A Woman's Guide to Breast Cancer Diagnosis and Treatment
TREATMENT OPTIONS
Surgery
Most women who have breast cancer today are diagnosed with Stage 0, I, or II breast cancer. Many of these women will live a long life. Most of these women can choose:
- Lumpectomy and radiation therapy, OR
- Mastectomy.
Studies show that both options provide the same long-term survival rates. However, neither option gives you a one hundred percent guarantee that cancer will not return at the treated site. Whichever choice you make, you will still need medical follow-up and monthly breast self-exams for the rest of your life. Here is a closer look at today's most common breast surgeries:
Lumpectomy
With a lumpectomy, a surgeon removes the breast cancer, a little normal breast tissue around the lump, and some lymph nodes under the arm. This procedure tries to totally remove the cancer while leaving you with a breast that looks much the same as it did before the surgery. Women who choose a lumpectomy almost always have radiation therapy as well. Radiation decreases the risk of cancer coming back in the remaining breast tissue.
Possible problems: Infection, poor wound healing, bleeding, and a reaction to the drugs (anesthesia) used in surgery are the main risks of any kind of surgery, including lumpectomy. Women may have a change in the shape of the breast that was treated.
Mastectomy
A mastectomy - the surgical removal of the breast - used to be the only treatment for breast cancer. Today a woman who has a mastectomy is likely to have either:
- Total Mastectomy. This surgery removes as much breast tissue as possible, the nipple, and some of the overlying skin. The lymph nodes in the armpit are not removed.
- Modified Radical Mastectomy. This surgery removes as much breast tissue as possible, the nipple, some of the overlying skin, and some lymph nodes in the armpit.
A mastectomy is needed when:
- The cancer is found in numerous areas in the breast.
- The breast is small or shaped so that the removal of the entire cancer will leave little breast tissue or a deformed breast.
- The woman does not want to have radiation therapy.
Possible problems: Infection, poor wound healing, drug reactions, and a collection of fluid under the skin are possible complications.
Questions to Ask Your Doctor
How large will my scar be? Where will it be?
How much breast tissue will be removed?
Will I need radiation or chemotherapy? Why? When should it start?
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Removal of Lymph Nodes
Whether you have a lumpectomy or mastectomy, your surgeon will usually remove some of the lymph nodes under your armpit. This procedure (an axillary node dissection) is most often done at the same time as the breast surgery. If cancer is found in the lymph nodes, your doctor will talk to you about additional treatments. These additional therapies are designed to control and kill cancer cells that could be in other parts of your body
Possible problems: Stiffness of the arm, numbness under your arm, and swelling of the arm. Physical therapy is often helpful to restore full motion of your arm.
Lymphedema: The lymph nodes in your armpit filter lymph fluid from the breast and your arm. Both radiation therapy and surgery can change the normal drainage pattern. This can result in a swelling of the arm called lymphedema. The problem can develop right after surgery or months to years later.
Treatment of lymphedema: This will depend on how serious the problem is. Options include an elastic sleeve, an arm pump, arm massage, and bandaging of the arm. Exercise and diet also are important. Should this problem develop, talk to your doctor and see a physical therapist as soon as possible. Many hospitals and breast clinics now offer help for this problem.
Protecting Your Arm
To avoid lymphedema or to protect your arm after treatment:
- Avoid sunburns and burns to the arm or hand.
- Have shots (including chemotherapy) and blood pressure tests done on the other arm.
- Use an electric razor for shaving underarms.
- Carry heavy packages or handbags on the other arm or shoulder.
- Wash cuts promptly, apply antibacterial medication, cover with a bandage, and call your doctor if you think you have an infection.
- Wear gloves to protect your hands when gardening and when using strong detergents.
- Avoid wearing tight jewelry on your affected arm or elastic cuffs on blouses and nightgowns.
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