Treatment

State-of-the-Art-Care
The Braman Family Breast Cancer Institute at UM/Sylvester offers state-of-the-art care to breast cancer patients. Treatment for breast cancer depends on the size, location, and stage of the tumor as well as the person's general health and other factors. The doctor develops a treatment plan to fit each person's situation. People with cancer are often treated by a team of specialists, which may include a surgeon, radiation oncologist, medical oncologist, and others.

The prognosis (chance of recovery) and treatment options depend on:

• The stage of the cancer (whether it is in the breast only or has spread to lymph nodes or other places in the body).
• The type of breast cancer.
• Estrogen-receptor and progesterone-receptor levels in the tumor tissue.
• A woman’s age, general health, and menopausal status (whether a woman is still having menstrual periods).
• Whether the cancer has just been diagnosed or has recurred (come back).

Treatment options for breast cancer include standard care, which includes surgery, radiation therapy, chemotherapy. Other important aspects of breast cancer treatment for many of today’s patients include hormone therapy, and reconstructive surgery involving breast reconstruction after cancer surgery and clinical trials.

Surgery
Surgery to remove as much of the cancer as possible is the primary treatment for breast cancer. Today, women have many surgical options and choices. The type of surgery performed depends on the size and location of the tumor, the type and stage of the breast cancer (whether the cancer has spread), the size of the breast, and the patient’s preference.

• Partial Mastectomy -- A surgical procedure to remove the part of the breast that contains cancer and some normal tissue around it.
• Total Mastectomy -- A surgical procedure to remove the entire breast that contains cancer. Some lymph nodes under the arm also may be removed.
• Modified Radical Mastectomy -- A surgical procedure to remove the entire breast that contains cancer, many of the lymph nodes under the arm, the lining over the chest muscles, and part of the chest wall muscles, if necessary.
• Radical Mastectomy -- A surgical procedure to remove the entire breast that contains cancer, chest wall muscles under the breast, and all of the lymph nodes under the arm. This procedure is called a Halsted radical mastectomy, and is rarely used to treat breast cancer.
• Skin-sparing Mastectomy -- A procedure to remove the entire breast, including the nipple and areola, conserving the skin of the breast.  This procedure allows immediate breast reconstructive surgery using the patient’s own breast skin tissue.
• Subcutaneous Mastectomy – A type of skin-sparing mastectomy where the nipple and areola are left intact.  No lymph nodes are removed.

Postsurgical exercises can help patients return as quickly as possible to using their affected arm(s) to perform activities of daily living, such as combing hair, bathing, dressing, and eating. In many cases, with their doctor's approval, a patient can start these exercises in the first three to seven days after surgery. The exercises often involve raising the affected arm and moving the hands in different ways to decrease swelling and enhance movement. Patients also should practice deep breathing exercises several times throughout the day using the diaphragm to expand the chest and abdomen. For a more detailed description of these exercises and when to begin any exercise program, consult your doctor.

Radiation Therapy
Radiation therapy is a process that sends high levels of radiation directly to the cancer cells. Radiation done after surgery can kill cancer cells that may not be seen during surgery. It also may be used prior to surgery to shrink the tumor, in combination with chemotherapy, or as a treatment to relieve symptoms such as pain, but not to alter the course of the disease. Radiation may be delivered externally through a beam, or internally, through an implant directly into the breast tumor.

Chemotherapy
Chemotherapy is the use of anticancer drugs to treat cancerous cells. Chemotherapy reaches all parts of the body, not just the cancer cells. Chemotherapy can be administered intravenously or by a pill and is usually a combination of drugs. Chemotherapy treatments are often given in cycles: a treatment period, followed by a recovery period, followed by another treatment period. Depending on the specific treatment plan, the drugs can be administered in a variety of settings including a patient’s home, a hospital outpatient facility, a doctor’s office, a clinic, or in a hospital.

Recent advances in chemotherapy make the treatment easier and much more tolerable than ever before. As a result, many patients are able to continue a normal lifestyle while undergoing chemotherapy treatment.

Hormone Therapy
Hormones are chemicals produced by glands, such as the ovaries. While some hormones help some types of cancer cells grow, others can kill cancer cells, make cancer cells grow more slowly, or stop them from growing. Hormone therapy as a cancer treatment may involve taking medications that interfere with the activity of the hormone or stop the production of the hormones. Hormone therapy also may involve surgically removing a gland that is producing the hormones.

The type of hormone therapy a person receives depends on many factors, such as the type and size of the tumor, the age of the patient, the presence of hormone receptors on the tumor, as well as other factors.

Sources: Greystone.net, American Cancer Society, National Cancer Institute, and National Breast Cancer Coalition

Reconstructive Surgery
In many cases, the deformity caused by a wide local excision of the tumor can be reduced dramatically with breast reconstruction techniques. Such an operation is best done at the time of the partial mastectomy or immediately after the partial mastectomy (before scar tissue distorts the defect) and before the patient receives any radiation therapy, which is usually required whenever partial mastectomy is substituted for a total mastectomy. Timing the breast reconstruction before radiation therapy is important because plastic surgical procedures on the breast are more likely to be successful if performed on tissues that have not been exposed to radiation.

There are two basic approaches to correct a deformity caused by partial mastectomy: breast remodeling and introducing additional analogous tissue. Breast remodeling involves reshaping the breast tissue remaining after the tumor removal to create a naturally-shaped breast. The plastic surgeon may use techniques similar to those used in breast reduction surgery. This approach can yield excellent results, particularly if the tumor was located in the lower half of the breast, and is usually preferred if sufficient breast tissue remains after the partial mastectomy. To achieve symmetry, breast remodeling is usually combined with a breast reduction on the opposite side. The two surgeries are performed at the same time. In addition, the plastic surgeon may use techniques similar to those used in breast augmentation surgery, where the reconstructed breast is made with the patient’s own (nonbreast) tissue or by using implants filled with saline or silicone gel. The choice regarding reconstruction is based on personal preferences and will not affect outcome.

Pain Management
Recent studies document that up to 75 percent of acute pain and more than 50 percent of cancer pain remains unrelieved. The first step in treatment is accurate assessment of the source of the pain. Our team takes a multidisciplinary approach to assessing each patient’s condition to assure access to the full range of treatment options and expertise available at UM/Sylvester. Pain can be treated with a combination of noninvasive and invasive modalities including medication, radiation therapy, nerve blocks, implantable devices, surgery, occupational and physical therapy, massage, acupuncture, and biofeedback training.

Clinical Trials
Clinical trial participation is integral to UM/Sylvester’s commitment to ground-breaking research. Clinical trials, which are research studies used to answer specific questions about new therapies or new ways of using known therapies, allow patients to participate in the newest treatments in development. 

Clinical trials activated at UM/Sylvester for breast cancer patients are in breast cancer genetics, prevention, imaging, pre-operative therapy, and new surgical techniques. These trials also look at post-surgical chemotherapy and radiation and at how to better treat advanced stages of breast cancer. Active trials use novel chemotherapies, anti-estrogen treatments, as well as novel molecular targeting drugs.

For more information about clinical trials at the Braman Family Breast Cancer Institute and UM/Sylvester’s Clinical Trials Matching Service for breast cancer patients, click here.