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 preferences.
The four stages of breast cancer
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 breast.
What types of surgery are there?
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
Symptoms of breast cancer