blood count, or CBC. Unless you have in-dwelling port
installed, the next step will be to place an intravenous (IV)
catheter through which the chemotherapy drugs will be
administered. You will also be given pre-chemotherapy
medications to prevent side effects such as nausea or
inflammation while the chemotherapy is being administered.
The chemotherapy will then be administered, either via an IV
pump or a slow drip. You will be monitored for any reaction and
the IV site will be carefully watched to make sure the
chemotherapeutic agent is not leaking outside of the vein,
where it could irritate the surrounding tissue. Once the
chemotherapy has been administered, the IV catheter will be
removed. You will be told what side effects to watch for and
given medications to be taken at home. Make sure you have your
doctor's after-hours number in case of emergency.
Common side effects of chemotherapy are
nausea, vomiting, diarrhea, hair loss, fatigue, anemia,
infections, mouth sores, memory loss, and neuropathy (numbness
of the hands and feet). Your doctor may prescribe medications
to help alleviate these symptoms.
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