In recent years, there's been an explosion of
life-saving treatment advances against breast cancer,
bringing new hope and energy to the cause. Instead of
only one or two options, today there's an
overwhelming list of treatment choices that
fight the complex mix of cells in each
individual cancer. The decisions - surgery, then
perhaps radiation, hormonal (anti-estrogen) therapy,
and/or chemotherapy - can feel overwhelming.
While there are several different ways
to treat breast cancer, all options can be
divided into two categories - local treatment or systemic treatment.
Local Treatment
Local treatment is directed only at the cancer cells
in the breast area and to lymph nodes around the breast.
"Regional" here refers to the lymph nodes in the region
of the body surrounding the breast - these are
also called "adjacent" lymph nodes.
In the case of metastatic disease,
local treatment may be given to
specific areas of
metastasis (places where cancer may have
spread, such as bones or lungs).
Surgery and radiation are the two
local therapies for treating breast cancer. Local
therapies only treat a specific area of the body and
they are often used in combination with systemic therapy.
A diagnosis of breast cancer is usually made on the basis
of some type of surgery (biopsy, lumpectomy). The surgery
may turn out to be only "diagnostic," which tells you and your doctor
what is actually there and what the next steps might be needed. A fine needle
aspiration and core biopsy are examples of such diagnostic surgery.
Or the initial surgery might turn out to be diagnostic AND therapeutic,
removing all of the cancer that can be detected in the breast. A
lumpectomy that removes the entire cancer is an example of this
type of therapeutic surgery. If no further surgery is required,
other local treatments may be added.
Surgery Options
The whole breast can be treated by breast preservation therapy or a mastectomy.
Breast preservation therapy removes the breast cancer
by lumpectomy (also called "wide resection," "partial mastectomy,"
or "quadrantectomy"). It is an operation in which
only the tumor and some surrounding tissue are
removed from the breast. In most cases, patients
undergo radiation treatment following their lumpectomy
to the remainder of the breast tissue.
Mastectomy is an operation in which the entire breast is removed.
Mastectomy may be followed by radiation to the area where the breast used to be.
After a mastectomy, breast reconstruction
(surgery to rebuild a breast's shape) may be considered.
Breast reconstruction may be done either at the time of the
mastectomy or at a future time.
Systemic Treatment
Systemic treatment is the use of medications that travel
in the bloodstream to affect or treat cancer cells that may have
spread to another part of the body. It's an
"insurance policy" that may be used even if there is no
direct proof that cancer has spread. If the cancer HAS
spread and formed tumors elsewhere, systemic treatment
can help shrink the cancer and, it is hoped, lead to remission.
Systemic treatments include chemotherapy, hormonal treatment,
and novel targeted therapies. They are often used in combination
with local treatment in early breast cancer. Systemic treatments
may also be used alone in more advanced stages when cancer has
spread to other parts of the body. Systemic therapy may be
used to help reduce the risk for
recurrence after local therapy is completed.
Systemic treatment decisions are made based on
"personality features" of the cancer. The "meaner" the cancer's
personality, the higher the risk of cancer spread and the greater
the need for systemic treatment. The milder the personality, the
lower the risk of spread, and the smaller the need for systemic management.
