Procedures to treat breast cancer

If you're among the 21,000-plus Canadian women diagnosed with breast cancer this year, you have a good chance of beating this disease. The tough part may be sorting through all the options now available. These guidelines will walk you through the process.

The first step in breast cancer treatment is a biopsy to determine the kind of tumour and whether it contains hormone receptors. The next step for most women is to have the cancer excised. This is your best shot at a cure. At this time, discuss different possibilities for reconstruction with a plastic surgeon.

For tumour removal, there are also a number of options:

If your tumour is stage I or II, your surgeon should be able to remove the cancer completely. Procedures called a lumpectomy or a partial mastectomy are used. You'll then need six or seven weeks of radiation to destroy any leftover cancer cells. Thousands of women now choose one of these breast-conserving approaches. The latest major research trials indicate your chance for long-term survival is the same with a lumpectomy as with radical or even a partial mastectomy.

If your tumour is stage III or at an early stage but you have small breasts, you may be better off having a mastectomy. There are several variations. Most women have an operation called a modified radical mastectomy, which removes breast tissue, chest muscle lining and axillary nodes.

Only if the cancer has spread to muscles in the chest will a surgeon recommend a radical mastectomy, in which the breast, nodes and muscles beneath the breast are removed. Sometimes pre-surgery chemotherapy shrinks a tumour sufficiently to make lumpectomy a possibility.

Finally, a total mastectomy is a treatment option for DCIS (ductal carcinoma in situ). After surgery, many women pursue radiation therapy to destroy any wayward cancer cells in the breast, chest wall or under­arm area. (Sometimes radiation is also recommended before surgery to shrink a tumour.)

Radiation can be key to surviving breast cancer and is often worth the discomfort of its possible side effects, which may include fatigue, blistered skin and skin colour changes. Technical innovations in radiation have reduced the risk that such side effects will occur.

With standard, widely recommended external beam radiation, a technician focuses two opposing beams of high-energy X-rays on the breast, angling them away from vital organs. The procedure is done five days a week, for about five weeks. Additional, even more focussed, radiation may be given for another one to two weeks.

If you've had a lumpectomy for a small, early tumour, and are post-menopausal, you may be a candidate for internal radiation therapy, or brachy­therapy. In this procedure, radioactive "seeds" are implanted directly into the site of the excised tumour. You only need twice a day treatments for four or five days, and side effects appear to be mild. Much about this new technique remains unknown, but early results indicate that for some women brachytherapy is as effective as standard radiation at preventing the recurrence of breast cancer.

The latest findings also show that combining radiation with breast-conserving surgery for stage I or II breast cancer offers the same odds for long-term survival as a mastectomy. But without the post-surgery radiation, the risk of a recurrence at or near the original tumour site is much higher. For this reason, if you're slated for a mastectomy, your doctor will likely recommend radiation therapy, particularly if your tumour is large or many lymph nodes (usually four or more) are involved. Not so clear is whether radiation will benefit you if fewer (one to three) lymph nodes are involved.