|
While more women are faced with breast cancer today than in past decades, advances in diagnostic and surgical procedures, combined with new medications and treatments, have made the disease much more curable and easier to live with than it once was. Treatment involves a comprehensive regimen of diagnostic procedures, pharmacology, surgery, and follow-up, provided by a variety of medical specialists.
Step One: Diagnosis & Testing
All women over age 40 should have annual mammograms. When a lump is detected in
the breast, either by a patient or her doctor or via a routine mammogram, patients are referred to a surgeon and are immediately scheduled for further diagnostic procedures at MKMG’s radiology department. There patients receive comprehensive diagnostic services, which may include mammography and ultrasound.
“In order to give surgeons precise information on the location and dimensions of the mass, we perform a variety of diagnostic procedures which are used both initially and as part of regular follow-up,” said Dr. Claire Hibbard, Radiologist. “We see breast cancer patients regularly and often develop personal relationships with them. It’s nice, because many of us are on a first-name basis. As a result, patients feel more comfortable.”
After initial testing is completed, a tissue diagnosis or biopsy may be necessary to determine whether the mass is cancerous. Together, the surgeon and radiologist decide which type of biopsy is required. Depending on such factors as the size and location of the mass, the radiologist or surgeon may recommend either a fine needle biopsy, which removes a very small amount of tissue, or a core biopsy, which extracts sections or “chunks” of tissue. “Stereotactic” core biopsies are used to locate and sample tumors identified through mammography. “Wire localization” or ultrasound-guided biopsies are performed on tumors that are only visible by ultrasound. All types of ultrasound-guided biopsies can be performed right in MKMG’s radiology department. Results are available within 24-48 hours after the procedure.
Open biopsies involve surgery on the breast to extract the tissue in question and are usually performed on an outpatient basis at the hospital. They may be deemed necessary based on the location or extent of the abnormal tissue.
“Biopsies provide physicians with the definitive information needed to recommend appropriate treatment,” said Dr. Hibbard. “Once we know if a patient has cancer and what type of cancer we’re dealing with, our team of surgeons and oncologists can schedule a suitable plan of care.”
Surgery and Treatments
From the outset, breast cancer patients typically receive coordinated care from both a surgeon and oncologist. MKMG Surgeons Dr. Barry Kassel and Dr. Ihor Cehelsky recommend and perform the two chief breast cancer operations: lumpectomies, to remove small tumors but preserve the remaining breast tissue, and mastectomies, which remove the entire breast. They often work together with Oncologists Dr. Dominick Chiarieri and Dr. Jonathan Goldberg, who recommend any appropriate chemotherapy, radiation or other treatments.
“For early (stage 1 or 2) cancers, the preferred treatment is a ‘lumpectomy’ or wide excision,” said Dr. Cehelsky. “Lumpectomies can successfully remove tumors that are small in comparison to the overall size of the breast. They are usually performed in a hospital under general anesthesia, and the vast majority (over 80%) of women can return home the same day. During the surgery, we can also test the lymph nodes under the arms for traces of cancer cells, because they are the primary channels through which breast cancer can spread to other areas of the body. This procedure, called sentinel node identification and biopsy, is done by first injecting a blue dye to identify which lymph nodes would be first in the pathway of spread. If cancer cells are detected, more lymph nodes will be removed to assess full staging.”
For larger breast cancer masses, a mastectomy, or complete removal of the breast is indicated. Often women consult with Dr. Douglas Roth, Plastic & Reconstructive Surgeon, prior to the surgery to decide whether or not to perform immediate breast reconstruction. About 60-70% of women are candidates for a “skin sparing” mastectomy, which preserves skin and fatty tissue to be used in reconstruction, and produces more natural results and less scarring. Breast reconstruction performed the same day as the mastectomy gives the most natural results and eliminates the need for a separate operation.
Options for breast reconstruction are many. The least complex choice is a breast implant, comprised of a silicon envelope with saline fluid inside. In cases where there is not enough skin to accommodate a regular implant, a tissue expander or flat breast implant is inserted. Over four to six months, the expander is filled with fluid to stretch the skin gradually. It is later removed and a normal breast implant inserted as a second procedure.
For women who choose a muscle flap reconstruction, the TRAM flap gives the best results. The TRAM flap procedure uses skin, fatty tissue and muscle from the abdomen to reconstruct the breast. The end result offers the double benefit of a “tummy tuck” combined with breast reconstruction.
Depending on the reconstructive options chosen, the second stage of breast reconstruction may be done as an outpatient procedure. When the tissue expander is exchanged for the permanent breast implant, patients can return home the same day. Nipple reconstruction is performed several months later as the final step.
“We are fortunate to have such varied options and advanced technologies available for the treatment of breast cancer,” said Dr. Roth. “Surgery for breast cancer does not have to be permanently disfiguring. And the vast majority of patients are very satisfied with the results of plastic surgery breast reconstruction.”
Depending on the size of the tumor, the age of the patient, and other factors, chemo-therapy, radiation treatments, or hormonal manipulation may be indicated as a follow-up to surgery. According to Dr. Chiarieri, chemotherapy is recommended almost universally for high-risk tumors, especially in pre-menopausal women when the cancer is typically more aggressive, or in cases in which the lymph nodes are involved. If the tumor is very large, chemotherapy may also be used to shrink the mass before surgery.
“MKMG’s infusion suite is a very convenient option for these treatments,” Dr. Chiarieri said. “Robin Lapine, our registered oncology nurse, and Susan Spicer work very closely with patients to make their treatments as comfortable as possible. We also have excellent medications that can make chemotherapy more tolerable than it was even five years ago.”
MKMG specialists and radiologists are available either by referral or directly at the following phone numbers: General Surgery: 242-1360; Oncology: 242-1355; Plastic Surgery: 242-1355; Radiology: 242-1395.
| 
