Treatment Decisions

The treatment options available to you depend on a number of factors, including the type of tumor, the extent of the disease at the time of diagnosis, your age, and your medical history. However, your personal feelings about the treatment, your self image, and your lifestyle will also be important considerations in your doctor's assessment and recommendations. You and your doctor should discuss these treatment methods and how they apply to your situation.

Understanding all of your options from the beginning of your diagnosis allows you to have all of the information you need to make an informed and rational decision about your care. Treatment options include surgery, chemotherapy, radiation and hormone therapy (anti-estrogen pills). Treatment varies with specific types of breast cancer.

Making Treatment Decisions

Important decisions are always hard to make, particularly when they concern your health. However, there are a number of things you can do to make decisions about breast cancer treatment easier. One is gathering information.

  • Talk with your doctor. There are a number of treatments that may be used for breast cancer. To make sure you will be comfortable with your decision to have a particular treatment, you may want to get a second medical opinion. Obtaining a second opinion does not mean you do not trust your doctor; it means you are insuring that you are receiving the best possible care and treatment that exists. 
  • Gather additional information from published reports. Many articles and books have been written about breast cancer for patients and professionals. There is also much information about cancer in general. Others are available at local libraries and may be available through local offices of the American Cancer Society.
  • Log onto the BreastCancer.org website or other related web sites.
  • Discuss treatment options with friends and relatives. Although you and your doctor are in the best position to evaluate treatment options, it sometimes helps to discuss your feelings with others whose judgment you respect. Often, close friends and relatives can provide insight that can help your own thinking.
  • Talk with other women who have had breast cancer. Many women who have been treated for breast cancer are willing to share their experiences. Your local American Cancer Society (ACS) office may be able to direct you to such women through its Reach to Recovery program. This program, which works through volunteers who have had breast cancer, helps women meet the physical, emotional and cosmetic needs of their disease and its treatment. Some ACS offices have volunteer visitors who have had a mastectomy, breast reconstruction, radiation or chemotherapy. Sometimes they are able to meet with women before surgery. Contact your local ACS office for additional information.

Surgery

 Surgical options for breast cancer include lumpectomy (removing the tumor and surrounding rim of normal breast tissue) or mastectomy.

Lumpectomy: remove the tumor and a surrounding rim of normal breast tissue.

Mastectomy: remove the entire breast

Reconstruction: Breast reconstruction is an option after mastectomy.  Options include implants or autologous tissue flaps in which the patient’s own tissue is used to create a new breast.  Reconstruction is performed by a plastic surgeon.

Sentinel lymph node biopsy: remove the first lymph node  in the axilla (armpit) that drains the breast tissue. 

The sentinel node is identified by injecting dye into the breast before surgery.  The dye drains into the first (sentinel) node.  The sentinel node is removed and sent to pathology while the patient is in the operating room.  If cancer cells are identified in the sentinel node then more lymph nodes are removed to ensure that cancer cells are not left in the axilla.

Radiation Therapy

Radiation is given to decrease the chance of cancer recurring in the breast.  It is routinely used after a lumpectomy and may be used after a mastectomy in the tumor is large or the disease is in the lymph nodes.

Standard external beam radiation consists of daily treatments that last just a few minutes.  Treatments are given Monday through Friday for 6-7 weeks.

Accelerated external beam radiation is a shorter course of daily treatments for 3-4 weeks.

Partial breast radiation is a one week radiation course in which a catheter is inserted in the lumpectomy cavity and remains there throughout the treatment.  Twice a day for 5 days an iridium seed is inserted into the catheter for about 40 minutes, and then removed.

Chemotherapy

Chemotherapy is given to decrease the chance of breast cancer occurring somewhere else in the body.  Chemotherapy can be given before or after surgery and is typically administered via a portacath (infusaport) which is an indwelling intravenous catheter attached to a port which remains under the skin for the duration of the patients’ treatment.

Neo-adjuvant chemotherapy: given before surgery

Adjuvant chemotherapy: given after surgery

Hormone Therapy

Anti-estrogen pills are given to patients who have estrogen positive tumors both to decrease the risk of a new tumor developing and to decrease the risk of breast cancer occurring elsewhere in the body.

Pills are taken daily for 5-10 years.

Tamoxifen is typically used for premenopausal women.

Letrozole, anastrazole and exemastane are typically used for postmenopausal women.

Treatment Team

During your treatment you are likely to meet several health professionals who will perform the various tests and treatments your doctor recommends. It may be difficult at first to talk with them about your illness and your feelings about treatment, but each of them can offer information to help you feel more at ease. By talking with the professionals who care for you, you will come to understand more about cancer and its treatment and be better able to cope.

In addition to the surgical and medical treatment of your cancer, you may also want to consider integrating holistic therapies into your treatment plan to enhance and promote your healing process. 

These are some of the specialists you may meet and hear about:

Anesthesiologist – A doctor who administers drugs or gases to put you to sleep before surgery.

Clinical nurse specialist – A nurse with special knowledge in a particular area, such as postoperative care orradiation therapy.

Medical oncologist – The doctor who administers anti-cancer drugs or chemotherapy.

Pathologist – Doctor who examines tissue removed by biopsy to see if it is cancerous.

Personal physician – Your doctor, who will be responsible for coordinating your treatment and working with you to ensure that treatment is satisfactory. Your personal physician may be a surgeon, radiation oncologist, medical oncologist or family physician.

Physical therapist – A specialist who helps in rehabilitation after surgery by using exercise, heat, light, and massage.

Plastic surgeon – Doctor who specializes in reconstructive and cosmetic surgery. Plastic surgeons perform breast reconstruction.

Radiation oncologist – Doctor who supervises radiation therapy.

Radiation therapy technologist – A specially trained technician who helps the radiation oncologist give external radiation treatments.

Surgeon – A doctor who performs surgery, such as biopsies,mastectomies and axillary node dissections.