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Treatment and SurvivorshipThe treatment of breast cancer in most patients involves several different therapies. The physicians of The Hoffberger Breast Center work closely with patients to offer treatment options best suited for their situation. The sequencing of the different treatment methods is also individualized. The treatment modalities available for consideration are:
More information on breast cancer treatments Information on breast cancer survivorship Surgical TreatmentSurgery is usually the first step of treatment for an early stage (Stage 1 and 2) breast cancer. Sometimes surgery is performed after chemotherapy or hormonal therapy is given to shrink the tumor (neoadjuvant treatment). Surgery removes the primary tumor and helps accurately stage the disease. Lumpectomy or Mastectomy All patients are not candidates for breast conserving surgery. If the cancer is too big, is located in the center of the breast, is large relative to the size of the breast, or is located in multiple different areas of the breast, the only option is a mastectomy – removal of the entire breast. The one benefit of a mastectomy is that most patients with early stage breast cancer do not require radiation. However with larger tumors, or if multiple lymph nodes are involved, patients need radiation treatment in addition to the mastectomy to reduce the risk of local recurrence. It is important to understand that there is no difference in survival with a mastectomy or lumpectomy. That is the reason patients are frequently given the choice, and they can decide which option suits them best. As noted above, there are instances where mastectomy is the only option. Sentinel Lymph Node Biopsy In the past, if any lymph node had cancer, a complete lymph node dissection was performed. However, a recent study has shown that in some instances, if a patient undergoes breast conserving surgery and is to receive radiation to the whole breast, if there is tumor in only 1 or 2 lymph nodes, it may not be necessary to perform a complete axillary lymph node dissection. This is a very complex individualized decision. It is frequently made after discussion with all the treating physicians. The physicians of The Hoffberger Breast Center attempt to minimize surgery in the axilla. The more lymph nodes that are removed from the axilla, the greater the likelihood of complications. Immediate complications include pain, cording and limitation of arm mobility. There is also the lifelong risk of lymphedema, which is swelling of the arm because of a backup of lymph fluid within it. Mercy's physicians and therapists of The Center for Restorative Therapies work closely with patients to treat and minimize the effects of lymphedema. More information on sentinel lymph node biopsy
Reconstructive SurgeryIf a woman has to have a mastectomy, she can consider wearing a breast prosthesis in her bra, undergoing breast reconstruction surgery or neither one. Breast reconstruction can be done at the same time as mastectomy or later on. There are many ways to reconstruct the breast including surgical implants as well as autologous breast reconstruction, in which fatty tissue is taken from another part of the body to reconstruct the breast. Mercy’s breast surgeons work in tandem with the renowned surgeons of The Center for Advanced Breast Restoration at Mercy to offer patients cutting-edge treatment to achieve the most natural results in breast reconstruction, breast restoration and breast revisions. Whether patients want to have their reconstructive surgery immediately after the removal of a cancerous breast, or a delayed breast reconstruction, which is performed separately from breast cancer surgery, patients can choose the option best for them.
Post-Surgical Treatment of LymphedemaLymphedema, the swelling of the arm due to a backup of lymph fluid, can often occur following breast cancer surgery. The clinical team of The Hoffberger Breast Center, along with the therapists of The Center for Restorative Therapies, work in concert to minimize post-surgical complications including pain, cording and limitation of arm mobility. Mercy's team takes a proactive approach to lymphedema with its early intervention program. With a focus on maintaining or improving a patient's quality of life, the early intervention program is based on national standards set forth by the National Lymphedema Network. Treatment begins before surgery with patient education and the acquisition of baseline measurements as a reference point for post-surgical mobility. Following surgery, an individualized treatment plan is put into place for patients. For those patients who have more severe, chronic cases of lymphedema, The Center for Restorative Therapies offers an intensive treatment program, including specialized massage techniques, compression bandaging, lymphatic exercise and comprehensive self-care education.
ChemotherapyChemotherapy can be used to kill or immobilize cancer cells. It can be used to treat all stages of breast cancer. The decision to treat with chemotherapy is usually affected by the patient's age, overall condition and personal preference. The type and stage of the breast cancer also affects this decision. For example, patients who have hormone negative receptor tumors would be more likely to benefit from chemotherapy. Chemotherapy is usually given before radiation, however, it can be administered before surgery (neoadjuvant) or after surgery (adjuvant). Mercy’s breast surgeons collaborate closely with the physicians of Medical Onoclogy & Hematology at Mercy to decide who is the best candidate for adjuvant versus neoadjuvant chemotherapy. This decision is often influenced by the size of the patient's tumor, the size of the patient's breast and the desire for breast conservation treatment. Chemotherapy can also be used to treat widespread or metastatic breast cancer. The treatment is usually not curative, but can prolong survival for some patients. Chemotherapy can be used in combination with targeted therapy or before hormonal therapy. There are tests available, such as Oncotype Dx and Adjuvant Online that can sometimes be used to define the patient's risk of relapse. These tests can be discussed with your medical oncologist and can help determine the type and sequence of treatments for each patient. For more information on chemotherapy:
Hormonal TherapySome breast cancers express female hormones, called estrogen and progesterone. These hormones attach to hormone receptors on the surface of the breast cancer and cause the cancer to grow. The pathologists assess all breast tumors for the expression of these receptors. The tumors are then classified into "hormone positive" or "hormone negative." Hormone positive breast tumors can be treated with drugs, such as Tamoxifen or aromatase inhibitors (eg. Anastrozole). Tamoxifen works by attaching to the hormone receptor and preventing the estrogen hormone from attaching to it. The aromatase inhibitors lower the levels of estrogen in the body, so that the estrogen is not readily available to the cancer cell. Tamoxifen and the aromatase inhibitors can be used to treat early, locally advanced or metastatic (widely spread) breast cancer. Your medical oncologist can review the risk and benefits of these medications with you if your tumor is hormone positive.
Targeted TherapiesAbout 20-30% of breast cancers overexpress a growth factor receptor, called HER2/neu. The pathologists assess all breast tumors for expression of this receptor by two methods, immunohistochemistry (IHC) or fluorescence in situ hybridization (FISH). A monoclonal antibody that targets the HER2/neu receptor, called Transtuzumab (Herceptin) is now available to treat these tumors. Your medical oncologist can review the risks and benefits of this drug with you. For additional information:
Radiation TherapyRadiation is used to remove and reduce the growth of cancer cells. Radiation treatment is either used alone or in combination with surgery and/or chemotherapy for cancer treatment. Undergoing radiation is non-invasive, painless and typically lasts less than 30 minutes. Patients who undergo radiation must be able to sit very still during the treatment session. Depending on the type of treatment necessary, your radiation oncologist may decide to use masks and immobilization devices designed to keep you in a single position. It is vital to remain still during a treatment session as it increases the accuracy of the radiation treatment. Radiation Oncology at Mercy offers a full array of radiation services in order to give you a treatment plan unique to your diagnosis. Below are some of the radiation services that are offered to patients of The Hoffberger Breast Center. External Beam Radiotherapy Intensity Modulated Radiation Therapy (IMRT) High Dose Rate Brachytherapy For more information:
Clinical TrialsAlthough the majority of breast cancers can be cured by conventional treatment, there are some patients who experience recurrence of their disease. Clinical trials are offered to determine if we can improve on our current treatment standards to further improve our cure rates or to help further prolong survival in patients who have widespread disease. Through The Prevention & Research Center at Mercy, there are a variety of clinical trials available at Mercy for hormone receptor positive and hormone receptor negative breast cancers at various stages.
SurvivorshipFollowing treatment many women continue to struggle with lingering symptoms including fatigue, weight gain, sleep and cognitive changes, and anxiety and depression. The Prevention & Research Center at Mercy provides several programs to help breast cancer survivors get back on track with overall health and wellbeing.
In addition to the above programs, the physicians and staff of The Breast Center can put you in touch with other support groups and programs. Additional Support Resources
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