Breast cancer treatment options
Beginning with the time a breast lump or lesion is found, women have a number of treatment options. As developments occur, surgeons are continuing to learn about the advantages and disadvantages of these different treatments. Because of the different stages at which breast cancer is diagnosed, there is not one specific treatment that is best for all women. There are too many variables involved to have one standardized treatment plan for breast cancer.
Currently, the basic types of treatment for breast cancer are:
4) hormonal manipulation.
Surgery and radiation are considered local treatment as they treat and affect one area of the breast or body. Chemotherapy and hormonal manipulation are systemic treatment that applies to the entire body.
The options available to you will depend on a number of factors, including the type of tumor, the extent of the disease at the time of diagnosis, your age, and your medical history. But your personal feeling about the treatment, your self-image, and your lifestyle will also be important considerations in your surgeon’s assessment and recommendations.
You and your surgeon should discuss these treatment options and how they apply to your situation. Remember, of primary importance in determining the appropriate treatment is the cure rate. Your life should be your number one priority.
Local treatment: surgical resection
Modified radical mastectomy
This procedure removes the entire breast including the nipple and some lymph nodes under the arm.
No chest muscle is removed and the patient retains normal use of her arm. Breast reconstruction is an option and may be performed at the time of the modified radical mastectomy or at a later date.
The breast is removed. In some cases, there may be swelling of the arm because of the removal of the lymph nodes.
This type of surgery removes only the breast tissue including the nipple. It may be followed by radiation therapy.
Chest muscles are not removed and arm strength is not diminished. All of the underarm lymph nodes remain, so the risk of swelling of the arm is greatly reduced. Breast reconstruction is an option.
The breast is removed. If cancer has spread to the underarm lymph nodes, it may remain undiscovered.
|Partial mastectomy / lumpectomy with axillary dissection
This procedure removes the tumor as well as a rim of tissue to obtain clear margins (healthy breast tissue). Once the diagnosis of breast cancer has been made, the patient undergoes a second surgical procedure at a later date for the removal of lymph nodes to check for the possible spread of cancer and to stage the disease. This is referred to as an axillary dissection. After surgery, once the patient has healed, they begin postop radiation therapy for approximately six weeks. This option is also referred to as Breast Conservation with Radiation Therapy.
The Sentinel Lymphadenectomy: This technique uses a radioactive dye and a blue colorant and replaces the formal axillary dissection. It is less invasive and identifies some key anatomical lymph nodes where the cancer will spread to first. Thus, only a few lymph nodes are removed versus 10 to 20.
The breast is preserved. There is little possibility of loss of muscle strength.
If a woman has extremely small breasts and the tumor is large, this procedure may noticeably change the shape of the breast. If the tumor involves the nipple, this procedure may not be feasible and a mastectomy should be done.
Mastectomy or axillary dissection: after surgery (Post operative Care)
Each woman reacts to surgery differently, but most women are able to go home the same day or are hospitalized for one night. The patient will be discharged from the hospital with a drain namely Blake Drains. They are soft, plastic tubes attached to a suction bulb coming out of the skin below the incision.
This drain is placed during surgery and removes fluid (seroma) that accumulates under the incision site after surgery. The body creates this fluid to the removal of the breast tissue and the lymph glands. Every patient’s body produces a different amount of seroma. The discharge nurse will instruct the patient as to how to empty the drain properly and record the amount of drainage to report to the surgeon on their postop visit. Patients have found it helpful to wear a band of elastic around their waist and to attach the JP drain to it.
The drain is removed once the drainage has decreased. If fluid continues to accumulate under the skin after the drain has been removed; the surgeon can aspirate it painlessly in his office.
The surgery is tolerated well by most patients. There is not a great deal of pain involved. For some patients the emotional aspect of the diagnosis is much more difficult than the physical aspect of the surgery.
In the days following surgery, it is important for you to realize your life can continue to be as rich and full as it was before your surgery. Some patients feel their lives have actually improved after their diagnosis of cancer. Although each woman recovers from a mastectomy or axillary dissection at her own rate, within two weeks after surgery you will be able to resume your normal activities.
You may experience numbness or hypersensitivity under and down the arm associated with the mastectomy or axillary dissection site. With time it will slowly decrease, but it may take a long time for total feeling to return.
Exercising immediately after a mastectomy or axillary dissection will help you ease the tension in your arm and shoulder and will hasten your recovery. It will also prevent the freezing of your shoulder, which can be very painful. Your surgeon, nurse, or physical therapist can show you what exercises to do. Use your arm as you normally would; that is the easiest and best form of exercise.
You might begin with these few simple movements:
Many women find help in support groups, where they can share experiences and learn coping skills. Several studies show that being with others who understand what you are going through can improve the quality of your life. Support groups can help to reduce stress and minimize depression. Having a positive outlook may allow your body to more effectively fight disease.
- Lie in bed with your arm at your side. Raise your arm straight up and back trying to touch the headboard.
- Raise your shoulders. Rotate them forward, down, and back in a circular motion to loosen your chest, shoulders, and upper back muscles.
- Lying in bed, clasp your hands behind your head and push your elbows into the mattress.
- With your elbow bent and your arm ant a 90 degree angle to your body, rotate your shoulder forward until the forearm is down and then backward until it is up.
- With your arm raised, clench and unclench your fist.
- Squeeze a tennis ball.
- Breathe deeply.
- Rotate your chin to the left and right. Cock your head sideways.
- Swing your arm in front of your body and then behind your body.
- In addition, to exercises such as these, many communities offer swimming, exercises, and dance classes designed specifically for breast cancer patients.
After you’ve had a mastectomy, it may be emotionally overwhelming. You may think about the fact that you’ve just been treated for a serious disease. You have had an operation that has changed your appearance, perhaps your self-image. You might wonder how the mastectomy will affect your lifestyle and your personal relationships. You may be unsure as how to act toward family and friends.
Every woman reacts to a mastectomy differently. You can take steps to ease your emotional adjustment. Express your feelings to your doctor, clinical coordinator, and the people close to you. This will help your doctor understand what you need to fully recover, and it will help your family and friends to share your difficulties and to help you work through them. Your family and friends can be your strongest supporters, but they may not know how to show their support. You can help them by being open and honest about the way you feel.
A problem that may arise after surgery is swelling of the arm on the side of the mastectomy. This condition is referred to as LYMPHEDEMA and is caused by the loss of the underarm lymph nodes and their connecting vessels. Because the lymph nodes have been removed, circulation of lymph fluid is slowed, making it harder for your body to fight infection. You should take special care of your arm to prevent infection. (If you had both breasts removed, ask your doctor about any special precautions). The following are some simple precautions to follow:
- Avoid burns while cooking or smoking.
- Avoid sunburns.
- Have all injection, vaccinations, blood samples, and blood pressure tests done on the other arm whenever possible.
- Use an electric razor with a narrow head for underarm shaving to reduce the risk of nicks or scratches.
- Carry heavy packages or handbags with the other arm.
- Wash cuts promptly, treat them with antibacterial medication, and cover them with a sterile dressing; check often for redness, soreness, or other signs of infection
- Wear watches or jewelry loosely, if at all, on the operated arm.
- Wear protective gloves when gardening and when using strong detergents, etc.
- Use a thimble when sewing.
- Avoid harsh chemicals and abrasive compounds.
- Use insect repellent to avoid bites and sting.
- Avoid elastic cuffs on blouses and nightgowns.
- Though you should be cautious, it’s important to use your arm normally—don’t favor it or keep it dependent.