The next step in the management of early stage disease is to reduce the risk of the disease recurring and to eliminate any cancer cells that may remain. If a tumor is of a certain size or lymph nodes are involved, the doctor may recommend additional therapy, such as radiation therapy, chemotherapy, or hormonal therapy. If the cancer recurs, the patient may choose additional surgery, depending on where the cancer is found, or a variety of treatments designed to fight distant metastases.
Surgery
Generally, the smaller the tumor, the more surgical options a patient has. The general types of surgery include the following:
- Lumpectomy - A lumpectomy removes the tumor and a small "clean," or disease-free, margin of tissue around the tumor. Follow-up radiation therapy is given to the disease site.
- Partial Mastectomy - A partial mastectomy removes the tumor, an area of normal tissue, and part of the lining over the chest muscle where the tumor was. This surgery is similar to a lumpectomy. It is also called a segmental mastectomy and requires follow-up radiation.
- Modified Radical Mastectomy - A modified radical mastectomy removes the breast, some of the underarm lymph nodes, and the lining over the chest muscles.
- Total Mastectomy - A total mastectomy removes the entire breast, leaving the underarm lymph nodes intact. This surgery is also called simple mastectomy.
- Radical Mastectomy - A radical mastectomy removes the breast, chest muscles, all lymph nodes under the arm, and additional fat and skin. It used to be the standard surgical treatment for breast cancer, but is an uncommon procedure today. About 15% of women who have had radical mastectomies experience lymphedema, the buildup of fluid in the lymph system.
Women are encouraged to talk with their doctors about which surgical option is right for them. More aggressive surgery is not always better and may result in additional complications.
Choosing Between Lumpectomy and Mastectomy
One advantage of lumpectomy is that it saves the way the breast looks. A downside is the need for several weeks of radiation after surgery. But some women who have a mastectomy will still need radiation. For most women with stage I or II breast cancer, lumpectomy or partial mastectomy (along with radiation) is as good as mastectomy. There is no difference in the survival rates of women treated with these 2 methods. Other factors, though, can affect which type of surgery is best for you. And lumpectomy is not an option for all women with breast cancer. Your doctor can tell you if there are reasons why a lumpectomy is not right for you.
Possible side effects of mastectomy and lumpectomy include infection and blood or fluid collecting at the place where the incision is made. If lymph nodes are removed, there could be other side effects as well such as swelling of the arm (lymphedema).
Radiation Therapy and Chemotherapy are often used after lumpectomy or mastectomy to make sure that all the cancer cells are destroyed and do not grow back.
- Radiation therapy almost always is recommended after lumpectomy to destroy any cancer cells left behind and to prevent the cancer from returning. Without radiation therapy, the odds of the cancer returning increase by about 25 percent.
- The need for Chemotherapy depends on how much the cancer has spread. In some cases, chemotherapy will be recommended before surgery to shrink a large tumor so that it can be removed more easily. Chemotherapy is almost always necessary if cancer recurs. A form of chemotherapy called hormonal chemotherapy usually is recommended when the pathology report shows that the cancer is estrogen-receptor positive.
