Breast Cancer Treatment

Breast cancer is a condition in which malignant cancer cells grow in the breast tissues.  There are many factors that go into the risk of getting breast cancer, such as family history.  Breast cancer is sometimes caused by hereditary genetic mutations.  Certain medications and other factors can lessen the chances of getting breast cancer.  Breast cancer can be identified by checking for changes in the breast or by finding a lump in the breast. 

There are 4 different types of biopsies used to see if a woman has breast cancer. They include an excisional biopsy (when the entire cancer is removed at the time of the biopsy), an incisional biopsy (when the part of the cancer is removed in the procedure), core biopsy (when a wide needle is used to suck up some breast cancer cells), and a fine needle aspiration procedure (when the tissue or fluid is removed using a slim needle).

If a cancer has been found, tests are performed to look at the cancer cells.  The best treatment for breast cancer is determined by the results of these tests. The test provides the doctor with information about the likelihood of recurrence, how well the treatment is likely to work, how likely it is that the cancer will spread inside the body, and how fast the cancer may grow.

Prior to treatment, several tests are done, including the following:

• Progesterone and Estrogen Test. These are tests that assess the amount of progesterone and estrogen receptors on the cancer cells. If there is an increased amount of progesterone and estrogen receptors on the cancer cells, the cancer is referred to a “progesterone receptor positive” or “estrogen receptor positive”.  These types of breast cancers often grow more quickly.  The test results show whether is possible to treat the cancer with progesterone or estrogen blockers. 
• Human Epidermal Growth Factor Type 2 Receptor (HER2). This is a test that measures how many HER2 genes there are and how much of the HER2 protein is made in a sampling of the tissue.  If there are more HER2 genes or greater levels of HER2 protein than normal, the cancer is referred to as being HER2 receptor positive.  This kind of cancer also grows more quickly and is more likely to metastasize.  If there are more HER2 receptors on the cells, the patient may be treated with a medication that blocks the growth of cells containing HER2 receptors on them.

• Multigene Tests.  These are tests in which tissue samples are taken and are looked at to see what the activity of the genes are. They help predict whether or not the cancer will come back or metastasize.

Prior to surgery, the surgeon will meet with the patient prior to the lumpectomy. The patient needs to bring a list of questions to remind them of which questions they have.  The patient will learn the risks and benefits of the procedure and will be able to discuss these with the surgeon. 

The patient will be given instructions regarding their presurgical restrictions and anything else they need to know prior to surgery.  In many cases, the surgery will be performed without hospitalizing the patient.  They should be able to return home the same day. 

The patient needs to tell their doctor about any vitamins, medicines, and supplements they are taking as some of these thigs can interfere with anesthesia or other aspects of surgery.  The patient should stop taking any blood thinners (including aspirin) at least a week prior to surgery.  The patient should also contact their insurance company to see if the surgery is covered under their plan.  The patient should fast prior to the procedure (eat or drink nothing for 8-12 hours prior to surgery) and should bring someone with them to drive them home after surgery.  

If the patient has had general anesthesia, they will wake up in a recovery room with other patients who have had surgery.  The recovery room staff will monitor the patient’s vital signs, including their breathing rate, their heart rate, and their blood pressure.  They help the patient become completely awake and make sure they are stable enough to go home.  If there is pain, the staff can give the patient pain medications at this time.

The patient may feel cold after the surgery. That is considered a normal aspect of the recovery from anesthesia.  The patient should ask for an extra blanket if they are cold.  If the patient is going home after the procedure, it helps to bring a warm blanket from home to use on the ride home from the surgery. 

If the patient is just having a lumpectomy without a lymph node resection, the surgery will usually be done as an outpatient.  There will be no overnight stay.  Patients who are having a lumpectomy with lymph node resection or a mastectomy, they need to stay at least one night in the hospital, and possibly more.

If the patient is hospitalized, the goal will be to try to become dependent as soon as possible.  The patient will be ambulated as soon as possible after surgery to make sure they don’t get pneumonia or a postoperative blood clot.  Pain medications will be prescribed for postop pain.

While many women with breast cancer have surgery, some may just have radiation and chemotherapy.  Breast cancer surgery is done to relieve the symptoms in advanced cancer, bring back the shape of the breast (breast reconstruction), find out whether or not the cancer has spread to other lymph nodes, and to get rid as much of the cancer as is possible using a mastectomy or breast conserving surgery. 

After surgery, the patient may be discharged from the hospital with a surgical drain in place.  The drain is there to collect fluid from the surgery site so it doesn’t build up in the patient’s breast tissue.  The doctor will help the patient learn how to care for the drain prior to leaving the hospital.  This includes learning how to empty the drain and what to do about taking care of the drain site.

The prognosis after surgery for breast cancer depends on the stage of the breast cancer, the kind of breast cancer the patient has, the hormone receptor status, the HER2 receptor status, how fast the cancer is growing, the woman’s age, the woman’s general health, and how likely it is that the cancer will recur.