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Breast Cancer Treatment, What To Expect After Diagnosis

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Breast Cancer Treatment, What To Expect After Diagnosis
June 19
14:53 2016

Being diagnosed with breast cancer causes an unexpected turn in a woman’s life, often putting a strain on her both physically and mentally. Thankfully, because of years of research and improvements in treatment, survival rates are now higher than they’ve ever been before.

“It’s the combined management of care today that includes surgery, chemotherapy and radiation that is curing over 90 per cent of women,” said Dr. Ralph George, medical director of the CIBC Breast Centre at St. Michael’s Hospital in Toronto.

He emphasized that removing breast cancer involves a combination of individualized treatments. While surgery is often the first step for some women, others may first require administration of chemotherapy and radiation if the tumour is too big. Chemotherapy will shrink the tumour and make surgery easier to perform, according to Dr. George.

If chemotherapy comes first, a woman will have six months before undergoing surgery, during which time she can think about her surgical options. If the initial stage is surgery, Dr. George mentioned that biological evidence has shown that if a woman needs some time before taking that step, she has the option of waiting up to three months.

“She has time to get a couple of opinions and she has time to speak to her plastic surgeon if she wants to, but it shouldn’t be longer than that.”

Breast Cancer Treatment, What To Expect After Diagnosis

Breast Cancer Treatment, What To Expect After Diagnosis

Surgical Options

There are different surgical options available, also dependant on each individual. The surgeries can be performed under general or local anaesthetic, depending on the patient’s preference. Here are the surgical options that a surgeon will consider to remove the tumour, which can be followed by breast reconstruction immediately after:

Nipple- and Skin-Sparing Mastectomy

According to the American Cancer Society (ACS), nipple-sparing mastectomy is a possibility for women who have a small cancer in its early stage, and is not near the skin or nipple. Dr. George added that it is most commonly done on high-risk, yet cancer-free, women as a preventive measure. Initially, the tissue behind the nipple is tested to make sure “there’s nothing worrisome,” explained Dr. George. If the tissue comes out worrisome, then the nipple and areola must be removed, leaving just the breast’s skin. If it’s okay, both the nipple and skin is preserved during the operation while the rest of the breast tissue is removed.

“When you do that, it facilitates reconstruction. The plastic surgeon has the entire envelope, including the nipple, skin and an incision underneath, and they can refill that envelope with a flap of the patient’s own tissue or some sort of implant,” said Dr. George.

Breast reconstruction aside, the surgery takes about one hour to complete. While the patient has the opportunity to preserve the nipple, there is the risk of the nipple becoming deformed due to a lack of blood supply, and most often, little feeling is left in the nipple, according to ACS.

Total Mastectomy

A total mastectomy involves the removal of the entire breast, including the nipple, areola and surrounding skin. “Sometimes, unfortunately, we have to do it this way, because there may be a tumour near the skin or near the nipple,” Dr. George explained.

Oftentimes, if a woman requires radiation right after mastectomy, breast reconstruction must be delayed, and therefore it’s preferred to do a complete removal of the breast for cosmetic reasons. According to Dr. George, this procedure takes the shortest amount of time to undergo, usually around thirty minutes without the breast reconstruction.

Lumpectomy

This option is considered breast conserving, where the cancerous lump is removed instead of the entire breast. Dr. George explained that today, this procedure is what most women with breast cancer undergo. Because of the availability of screening and diagnostic tests, many tumours are found before they have the chance to expand, reducing the need for a mastectomy. Dr. George mentioned that the difference between a mastectomy and lumpectomy is the amount of tissue that’s removed.

“What they’re both trying to do is to remove the cancer with negative margins. In some people, because of their body build and size of their tumour, they may not be able to have a good cosmetic result with a lumpectomy,” said Dr. George, adding that with the necessary combination of treatments, both types of surgeries can have a successful outcome.

Lymph Node Removal

According to the Canadian Breast Cancer Foundation (CBCF), the first sign that the cancer could possibly be spreading to other parts of the body is through examining the breast’s nearby lymph nodes. The first place the cancer would travel to is what’s called the sentinel lymph node. One or more sentinel lymph nodes are dissected during surgery and tested for cancer. If cancer is found, then the surgeon will also remove the axillary lymph nodes, located in the armpit area, and test them as well. The results will help decide what path of treatment will be required.

According to Dr. George, “most of the complications come from the lymph node component of the surgery, not the mastectomy,” as removing the lymph nodes could result in lymphedema, which according to CBCF, is caused by a build-up of lymph fluid around the breast area, often causing swelling in the arm, chest and hands.

Dr. George did mention, however, that because doctors can now do a biopsy of the sentinel lymph node, it allows for the removal of just one or two lymph nodes instead of several. He added that because of an increase in early detection, women who are coming in for surgery have smaller tumours than women did 20 years ago. This allows for less invasive surgeries. Nonetheless, if a sentinel node biopsy comes back positive, more lymph nodes will have to be removed, putting the patient at a greater risk for complications.

Following surgery, a woman can go home the same day. Downtime and how soon you can go back to work varies. Dr. George stated that for an office job, a patient can go back to work in two days. However, if someone has a very physical job, then it’s recommended to take time off work for around six weeks. Downtime is also dependant on the medical treatment that is given post-surgery.

Post-Surgery Treatments

There are various treatment options available to help reduce the chances of the cancer returning, which will depend on the patient’s circumstance.

Radiation

Some women may benefit from radiation, a machine similar to an x-ray, but stronger. According to ACS, the treatment usually begins one month after surgery once the breast tissue has healed and is commonly given five days a week for five to six weeks. If, however, a patient requires chemotherapy as well, the radiation is postponed until chemotherapy is complete.

Chemotherapy

Chemotherapy is administered intravenously and is most commonly given once every three or four weeks. According to Dr. George, this treatment usually takes around six months to complete. While there are various combinations and doses of chemotherapy, there are a few common side effects that ACS lists, including hair loss, loss of appetite, nausea and fatigue. Dr. George explained that more commonly, the downtime that breast cancer patients experience is not from the surgery, but more often from the chemotherapy.

Targeted Therapy

Targeted therapy involves intravenous or oral drugs that help target the antibodies of tumours. This provides fewer side effects than chemotherapy and is easier to tolerate.

Hormone Therapy


According to ACS, estrogen promotes the grown of cancer cells. Hormone therapy, which is given in pill form, helps decrease estrogen levels.

By getting different components of treatment, on average it will take a patient six to nine months to complete the journey. It’s a difficult road to take, but doctors continue to look optimistically at the long-term effects.

“Our cure rates have never been as high as they are today,” said Dr. George. “That’s because people are getting therapies that are targeted at what’s going to do best for them.”


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