Active Breast Cancer Treatment
Breast Cancer Treatments & Surgery Options
Treatments & Surgery Options
Surgery Options
There are two main types of surgery to remove breast cancer:
Lumpectomy (Breast-Conserving Surgery): This procedure involves removing the tumor along with a small margin of surrounding healthy tissue. The goal is to conserve as much of the breast as possible. It is usually followed by radiation therapy to the remaining breast tissue to reduce the risk of cancer recurrence.
Mastectomy: This surgery involves removing the entire breast but not the nearby lymph nodes. It may be recommended for patients with multiple tumors or if the tumor is large compared to the size of the breast. It can also be a choice for those who prefer this approach or have a higher risk of recurrence. Some may choose to have a bilateral mastectomy (removal of both breasts) or a unilateral mastectomy (removal of only one breast).
Partial Mastectomy: Similar to a lumpectomy, this surgery involves removing a larger portion of the breast, but not the entire breast. It may be considered when the tumor is larger or there are multiple areas of cancer in the breast.
- Skin-Sparing Mastectomy: This type of mastectomy removes the breast tissue while preserving most of the skin over the breast. It is often done in preparation for breast reconstruction surgery and may leave a more natural appearance.
- Nipple-Sparing Mastectomy: This procedure removes the breast tissue but preserves the nipple and areola. It is typically considered when the cancer is not near the nipple and there is a low risk of cancer involvement in the nipple area. It is often followed by breast reconstruction.
- Sentinel Node Biopsy: During this procedure, the surgeon removes a limited number of lymph nodes (the sentinel nodes) that are the first to receive drainage from the tumor. This helps determine if cancer has spread to the lymph nodes. If cancer is found in the sentinel nodes, further lymph node removal may be needed.
- Axillary Lymph Node Dissection: If cancer is detected in the sentinel nodes or there is a high risk of spread, this procedure involves removing several lymph nodes from the underarm area (axilla) to assess for cancer spread. This is often done in conjunction with a lumpectomy or mastectomy.
Chemotherapy (chemo)
Neoadjuvant Chemotherapy: Given before surgery to shrink the tumor and make it easier to remove. Common regimens include a combination of drugs like doxorubicin, cyclophosphamide, and a taxane (e.g., docetaxel or paclitaxel). Neoadjuvant chemotherapy can also help assess how well the cancer is responding to treatment.
Adjuvant Chemotherapy: Administered after surgery to eliminate any remaining cancer cells and reduce the risk of recurrence. The regimen might be similar to neoadjuvant chemotherapy, depending on the individual case.
Specific kinds of chemotherapy used in breast cancer treatment are: Anthracyclines, such as doxorubicin (Adriamycin) – also known worldwide by patients as the “”red devil”” due to it’s color and toxicity Taxanes, such as paclitaxel (Taxol) and docetaxel (Taxotere) Cyclophosphamide (Cytoxan) Carboplatin
Radiation
Radiation therapy uses high energy radiation to kill cancer cells or slow their growth by damaging their DNA. Damaging the DNA of cancer cells causes the cells to stop dividing or die. It takes days or weeks of radiation to cancer cells for the cells to die. Cancer cells then keep dying for weeks or months after treatment ends.
While some people may need only radiation to treat their cancer, most often, radiation therapy is given with other treatments like surgery, chemotherapy and/or immunotherapy. Radiation therapy may be given before, during or after other treatments.
Usually recommended after lumpectomy to target any remaining cancer cells in the breast and surrounding tissues. It may also be used after mastectomy, particularly if there is a high risk of recurrence based on tumor characteristics or lymph node involvement.
The choice of radiation therapy depends on various factors, including the tumor’s size, location, and type, as well as the patient’s overall health and preferences. Your oncologist will tailor the treatment plan based on these considerations to achieve the best outcomes.
Targeted Therapy and Immunotherapy (Emerging Options)
Immunotherapy: Research is ongoing into the use of immunotherapy for TNBC. For example, pembrolizumab (Keytruda) is an immune checkpoint inhibitor that has shown promise in combination with chemotherapy for certain types of early-stage TNBC.
PARP Inhibitors: These drugs, such as olaparib (Lynparza) or talazoparib (Talzenna), target cancer cells with BRCA1 or BRCA2 mutations, which are sometimes found in TNBC. They are typically used in advanced stages but are being studied for earlier stages as well.
Why are clinical trials important?
Clinical trials test new ways to find, prevent, and treat cancer. They also help doctors improve the quality of life for people with cancer by testing ways to manage the side effects of cancer and its treatment.
People join clinical trials for many reasons. People living with cancer often join trials because they want to help future patients. People with certain risk factors want to help doctors learn how to prevent cancer. Healthy volunteers want to help doctors learn how to find cancer early.
People with cancer and healthy volunteers join trials to play a role in cancer research and move science forward to help others.
Clinical Trial Resources
Patients with early-stage TNBC may be eligible for clinical trials exploring new treatments or combinations of existing therapies. Participation in clinical trials can provide access to cutting-edge therapies and contribute to advancing cancer treatment.
Check out BreastCancerTrials.org for more options for those with early-stage breast cancer.
Breast Reconstruction
- Type of mastectomy
- Cancer treatments
- Patient's body type
Breast Reconstruction Options
Tissue expansion and implant
During tissue expansion, an expandable, balloon-like implant is inserted in the place of the breast, either above or under your chest muscle. This temporary implant is gradually filled with saline over several weeks or months. This can be done at the time of your mastectomy or at a later time. The tissue expander is gradually inflated to stretch the skin and tissue over your chest and make room for a permanent implant.
After the tissue is adequately expanded, your surgeon performs a second surgery to remove the tissue expander and replace it with a permanent implant. This can be a silicone or saline device that reshapes your breast and is filled with silicone gel or salt water.
Flap procedure
Breast reconstruction with flap surgery involves taking a section of tissue from one area of your body and relocating it to create a new breast mound. Most of the time, this is done as a separate procedure from your mastectomy.
Breast reconstruction with flap surgery is the most complex breast reconstructive option. Your surgeon transfers a section of skin, muscle, fat and blood vessels from another part of your body to your chest to create a new breast mound. In some cases, the skin and tissue need to be augmented with a breast implant or other surgery to achieve the desired breast size.
The tissue for reconstructing your breast most often comes from your abdomen; it may also come from your back or, less commonly, your buttocks.
The most common flap procedures are:
Pedicle TRAM flap
In a pedicle TRAM flap procedure, the surgeon cuts a section of skin, muscle, fat and blood vessels from your abdomen, tunnels the tissue underneath your skin to its new location and uses it to form a new breast mound.
Deep inferior epigastric perforation (DIEP) flap
A newer procedure, DIEP flap, is similar to a TRAM flap, but only skin and fat are removed. Most of the abdominal muscle is left in place, and minimal muscle tissue is taken to form the new breast mound. An advantage to this type of breast reconstruction is that you'll retain more strength in your abdomen.
Latissimus dorsi flap
In this flap procedure, the surgeon takes tissue from the latissimus dorsi muscle with skin from your back, tunnels it underneath your arm to its new location and uses it to form a new breast mound.
Nipple reconstruction
If you choose, breast reconstruction may also involve reconstruction of your nipple, including 3D tattooing to define the dark area of skin surrounding your nipple called the areola.
The Stages of Breast Cancer
At some point, your doctor will tell you what stage your breast cancer is. Put simply, the stage describes how widespread or advanced the cancer is in the breast tissue and possibly other parts of your body. Determining the stage helps doctors explain the breadth of the cancer to you. It also helps them determine how to move forward with treatment, including surgery, if needed.
Stage 0: Stage 0 is used to describe non-invasive breast cancers, such as ductal carcinoma in situ (DCIS). Within stage 0, there is no evidence that cancer cells or other abnormal cells have invaded neighboring normal tissue.
Stage I: It is invasive breast cancer (cancer cells are breaking through to or invading normal breast tissue. There are 2 types:
- Stage IA: The tumor is small. It has not spread to the lymph node.
- Stage IB: The tumor is in the lymph nodes and may also be in the breast tissue. It is less than 2 cm in size.
Stage II describes invasive breast cancer. There are 2 types:
- Stage IIA: A tumor may not be found in the breast or there is a tumor that is 2cm or smaller in the breast, but cancer cells have spread to at least 1 to 3 lymph nodes. Or Stage IIA may show a 2 to 5 cm tumor in the breast without spread to the axillary lymph nodes.
- Stage IIB: The tumor is 2 to 5 cm and the disease has spread to 1 to 3 axillary lymph nodes. Or the tumor is larger than 5 cm but has not spread to the axillary lymph nodes.
Stage III describes invasive breast cancer. There are 3 types:
- Stage IIIA: The tumor of any size has spread to 4 to 9 lymph nodes. Or the tumor is larger than 5cm and only has spread to 1-3 lymph nodes.
- Stage IIIB: The tumor may be any size and the disease has spread to the chest wall. It may cause swelling of the breast and may be in up to 9 lymph nodes. Inflammatory breast cancer is considered Stage IIIB.
- Stage IIIC: The tumor may be any size with spread to 10 or more lymph nodes.
Stage IV (metastatic): The tumor can be any size and the disease has spread to other organs and tissues, such as the bones, lungs, brain, liver, distant lymph nodes, or chest wall.
Mental Health Support
When to Seek Mental Health Support
- having a hard time accepting your diagnosis and the changes it brings
- experiencing physical and emotional side effects, such as fatigue, nausea, and mood swings, which can be caused by breast cancer treatments
- feeling overwhelmed about choosing from possible treatment options or where to receive care
- feeling unsure about how you’re going to keep up with everyday responsibilities and expectations at your job or at home
- feeling angry about the way the breast cancer diagnosis has changed your life and affected your personal relationships with a partner, children, family members, or friends
- feeling stressed about finances, including the cost of medical care, having to take unpaid time off from work, or not having enough money to spend on things you enjoy
- feeling anxious about the cancer returning (recurrence)
- feeling afraid of death, particularly if you have been diagnosed with metastatic breast cancer
- grieving about physical changes to your body, such as losing your hair or breasts, or changes to your sexual health
- worrying about fertility
How Mental Health Support Can Help In Survivorship
- reduce feelings of anxiety, depression, and chronic stress
- maintain a more positive outlook by promoting feelings of happiness, contentment, and optimism
- learn coping skills that you can draw upon if you feel overwhelmed
- strengthen your relationships with family and friends
- improve how well you sleep
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