Basic surgical treatment for breast cancer

By Dr. Olubunmi Esan - Contributing Writer

Breast cancer is a diagnosis no woman wants, but it remains the most common female cancer in the country.

The key to successfully treating cancer is to find it early and treat it while it’s still confined to the surrounding tissue.

Most women with breast cancer will have some type of surgery because it’s the treatment method needed to remove a tumor. Surgery is also used to check the lymph nodes under the arm to see if the cancer has spread.

Today’s technology and surgical techniques often allow us to conserve breast tissue rather than remove, and examine tissue in the laboratory without the need for a major surgical procedure.

For example, by using the stereotactic breast biopsy technology – which is an x-ray guided needle method to obtain a tissue sample from the affected area for microscopic examination – many patients can be spared an invasive surgical procedure.

This type of exam will show the doctor whether a mass seen on a mammogram is an abnormal tissue change, just calcium deposits or something else.

The stereotactic exam is normally done when:

• A woman has a mammogram showing a suspicious lesion that cannot be felt on examination;

• A woman has a mammogram showing a suspicious cluster of small calcium deposits;

• The structure of the breast tissue is distorted;

• A new mass or area of calcium deposits is present at a previous surgery site; and

• The patient or physician strongly prefers a non-surgical method of assessment.

If the results are benign, then the physician and patient celebrate good news. If the results show cancer cells, then the next decisions are based on what stage the cancer has reached. Staging is determined by the size of the tumor, the status of lymph nodes and how much the cancer has spread to distant sites in the body.

The biopsy will show the doctor whether the cancer is invasive or not. Invasive cancers usually require surgery as well as adjuvant (or follow-up) treatment like radiation or chemotherapy.

The options for breast surgery include mastectomy, removing the breast, or breast conserving surgery that removes just the cancerous area and a small amount of surrounding normal tissue.

Mastectomy may be necessary because of the tumor’s location, the size and shape of the breast, findings from the radiographic images taken of the breast, whether radiation may be used, or by the patient’s preference.

A simple mastectomy removes the entire breast without taking the lymph nodes, which are examined by biopsy. With a skin-sparing mastectomy, the nipple and areola are removed but the rest of the skin over the breast is preserved while an immediate reconstruction is performed.

Breast conserving therapy is the surgical removal of the tumor and surrounding normal tissue, followed by radiation therapy. This is sometimes referred to as a partial mastectomy and is the most common procedure to conserve breast tissue.

A “quadrantectomy” refers to the removal of the tumor and about one-fourth of the breast tissue on the same side. This is not a common procedure in the U.S.

Studies show that women with localized breast cancer are equally likely to survive their cancer whether they are treated with mastectomy or a conserving therapy.

More detailed information on surgical options for treating breast cancer will be discussed on Jan. 29 at the hospital’s Lunch & Learn program, which begins at noon in the One West Conference Room. I look forward to meeting you there.

Olubunmi Esan, M.D., is a general surgeon at the ARH Daniel Boone Clinic in Harlan

By Dr. Olubunmi Esan

Contributing Writer

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