Most women undergo surgery for breast cancer and also receive additional treatment before or after surgery, such as chemotherapy, hormone therapy, or radiation.
Surgery to remove the cancer is often a key part of treatment. The goal is to remove all of the cancer to lower the chance of the cancer coming back in the breast. During surgery cancer in the breast and often some lymph nodes in the armpit will be removed. Operations to treat breast cancer include:
- During a lumpectomy (also called breast-conserving surgery or partial mastectomy), the surgeon removes the tumor and a small margin of surrounding healthy tissue. It is often done with a sentinel lymph node biopsy. This surgery is usually followed by radiation therapy 4-6 weeks after surgery is done.
- A mastectomy is an operation to remove all of your breast tissue. It is performed on women who are not candidates for lumpectomy due to genetic history, previous radiation therapy, or large/multiple tumors or those who prefer to be treated by mastectomy. There are several types of mastectomy, including nipple sparing mastectomy (NSM). The appropriate operation is determined by the breast surgeon, the reconstructive surgeon, and other members of the treatment team.
- Sentinel lymph node biopsy. During sentinel lymph node biopsy, the surgeon removes the lymph nodes to which breast cancer will first spread in the axilla (armpit). These nodes are called sentinel nodes. Often, two or three nodes are removed. If no cancer is found in those lymph nodes, the chance of finding cancer in any of the remaining lymph nodes is small and no other nodes need to be removed.
- Axillary lymph node dissection. If cancer is found in the sentinel lymph nodes, your surgeon will discuss with you the role of removing additional lymph nodes in your armpit. All lymph nodes that are removed will be sent to a laboratory to be tested for cancer by a pathologist.
- Breast reconstruction. Some women choose to have breast reconstruction after surgery. Your options may include reconstruction with a breast implant (silicone or saline) or reconstruction using your own tissue. These operations can be performed at the time of your mastectomy or at a later date based on your specific treatment plan. Breast reconstruction is done by a plastic surgeon.
Complications of breast cancer surgery depend on the procedures you choose. Breast cancer surgery carries a risk of pain, bleeding, infection and arm swelling (lymphedema).
Radiation therapy is a local treatment for breast cancer. It may be given after surgery to the breast, chest wall, or nearby lymph nodes. The purpose of treatment is to decrease the chance of cancer returning at the treatment site. Radiation therapy uses high powered beams of energy, such as X-RAYs to kill cancer cells.
A doctor who uses radiation to treat cancer (radiation oncologist) determines the length of treatment and which treatment is best for you based on your
cancer type and the location of your tumor.
Side effects of radiation therapy may include fatigue (feeling tired) and a red, sunburn-like rash where the radiation is aimed. Breast tissue may also appear swollen or more firm. Discuss other potential side effects with your radiation oncologist.
Estrogen and progesterone are the female hormones that can make some breast cancers grow. Hormone (blocking) therapy stops cancer growth caused by these hormones.
Breast cancer cells that have estrogen and/or progesterone markers on them are called estrogen (ER) or progesterone (PR) receptor positive cancers. When estrogen and progesterone attach to these receptors it causes the cancer cells to grow. There are medications that can prevent this from happening.
Hormone therapy can be used before or after surgery or other treatments to decrease the chance of your cancer returning. If the cancer has already spread, hormone therapy may shrink and control it.
Treatments that can be used in hormone therapy include:
- Medications that block hormones from attaching to cancer cells (selective estrogen receptor modulators)
- Medications that stop the body from making estrogen after menopause (aromatase inhibitors)
- Surgery or medications to stop hormone production in the ovaries
These medications will be managed by your medical oncologist.
HER2 Targeted Therapy:
Antibodies are proteins made by your body. They help your body’s disease fighting (immune) system. Monoclonal antibodies are antibodies made in a lab. These antibodies are made to attach to receptors (such as HER2 receptors) on cancer cells in order to make the cells behave differently. There are HER2 monoclonal antibodies that are made to target HER2 positive breast cancer cells. The HER2 monoclonal antibody medications work to prevent the growth of cancer cells. These medications are managed by your medical oncologist.
Chemotherapy uses medications to destroy fast-growing cells, such as cancer cells. If your cancer has a high risk of returning or spreading to another part of your body, your doctor may recommend chemotherapy after surgery to decrease the chance that the cancer will recur.
Chemotherapy is sometimes given before surgery in women with larger breast tumors, or more aggressive tumor types. The goal is to shrink a tumor to a size that makes it easier to remove with surgery. You know the chemotherapy is working all over your body if the tumor is shrinking.
Chemotherapy is also used in women whose cancer has already spread to other parts of the body. Chemotherapy may be recommended to try to control the cancer and decrease any symptoms the cancer is causing.