Treatment of Breast Cancer
only the area of the breast immediately surrounding the cancer is removed,
possibly along with axillary (armpit) lymph nodes.
- Segmental mastectomy: involves
the removal of a larger area of breast tissue, possibly with some of the deep
fascia of the pectoralis major and the axillary lymph nodes.
- Total mastectomy: involves
removal of the whole affected breast, as well as the axillary lymph nodes.
- Modified radical mastectomy:
goes further to remove the affected breast, most of the axillary lymph nodes,
and the deep fascia of the pectoralis major, and possibly also the pectoralis
- Radical (Halsted) mastectomy:
the breast, chest muscles, all the axillary lymph nodes, and additional fat
and skin are removed. This operation has fallen out of favor as it is too
severe a treatment in all except the most severe cases of spread to the chest
- What happens after surgery?
Surgery results in significant short-term pain and tenderness, along with a
risk of infection, bleeding, or reaction to anesthesia. Other complications
with breast removal include shifting of weight resulting in neck and back
discomfort, tightening of skin and muscle stiffness or loss of strength in the
affected area. Any operative nerve injuries have complications, including
numbness or tingling. Removing the lymph nodes can slow flow of lymph
resulting in edema (swelling) and an increased risk of infection locally.
Finally, the emotional repercussions of losing a breast, as well as dealing
with cancer, can be quite significant and should be addressed by the
physician. Reconstruction of
a breast that has been operated on is an option
available to women and should also be addressed.
- How does it work? For breast
cancer, usually a combination of drugs, administered orally or injected, is
preferred. Treatment is administered in cycles with recovery periods in
between. Although the therapy is given on an outpatient basis, recovery may
require hospital stays.
- Side effects include damage to
rapidly dividing normal cells, including blood-making cells (resulting in
bleeding, clots, and infections, and decreased energy), hair follicles, and
the lining of the digestive tract. As a result, hair loss, nausea, vomiting,
and mouth sores can result. Fortunately, improvements in anti-vomiting drugs
can reduce these side effects.
- Long-term side effects are not
as common, but may include second cancers and loss of fertility. Menstruation
may cease during treatment, and birth control during chemotherapy must be
discussed with a doctor due to the risk to the fetus. In women above the age
of 35-40, infertility may be permanent after chemotherapy.
- How does it work? Radiation
therapy can be administered externally with a particle accelerator or
internally with a radiative implant. Some women receive both.
- External therapy usually follows
surgery and is given 5 times a week for 5-6 weeks, with a higher dose at the
end, administered externally or internally.
- Internal radiation requires a
short hospital stay.
- Do you use radiation with chemo? Radiation can also be used alone or with chemotherapy or hormone
therapy to attack tumor cells before surgery or if surgery is difficult due to
tumor size or other factors.
- Side effects include fatigue,
but patients are encouraged to remain active. Skin in the treated area can
become red, dry, itchy, and "weepy;" air exposure is encouraged to help
healing of the skin. In addition, wearing loose cotton clothing is recommended
to reduce irritation. Permanent changes in skin color may result. It is also
possible that the breast will change in appearance, firmness, or size after
- Does this affect my whole body? Yes, This is a systemic treatment, and will include drugs that change
hormone levels and may also include removal of the ovaries with resulting
infertility. It may be administered with other treatment forms.
- How does tamoxifen work? The
most common form of hormonal therapy is tamoxifen, which blocks the body's use
- Side effects may include hot
flashes, vaginal discharge, and irregular periods. Unusual bleeding must be
reported to a physician. Younger women have an increased chance of becoming
pregnant and should discuss birth control with their physician. Clots in the
body's veins are also possible, as well as cancer of the lining of the uterus.
Thus, regular pelvic exams are required. If the ovaries are removed, the
result is infertility and immediate menopause, which is more severe than
http://rex.nci.nih.gov/PATIENTS/aboutbc/ubc_treatment.html&emdash;Booklet put out by the National Institutes of Health.
Contains information about breast cancer treatment, including breast reconstruction.