The purpose of surgery is to remove the original tumor so that it cannot send cancerous cells to other parts of the body. Depending on the size of the tumor or the stage of the cancer, a woman and her doctor must make several decisions regarding her treatment. The first is the amount of tissue to be removed: should it be just the tumor, the tumor and part of the surrounding breast, or the entire breast?

If the cancer is found while the tumor is quite small (3-4 cm, or 1-1.5 inches), then treatment options include lumpectomy, mastectomy with immediate breast reconstruction, delayed reconstruction, or no reconstruction.

What is a lumpectomy?

A lumpectomy is a surgical procedure in which a cancerous breast lump with a rim of normal tissue is removed. In addition to taking out the cancerous tissue, the surgeon may remove one or more lymph nodes from the armpit on the side of the affected breast.

Why are lymph nodes analyzed?

Lymph nodes are removed and biopsied to investigate whether the cancer has spread to other parts of the body. There are two methods for doing this. One, called lymph node dissection, involves removing a percentage of the lymph nodes and testing them to see whether cancer cells are found. The second technique, called sentinel lymph node biopsy, focuses on a single lymph node — the first one to receive drainage from the breast. This single lymph node is identified through a special technology. A dye is injected into the breast, and x-rays are taken to see which lymph node picks up the dye first. This node is most likely to be the first stopping site of any cancer cells as well. If the node is removed and found to be free of cancer, it is highly unlikely that the cancer has spread to other lymph nodes or anywhere outside the original tumor.

What is a mastectomy?

A mastectomy is a surgical procedure in which the breast itself is removed. In a simple mastectomy, just the breast is removed. In more radical procedures, some of the muscles underneath are taken out as well.

When is a lumpectomy a good choice?

A woman with a cancerous lump no larger than 3-4 cm who can tolerate radiation therapy has the choice of lumpectomy or mastectomy. About fifteen years ago a study called the National Surgical Adjuvant Breast Project showed that women who had lumpectomies for a single lump less than 3-4 cm in size had survival rates equal to those of women with similar tumors who had mastectomies. Since lumpectomy is less disfiguring, many women who have the option make that choice.

What follow-up treatments are recommended for women with small tumors who have either lumpectomies or mastectomies?

Women who have lumpectomies usually have follow-up radiation therapy to destroy any cancerous cells in the breast that may not have been removed along with the lump. Radiation is quite effective in preventing recurrence of the cancer: about 40 percent of women who have lumpectomies but no radiation have recurrence of the cancer within five years, but only 10 percent of women who have follow-up radiation have recurrences in the same period.

Chemotherapy is often used as a follow-up treatment after a lumpectomy or a mastectomy. The purpose of the chemotherapy is to destroy any cells that may have escaped from the breast and been disseminated into the body.

What is the treatment for inflammatory carcinoma?

Women with inflammatory carcinoma usually receive chemotherapy before surgery. After the tumor is reduced in size, most of these women undergo a mastectomy.

Are there any new ways of using chemotherapy or radiation therapies?

Ongoing studies in Italy are examining the possibility of using chemotherapy before the removal of small cancers in women’s breasts. The hope for the future is that perhaps women with such cancers will not need surgery; perhaps they can have a needle biopsy followed by chemotherapy or radiation that will destroy all the cancer cells. However, this kind of therapy is still experimental.

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