Most patients will have surgery to remove cancer from the breast. Lymph nodes under the arm are usually removed at the same time. A pathologist will examine the lymph nodes under a microscope to see if they contain cancer, an indicator of how far the cancer has advanced.
Breast Conserving TherapyThis therapy involves removing the primary cancer from the breast (also called a "lumpectomy," "wide excision," "partial mastectomy," or "quadrantectomy") while leaving the rest of the breast intact.
Breast conserving therapy is usually delivered as complete removal of the cancer followed by radiation to the breast. Patients who are treated with breast-conserving surgery typically have several of the lymph nodes under the arm removed for biopsy. This is called a lymph node dissection. It may be done at the same time as the breast-conserving surgery or after. Lymph node dissection is done using a separate incision.
At the U-M Comprehensive Cancer Center, tissue samples are examined microscopically while the patient is still under anesthesia. Traditionally, patients have to wait several days for standard laboratory processing to evaluate whether surgery removed all of the cancer. If not, another surgery would be scheduled to remove more tissue or lymph nodes.
At U-M's East Ann Arbor Ambulatory Surgery Center, a laboratory next to the operating rooms allows pathologists to evaluate tissue samples immediately. Based on the lab's findings, surgeons can decide to remove additional tissue or lymph nodes during the same surgery. This approach reduces the likelihood of additional surgery, improves patient care and outcomes, and reduces the overall cost of care.
MastectomyMastectomy - removal of the entire breast - may be a better treatment option for some women.
Doctors have found that if the primary tumor cannot be completely removed, the risk of having the cancer come back in the breast is unacceptably high, even with radiation after the surgery. Thus, women with large tumors and especially small breasts usually are better treated with mastectomy, since a complete excision requires removal of most of the breast anyway.
Another reason to perform a mastectomy instead of breast conserving therapy includes finding cancer at the edge of the excised tissue. This is called a positive margin.
Multiple cancers in the same breast - either as separate cancers or evidence that the cancer is in many places - may also lead your doctor to suggest a mastectomy.
Breast reconstructionThis is surgery to rebuild the breast shape - may be considered at the time a mastectomy is done. The reconstructed breast may be made with the patient's own (non-breast) tissue or by using implants filled with saline or silicone gel.
Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given radiation therapy, chemotherapy or hormone therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.
Lymph NodesAt the time of primary breast surgery, most women have evaluation of their axillary nodes, to determine whether the cancer has spread there. This evaluation helps to determine a prognosis and to decide which direction therapy will take.
Primarily this is done through a procedure called sentinel lymph node biopsy. This involves removing the first lymph node that drains the breast, called the sentinel node, and evaluating it for cancer. If the sentinel node is cancer-free, it is unlikely that any of the other axillary lymph nodes are positive. If the sentinel node shows cancer, an axillary node dissection is performed to remove 10-15 additional nodes. This allows doctors to determine how many lymph nodes are affected.
The number of lymph nodes involved will help determine whether chemotherapy is recommended. Most women who have positive axillary lymph nodes will also receive radiation therapy to that area after surgery, while those with negative axillary lymph nodes may not.
Removing lymph nodes can lead to severe swelling, a condition called lymphedema.
The U-M Comprehensive Cancer Center offers monthly classes with physical and occupational therapists to help patients prevent or manage lymphedema.