Local Treatment of Breast Cancer

Invasive breast cancer is treatable. Treatment can be local, systemic, or a combination of both. It is important to have regular talks with your doctor about your goals for treatment and your treatment plan.

There are 2 types of treatment:

  • Local therapy focuses on a certain It includes surgery, ablation, and radiation therapy.
  • Systemic therapy works throughout the It includes endocrine therapy, chemotherapy, and targeted therapy.

There are many treatment options. However, not everyone will respond to treatment in the same way. Some people will do better than expected. Others will do worse. Many factors play a role in how you will respond to treatment.

Surgery

Surgery is the main or primary treatment for invasive breast cancer. Systemic therapy or radiation therapy might be used before surgery to shrink the tumor or reduce the amount of cancer (called cancer burden).

  • Preoperative is treatment before. It also called neoadjuvant therapy.
  • Postoperative is treatment after. It is also called adjuvant therapy.

Surgery requires collaboration between a breast surgeon and the reconstructive (plastic) surgeon.

Lumpectomy

Lumpectomy is the removal of abnormal cells or tumor. It is also called breast-conserving therapy. In a lumpectomy, only the tumor area along with a rim of tissue will be removed. The rest of your breast is left alone. Extra tissue is removed around the tumor to create a cancer- free area. This cancer-free area is called a surgical margin. Having a surgical margin will decrease the chance that cancer may return in that area of the breast. You may have more than one surgery to ensure all of the cancer was removed.

For invasive cancers, a lumpectomy is often done with a sentinel lymph node biopsy (SLNB). A lumpectomy might be followed by radiation therapy to part of or the whole breast. A boost is extra radiation to the tumor area.

The breast might not look the same after a lumpectomy. Speak to your doctor about how a lumpectomy might affect the look and shape of your breast and what reconstruction options are available.

Mastectomy

A total mastectomy is a surgery that removes the whole breast. Chest muscle is not removed. This operation is also called a simple mastectomy. A skin-sparing mastectomy removes the breast but not all of the skin, in order to have reconstruction. Nipple-sparing mastectomy preserves the nipple-areola complex as well. Not everyone is a candidate for nipple-sparing mastectomy.

Before removing the breast, the surgeon may do a sentinel lymph node biopsy (SLNB). Sentinel lymph nodes are the first place cancer cells are likely to have spread.

Breast reconstruction is an option after a mastectomy. It might be done at the same time as mastectomy (“immediate”) or at some time following the completion of cancer treatment (“delayed”). Breast reconstruction is often done in stages.

Radiation therapy

Radiation therapy (RT) uses high-energy radiation from x-rays, gamma rays, protons, and other sources to kill cancer cells and shrink tumors. It is given over a certain period of time. Radiation therapy can be given alone or before or after surgery to treat or slow the growth of cancer. Sometimes, radiation is given with certain systemic therapies. It may be used as supportive care to help ease pain or discomfort caused by cancer.

Types of radiation therapy:

  • Whole breast radiation therapy (WBRT) is radiation of the whole breast.
  • Accelerated partial breast irradiation (APBI) is radiation to the area where the tumor was
  • Lymph node radiation therapy is radiation of the lymph nodes. It is also called regional nodal

Radiation may be given to the chest wall, infraclavicular region (below the collarbone), supraclavicular area (above the collarbone), lymph nodes found inside the breast (internal mammary), or axillary bed (armpit).

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