Understanding and knowing more about breast cancer will assist you in choosing the best choices for your surgeon, type of breast surgery and your treatment plan. The outlook for treatment today is hopeful since there are more advanced and better treatment options available.
Our expert breast surgeons in our practice in Connecticut are eminently qualified to assist you in making the right decisions and care for you in a compassionate and comprehensive way.
Cancer cells are different from normal cells. They can divide and spread uncontrollably. Within time, some of these cells can spread beyond the breast to other areas of the body.
The two main types of breast cancer are:
- Ductal carcinoma starts in the ducts (tubes) that move milk from the breast to the nipple.
- Lobular carcinoma starts in the parts of the breasts that produce milk (lobules).
Rarely will cancer develop in other areas of the breast.
Men can develop breast cancer with symptoms that include a breast lump, breast pain, and tenderness.
Breast cancer can be invasive or noninvasive:
- Noninvasive – Early breast cancer (in situ) is restricted to the ducts located within the breasts. If left untreated it may become invasive.
- Invasive – Invasive breast cancer occurs when cancer cells spread beyond the ducts or lobules in the breasts. The cells will first spread to nearby breast tissue.
- Over a period of time cancer cells may metastasize (travel) to other parts of the body if they move in the lymph nodes or bloodstream
Early Breast Cancer
Symptoms are not always present when early breast cancer develops. Breast exams are very important for early detection of the disease. As cancer develops and the symptoms do begin to appear, they can include:
- A palpable breast lump which may have uneven edges is hard and generally does not hurt.
- Change in the shape, size or feel of the breast or nipple. Patients may experience redness, dimpling or puckering.
- Discharge coming from the nipple that may appear bloody, green, clear to yellow and may look like pus.
Advanced Breast Cancer
Symptoms of advanced breast cancer can include:
- Breast pain or discomfort
- Bone pain
- Skin ulcers over the breast
- Swelling of the arm (underarm) near the breast with cancer
- Weight loss
Although less common, men can develop breast cancer with symptoms that may include a breast lump, breast pain, and tenderness.
Should you notice a change or lump in your breast, it should be examined without delay. A physical exam and diagnostic tests will be performed to determine the cause.
History and Physical Examination
We will ask you for a complete medical history that will include questions regarding the time you discovered the lump and if there were any changes to the lump, questions concerning your period, pregnancies, prior breast problems, if any, and if you’re using birth control pills or HRT. Our surgeon will perform a clinical breast exam, using gentle pressure to feel your breast tissue for lumps and other changes as well as a comprehensive evaluation and physical to check your overall health.
Diagnostic tests will provide additional information about the change in your breasts. You may have one or more of the following tests.
This is an x-ray of your breasts using a low dose of radiation. Mammograms are also regularly used to check women who have no problems. It is a screening process that should be used on a regularly scheduled basis. Women age 40 usually go annually, and sooner if there is a family history of breast cancer
- Breast Ultrasound
Painless sound waves are used to produce a picture of the breast. This helps determine if a lump is solid or filled with fluid.
Magnetic resonance imaging magnetic resonance imaging (MRI) is a noninvasive medical test that uses a powerful magnetic field, radio frequency pulses and a computer to produce detailed pictures of organs, soft tissues, bone and all other internal body structures. The images are then examined on a computer monitor, transmitted electronically printed or copied to a CD. An MRI of the breast offers valuable information about many breast conditions that cannot be obtained by other imaging modalities like mammography or ultrasound.
Following the examination and diagnostic tests, a biopsy may be recommended. The biopsy procedure removes a sample of tissue from the breast lump. The cells in this tissue are studied for the presence of cancer. The type of biopsy you may have is contingent upon the size and location of the lump.
Needles or special probes are used to remove samples through the skin. This is usually performed in our office or in an outpatient setting. If on examination the lump is not palpable an image-guided biopsy is performed.
Fine Needle Aspiration
This is the simplest form of biopsy requiring no anesthesia and is used to sample cells of lumps that can be felt. They can be fluid-filled cysts or solid masses.
- BEFORE – Our surgeon will discuss the risks of the procedure prior to performing it in our office. This is considered a minor procedure and you may have a little bleeding, pain or bruising in the area where the needle is inserted. solid.
- DURING – This procedure is performed in a few minutes. A very thin needle is placed in the lump and fluid is sampled or cells are removed if the lump is
- AFTER – If any pain or bruising occurs, it will disappear quickly, leaving you without a scar. Results will be available a few days after the biopsy.
Core Needle Biopsy
A core needle biopsy will provide a larger sample than a fine needle biopsy. This can be used for solid masses that can be felt as well as breast changes that can’t be felt. All biopsy samples are sent to a lab for study.
- BEFORE – Our surgeon will discuss the procedure with you and tell you what you can expect to happen before, during and after the biopsy. You can anticipate some swelling and possible bruising as well as a slight chance of an infection in the area where the needle was inserted. You will have to tell us what prescription and over the counter medications you are taking as well as any vitamins and herbal supplements.
- DURING – A local anesthesia will be administered so that you will be pain-free, but alert. A hollow needle is used to remove a section of the mass or breast change. More than one biopsy sample may be taken requiring the needle to be inserted several times.
- AFTER – Within a short time after the biopsy you will be able to go home. Stitches are normally not necessary and you will probably require a small bandage. There is a possibility of a small scar appearing that looks like a freckle forming at the site where the biopsy was performed.
An image-guided biopsy is performed if a lump or breast change is unable to be felt. This procedure is performed in the Radiology Department of the hospital. Computer mapping guided by mammograms is used to pinpoint the breast changes. Ultrasounds can also be used to locate breast changes. A core needle is used to take tissue samples once the change is located. A vacuum-assisted probe may sometimes be used. This procedure is similar to a core needle biopsy but the probe is only inserted once.
Sentinel Lymph Node Biopsy
This procedure is performed to see if the breast cancer has spread to the lymph nodes. The first node that the fluid passes through in a group of lymph nodes is called the sentinel lymph node. The sentinel nodes are the first lymph nodes to which the cancer cells in the breast tumor are most likely to spread. Lymph node tissue is removed to search for the presence of cancer. If cancer is found in the sentinel lymph node at the time the biopsy procedure is being performed, additional surgery will be required to remove additional lymph nodes. A dye or tracer is injected in the area with the breast tumor. A camera (lymphoscintigraphy) is used to take pictures of the lymph nodes. The first lymph node or nodes that will absorb the dye or tracer are called the sentinel nodes. Once found, the sentinel node(s) are removed to look for the presence of cancer cells.
When to Call the Doctor
We ask that you call us in the event the following should occur following any of the procedures:
- A fever over 101 degrees
- Severe pain
- Bloody drainage lasting for several days
- BEFORE – We must know what prescription and over the counter medications, vitamins and herbal supplements you are taking. Some medications may adversely affect the body’s response during surgery and healing after surgery. You will need to make arrangements for someone to take you home.
- DURING – This procedure is performed at the hospital. Intravenous sedation is given to produce a light sleep or”twilight state” and prevent you from feeling pain. An incision is then made in the breast, and whenever possible, in a way to hide the scar. Then, in most cases, the lump is completely removed and the incision is closed with stitches. Some stitches will have a tendency to dissolve on their own, while others will need to be removed at a later date.
- AFTER – You will be able to go home the day of the biopsy. You can expect not to be too uncomfortable, but pain medication will be prescribed if the need to take it arises. Ice packs will be used to help decrease the soreness and swelling. We will advise when to remove the dressing and when to bathe and exercise.
- RISKS AND COMPLICATIONS – The possible risks that can occur with a surgical biopsy include:
- Excessive bleeding or bruising
- Difficult wound healing
- Problems resulting from the general anesthesia
- A slight change in the contour of the breast
- Swelling due to the accumulation of fluid
A larger sample of tissue can be removed with a surgical breast biopsy. Most often, the entire lump will be removed. Should the breast change be a result of tiny deposits of calcium (microcalcifications), then tissue containing the calcifications will be removed. Most surgical biopsies are done on an outpatient basis.
It is difficult to locate a breast change that cannot be felt. In such a situation one or more guidewires might be placed in the breasts prior to the biopsy procedure. These are thin wires that are used to mark the tissue that has to be removed. A mammogram or ultrasound is used to direct the placement of the wires. Before the wire is inserted, the area is numbed. During the biopsy procedure, the wire is removed.
When to Call the Doctor
We ask that you call us in the event the following should occur:
- A fever over 101 degrees
- Pus draining from the incision site
- Pain increasing at the incision site
- Increasing warmth or redness at the incision site
- Severe swelling or bloody drainage that lasts for several days
- Coughing, chest pains or shortness of breath
- Bleeding that soaks through the dressing
The Treatment of Breast Cancer
Breast cancer can be treated in several ways. Factors affecting the decision-making process include the extent of cancer and your feelings as well as your needs. Some of the factors determining the treatment include:
- Type and stage of the cancer
- Whether the cancer cells have a sensitivity to certain hormones
- Whether the cancer cells overproduce a gene called HER2/neu
Cancer treatment can be either local (only the area of the disease) or systemic (the entire body). Examples of local treatments are surgery and radiation. Chemotherapy is a form of systemic treatment.
- Surgery – Used to remove cancer. Surgical options include only removing the lump (lumpectomy) or removing the breast (mastectomy – partial or complete).
- Chemotherapy – Medications are used to destroy cancer cells. These drugs travel through the bloodstream and move throughout the body. Chemotherapy may be given before surgery, after surgery or on its own without surgery.
- Radiation Therapy – X-rays are focused on the breast and possibly the lymph nodes and used to destroy cancerous cells. This type of therapy is almost always used after a lumpectomy is performed since it helps to destroy cancer cells that might remain after the surgery.
- Hormonal Therapy – A method used to fight cancers that respond to the female hormones estrogen and progesterone. Hormonal therapy can be taken in pill form for approximately five years and may help prevent cancer from returning.Tamoxifen is the drug taken to block the effect of estrogen which helps cancer cells grow and survive. Most women will benefit from this drug when they have estrogen-sensitive breast cancer.Aromatase inhibitors are another class of hormonal therapy medication. Medicines like Aromasin have been known to work as well or better than Tamoxifen when taken by postmenopausal women with breast cancer. These inhibitors block estrogen from being made.
- Targeted Therapy – A newer form of cancer treatment that is also referred to as biologic therapy. Special anticancer drugs are used to target changes in a cell that can lead to cancer. Trastuzumab is a drug in that category and it may be used for women with HER2-positive breast cancer.
Treating Different Stages of Breast Cancer
Most women will receive a combination of treatments.
- STAGE 0 and DCIS – The standard treatment consists of a lumpectomy with radiation or a mastectomy. There is controversy over how to treat DCIS.
- STAGE 1 and 2 – The goal is to treat cancer and prevent it from returning. Standard treatment includes a lumpectomy plus radiation or a mastectomy with some kind of lymph node removal. Following surgery hormone therapy, chemotherapy and/or biologic therapy may also be recommended.
- STAGE 3 – The goal is to treat cancer and prevent it from returning. Treatment includes surgery possibly followed with chemotherapy, hormone therapy, and biologic therapy.
- STAGE 4 – The goal is to improve the symptoms and help the patient live longer. Treatment may include surgery, chemotherapy, radiation, hormonal therapy or a combination of all four.
Some women will continue to have treatment after the initial plan is completed. Blood tests, mammograms and other tests are standard means of continued future treatment and follow up.
Reconstructive breast surgery for women who have mastectomies can be performed at the same time as the mastectomy or at a later date. In many cases, the restorative procedure is covered by insurance.
Breast Cancer It can be extremely overwhelming to learn that you have breast cancer. Other women can be a tremendous source of support and information when you share common experiences and problems. Joining a support group for women with breast cancer can help ease the situation and help you cope. The following organizations can help you learn more about the disease:
- American Cancer Society: 800-227-2345, www.cancer.org
- National Cancer Institute: 800-422-6237, cis.nci.nih.gov
- National Women’s Health Information Center: 800-994-9662, www.4woman.org
People with breast cancer are living longer than before with the advent of new and improved treatments. How well you do after treatment is contingent upon several factors. Our team will review the factors of your case and discuss the potential risk of possible recurrence with you.