Until relatively recently, a mastectomy was a standard
procedure for women diagnosed with breast cancer. Today, fortunately, there are
also other options available.
The treatment that is decided on depends on the stage of the
breast cancer, the type of cancer, the patient’s age, and the patient’s
The four stages of
Stage 1 – the
breast tumour is small and hasn’t spread
Stage 2 – the
tumour is smaller than 5cm and may have spread to the lymph nodes
Stage 3 – the
primary tumour is larger than 5cm and has usually spread to the lymph nodes
Stage 4 – The
cancer has spread to other organs, such as the lungs, the liver and the bone
There are two types of treatment: the one is aimed at
removing and killing the cancer cells in the breast and the lymph nodes. The
other is a systemic treatment, in which the whole body is targeted. This is
usually in the form of hormonal therapy or chemotherapy.
Stage 1 disease is treated
locally (usually surgery) and sometimes also hormonally. Stage 2 disease is
treated with surgery first, followed by systemic treatment. Treatment for stage
3 disease is mostly treated systemically first and then with surgery. Stage 4
disease is usually treated systemically. Radiation may be used to treat spread
to the bones.
What is radiation therapy?
Radiation therapy uses high-energy rays to reduce the size of the tumour or
destroy cancer remaining in the breast area after surgery. It may also be used
to treat localized areas of spread, such as bone involvement.
What is chemotherapy?
Chemotherapy is a systemic therapy, which is given via the bloodstream, or
taken orally. This treatment is used to kill off cancer cells that have spread
beyond the breast.
Hormone therapy involves
drugs that change the way hormones work. Sometimes it also involves removing
hormone-producing organs, such as the ovaries. Many women undergo systemic
therapy after surgery, as it appears to reduce the chances of the cancer
recurring and may decrease the chance of developing breast cancer in the other
What types of surgery are
Three issues need to be considered when deciding on breast surgery: the
treatment of the breast itself, the treatment of the lymph nodes and the
question of reconstruction.
Radical mastectomy means
the removal of all breast tissue and entails the removal of the breast,
underarm lymph nodes and the chest muscles under the breast. This is rarely
done these days, because of the disfigurement, and because modified radical
mastectomy has proved equally effective.
Modified radical mastectomy
involves the removal of the breast tissue, the fascia on top of the muscle and
the lymph nodes. The advantages of this procedure are that it is less
disfiguring, and can also be done through a small incision keeping the skin,
and this allows for immediate reconstruction.
Breast conservation therapy
(BCT) can be performed if the tumour is less than 5 cm in size. When used with
the correct patients, modified radical mastectomy and BCT are equally effective
as long as radiotherapy is given after the surgery.
The lymph nodes must be
dealt with at the same time. All the underarm lymph nodes may be removed or a
sentinel node biopsy may be performed to see how far the cancer has spread.
Depending on the results, more lymph nodes may be removed.
Preventing breast cancer
Risk factors for breast cancer
Diagnosing breast cancer