Once you have been diagnosed with breast cancer, you and your surgeon will develop a treatment plan that best suits you. Breast cancer is locally treated with surgery followed by possible chemotherapy and radiation therapy. These terms can be somewhat confusing, so this section is designed to help you understand what is available to you.
- Sentinel Lymph Node Biopsy: Lymph nodes in the armpit are referred to as the axilla. Axillary lymph node evaluation has been the standard of care in breast cancer treatment for many decades. We know that breast cancer likes to spread to these lymph nodes. A sentinel lymph node biopsy is a way to identify the first line lymph nodes along a chain of lymph nodes. These first few lymph nodes can be evaluated for microscopic spread of the cancer.
This test is indicated in nearly all breast cancers and is appropriate in both lumpectomy and mastectomy patients. The procedure starts on the day of your surgery with a visit to the nuclear medicine or radiology department where an injection of radioactive tracer called technetium sulphur colloid is performed by a physician.
At the time of surgery, after you are asleep, a vital blue dye may be injected around the tumor bed. These two traces act as a road map for your surgeon to find those first lymph nodes in the chain. When the sentinel lymph node is found, a frozen section (quick diagnosis) is performed. Once the sentinel lymph node is identified, your surgeon will feel for other lymph nodes in your armpit that may have tumor in them. Lymph nodes filled completely with cancer cells may not have the ability to pick up the radioactive tracer and blue dye, therefore this is an important part of the process.
If the frozen section reveals spread of cancer cells to the lymph nodes, additional lymph nodes may be removed at the time. If the frozen section is negative for spread of the cancer, then no further lymph node surgery is performed at that time. At your postoperative visit, you will discuss your final pathology, which will include the results of your margins of tumor resection and the final staining of the lymph nodes for tiny areas of tumor spread.
- Lumpectomy: This is a way to remove the tumor but maintain your breast. A wedge of normal tissue must be removed with the tumor to ensure that we minimize the risk of local recurrence. For large breasted women, this is an acceptable option as most of the breast can be preserved. For smaller breasted women and those with larger tumors in relation to the breast size, there may be a noticeable change in the appearance of the breast which may not be acceptable. Patients who opt for a lumpectomy will need to undergo six weeks of radiation therapy.
- Mastectomy: This is the term we use to describe the surgical removal of the breast. It is usually followed by reconstruction of some type. Surgical removal of the breast is a choice that many women still make. You may eliminate the need for postoperative radiation therapy and you will no longer need mammography of the affected breast.
- Radiation Therapy: This is a primary treatment that can kill any cancer cells that may remain in the breast after surgery. It is performed at Cape Fear Valley and usually consists of six weeks of daily short radiation treatments (Monday through Friday only). It is necessary in patients who opt for lumpectomy and may be required in patients that undergo a mastectomy when cancer is found in three or more lymph nodes or the tumor is very large or very close to the chest wall.
- Chemotherapy: This is required for patients who have tumors which are large or have spread outside the breast. Our facility has a full time oncology section which administers chemotherapy and follows along with you during your treatment.
- Reconstruction Options: Our plastic surgery department is very willing to provide all different types of reconstruction options from tissue expanders with implant reconstruction to flap reconstruction, which borrows tissue from other parts of your body to recreate a breast mound. We are committed to providing tailorized approaches to reconstruction based on our patient’s individual needs and desires.