Breast Cancer
Through continuing breast cancer research, women now have more treatment options and hope for survival than ever before. The treatment options for each woman depend on the size and location of the tumor in her breast, the results of lab tests (including hormone receptor tests), and the stage (or extent) of the disease.
Breast cancer classification is determined by the location and cellular type, which is identified via a tissue sample (biopsy). Understanding the type and stage of breast cancer you have is essential in determining your treatment options.
The most common type of breast cancer begins in the lining of the ducts and is called ductal carcinoma. Another type, called lobular carcinoma, arises in the lobules. When breast cancer spreads outside the breast, cancer cells are often found in the lymph nodes under the arm (axillary lymph nodes). If the cancer has reached these nodes, it may mean that cancer cells have spread to other parts of the body—other lymph nodes and other organs, such as the bones, liver, or lungs—via the lymphatic system or the bloodstream.
Cancer that spreads is the same disease and has the same name as the original (primary) cancer. When breast cancer spreads, it is called metastatic breast cancer, even though the secondary tumor is in another organ. Doctors sometimes call this “distant” disease.
Signs and Symptoms:
Early breast cancer usually does not cause pain. In fact, when breast cancer first develops, there may be no symptoms at all. But as the cancer grows, it can cause changes that women should watch for:
- A lump or thickening in or near the breast or in the underarm area
- A change in the size or shape of the breast
- Nipple discharge or tenderness, or the nipple pulled back (inversion) into the breast;
- Ridges or pitting of the breast (the skin looks like the skin of an orange; or
- A change in the way the skin of the breast, areola, or nipple looks or feels (for example, warm, swollen, red, or scaly).
A woman should see her doctor about any symptoms like these. Most often, they are not cancer, but it’s important to check with the doctor so that any problems can be diagnosed and treated as early as possible.
Surgery is the most common treatment for breast cancer. Several types of surgery may be used. The doctor can explain each of them in detail, discuss and compare the benefits and risks of each type, and describe how each will affect the patient’s appearance.
An operation to remove the breast (or as much of the breast as possible) is a mastectomy. Breast reconstruction is often an option at the same time as the mastectomy, or later on.
An operation to remove the cancer but not the entire breast is called breast-sparing surgery or breast-conserving surgery. Lumpectomy and segmental mastectomy (also called partial mastectomy) are types of breast-sparing surgery. They usually are followed by radiation therapy to destroy any cancer cells that may remain in the area.
In most cases, the surgeon also removes lymph nodes under the arm to help determine whether cancer cells have entered the lymphatic system.
In lumpectomy, the surgeon removes the breast cancer and some normal tissue around it. Often, some of the lymph nodes under the arm are removed.
In total (simple) mastectomy, the surgeon removes the whole breast. Some of the lymph nodes under the arm may also be removed. In modified radical mastectomy, the surgeon removes the whole breast, most of the lymph nodes under the arm, and often the lining over the chest muscles.
Breast reconstruction (surgery to rebuild a breast’s shape) is often an option after mastectomy. Women considering reconstruction should discuss this with a plastic surgeon before having a mastectomy.
Your surgeon will share with you the options available and best course to take for treatment. Your surgeon will also communicate and coordinate with your primary care provider to ensure that the best possible care is being provided to you.
Here are some questions you may want to ask your doctor before having surgery:
- What kinds of surgery can I consider? Which operation do you recommend for me?
- Do I need my lymph nodes removed? How many? Why?
- How will I feel after the operation?
- Where will the scars be? What will they look like?
- If I decide to have plastic surgery to rebuild my breast, how and when can that be done?
- Can you suggest a plastic surgeon for me to contact?
- When can I get back to my normal activities?