What Stage Breast Cancer Requires Mastectomy

How Long After Cancer Diagnosis Does Treatment Start

In general, most breast cancer treatments should start soon after a diagnosis. What does soon mean? This depends on the type of cancer, how aggressive it is, if additional testing is needed and if you plan to seek a second opinion.

A few days or a week may go by without treatment as your doctors put a plan in place. If this occurs, you may feel antsy and wonder if those lost days will cause your cancer to spread. Most cancers grow slowly, though, so waiting a short amount of time wont typically alter the outcome.

Inflammatory Breast Cancer Treatment

Inflammatory breast cancer is an uncommon and aggressive type of breast cancer caused by cancer cells blocking lymph vessels in the skin.

All IBC cases are classified as at least stage 3 breast cancer. If the cancer is metastatic , its considered stage 4.

Treatments for IBC depend on what stage the cancer is in.

Radiation Therapy And Mastectomy

Most women who have a mastectomy dont need radiation therapy if theres no cancer in the lymph nodes.

In some cases, radiation therapy is used after mastectomy to treat the chest wall, the axillary lymph nodes and/or the lymph nodes around the collarbone.

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Mastectomy Versus Lumpectomy: 3 Questions To Ask Your Doctor

Women whove been recently diagnosed with breast cancer are almostimmediately faced with treatment choices. The most common options areto remove the cancerous tissue in part of the breast or toremove the entire breast .

Over the past decade, women with early-stage breast cancer areincreasingly opting for mastectomy or double mastectomy removal ofboth breasts in hopes that they will reduce the risk of recurrence.

The increased availability of advanced breast reconstruction techniquesand the federal law requiring that reconstruction be covered byinsurance have contributed to the trend, saysLisa Jacobs, a surgical oncologist with theJohns Hopkins Breast Center.

The topic also garnered national attention in 2013 after actressAngelina Joliesnational announcementabout her decision to have a prophylactic double mastectomy.

If youre weighing your treatment options, here are a few things to askyour doctor:

Intensity Modulated Radiation Therapy

Intensity modulated radiation therapy, or IMRT, is a specialized form of 3D-CRT that allows radiation to be more exactly shaped to fit the tumor. With IMRT, the radiation beam can be broken up into many âbeamlets,â and the intensity of each beamlet can be adjusted individually. Using IMRT, it may be possible to further limit the amount of radiation that is received by healthy tissue near the tumor. In some situations, this may also allow a higher dose of radiation to be delivered to the tumor, potentially increasing the chance of a cure.

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Checking The Lymph Nodes

The usual treatment is surgery to remove the cancer. Before your surgery you have an ultrasound scan to check the lymph nodes in the armpit close to the breast. This is to see if they contain cancer cells. If breast cancer spreads, it usually first spreads to the lymph nodes close to the breast.

Depending on the results of your scan you might have:

• a sentinel lymph node biopsy during your breast cancer operation
• surgery to remove your lymph nodes

You may have other treatments after surgery.

What Are The Different Mastectomy Procedure Types

There are many types of mastectomy. Your surgeon will recommend the type that is best for your specific diagnosis. The main difference between the types is how much tissue your surgeon removes.

Total mastectomy

In this procedure, the surgeon removes your entire breast. But the chest muscle underneath your breast remains.

Skin- or nipple-sparing mastectomy

The skin- or nipple-sparing procedure is a variation of the total mastectomy and is normally performed to allow the surgeon to perform breast reconstruction. The surgery removes the same amount of breast tissue. The difference is that the surgeon leaves the breast skin and sometimes the nipple . Saving the skin and nipple makes breast reconstruction look more natural.

Modified radical mastectomy

A modified radical mastectomy removes the entire breast and the underarm lymph nodes. The chest muscles are left intact.

Radical mastectomy

A radical mastectomy is the most comprehensive surgery. Its reserved for cases where breast cancer has spread to the underlying muscles. Your surgeon will remove the entire breast, underarm lymph nodes and chest wall muscles during this operation. This type of surgery is rarely performed today.

Double mastectomy

A double mastectomy removes both breasts at the same time. You may have this procedure to treat or prevent cancer. A double mastectomy is usually the same as a total mastectomy. The only difference is that it affects both of your breasts.

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How Effective Is Radiation Therapy

If early-stage breast cancer hasnt spread, radiation therapy after a lumpectomy significantly reduces the risk of cancer coming back by approximately 50%. Studies show that a lumpectomy followed by radiation therapy is as effective as a mastectomy without radiation therapy.

People who undergo a lumpectomy have a 20% to 40% chance of the cancer coming back at 10 to 20 years. With the addition of postsurgical radiation therapy, that risk drops to 5% to 10%. However, there are some patients who derive less benefit from radiation including patients 65 years or older with small cancers.

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Physical Emotional And Social Effects Of Cancer

In general, cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.

Palliative care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative care along with treatment for the cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments similar to those meant to get rid of the cancer, such as chemotherapy, surgery, or radiation therapy.

• Music therapy, meditation, stress management, and yoga for reducing anxiety and stress.

• Meditation, relaxation, yoga, massage, and music therapy for depression and to improve other mood problems.

• Meditation and yoga to improve general quality of life.

• Acupressure and acupuncture to help with nausea and vomiting from chemotherapy.

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What Are The Possible Complications After A Mastectomy

Like any surgery, theres a chance that some problems could occur after a mastectomy. About one in 10 women experiences a complication. Having a double mastectomy or breast reconstruction at the same time slightly increases your risk. Diabetes, excess weight, smoking and other medical problems can also increase your risk for a complication. Possible complications include:

• Buildup of blood or fluid under the wound.
• Burning or shooting pain in the chest, underarm or arm.
• Increased sensitivity in the scar area.
• Infection.
• Lumpy or painful scar tissue.
• Numbness in the scar area, chest, nipple or upper arm.

Another complication of mastectomy and lymph node surgery is lymphedema, which causes swelling in your arm. Approximately 20% of people develop lymphedema after a mastectomy with lymph node removal.

Immunotherapy As An Emerging Treatment

Immunotherapy is a relatively new treatment option, and while it hasnt been approved by the Food and Drug Administration for breast cancer yet, its a promising area.

Immunotherapy works by raising the bodys natural defenses to fight off the cancer. It has fewer side effects than chemotherapy and is less likely to cause resistance.

Pembrolizumab is an immune checkpoint inhibitor. Its a type of immunotherapy that has shown particular promise in the treatment of metastatic breast cancer.

It works by blocking specific antibodies that make it harder for the immune system to fight the cancer. This allows the body to fight back more efficiently. A 2016 study found 37.5 percent of patients with triple-negative breast cancer saw a benefit from the therapy.

Because immunotherapy isnt FDA approved yet, treatment is mostly available through clinical trials at this time.

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Stage 1b Breast Cancer Means One Of The Following Descriptions Applies:

Lymph nodes have cancer evidence with small clusters of cells between the approximate size of a pinprick to the approximate width of a grain of rice .

AND EITHER No actual tumor is found in the breast.

OR The tumor is smaller than the approximate size of a peanut .

Similar to stage 0, breast cancer at this stage is very treatable and survivable. When breast cancer is detected early, and is in the localized stage , the 5-year relative survival rate is 100%.

How Long Is Too Long To Wait

How soon you might need to have surgery after a cancer diagnosis can vary. It depends on the type of cancer and other factors. Sometimes cancer surgery needs to happen as soon as possible. Other times, waiting a while is not a problem. And sometimes you might need chemotherapy or radiation before having surgery. Its not unusual for patients to wait a few weeks after learning they have cancer to have surgery. Talk to your doctor and others on your health care team about how long to wait before having surgery. Dont be afraid to ask questions! You might want to ask if you have time to think about other options or get a second opinion.

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Changes To The Look And Feel Of The Breast

Radiation therapy may cause the breast to feel firmer and to be slightly smaller in volume. There may be some permanent discolouration of the skin in the treatment area and visible small red blood vessels may develop.

Your radiation oncologist will discuss with you the very small risks of long-term damage to normal tissue in the treatment area, such as changes in the lungs underlying the chest wall, rib fracture, heart problems if you have a left-sided breast cancer, nerve damage causing weakness in the arm, or lymphoedema of the arm or breast. There is an extremely small risk of inducing a second cancer in the treatment area many years after your breast cancer radiotherapy.

It is felt that the benefit of radiation therapy using modern radiation techniques outweighs the potential risks of treatment and your radiation oncologist will discuss this with you.

Lumpectomy Versus Mastectomy For Early

Every woman diagnosed with early-stage breast cancer faces a decision about what type of surgery to have. Together with her doctors, she will have to choose between breast-conserving surgery , also called lumpectomy, and mastectomy. BCS preserves the breast, removing the tumor and a rim of surrounding tissue, whereas mastectomy removes the entire breast. Patients with early-stage disease are usually eligible for either BCS or mastectomy. More importantly, lumpectomy followed by radiation is just as effective as mastectomy. One would think most women would choose BCS as a less invasive procedure, but the numbers tell a different story.

Mastectomy used to be the routine surgical treatment for breast cancer, including early-stage cancer, up until the mid-1980s. In 1990, the National Institutes of Health Consensus Development Conference on Treatment of Early-Stage Breast Cancer recommended BCS for the majority of women with stage I or II breast cancer. By the mid-1990s, BCS had become the predominant type of surgery for early breast cancer. An analysis performed in 1999 estimated that from 1985 through 1989, approximately 35% of women with stage I cancer underwent BCS, and in the next 5 years the percentage jumped to 60%. For women with stage II breast cancer, the percentage rose from 19% to 39%.

In favor of mastectomy:

Against mastectomy:

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What Else Do You Need To Make Your Decision

Check the facts

• No, that’s wrong. The right answer is breast-conserving surgery. It leaves behind more breast tissue, so there is a slightly higher chance of cancer coming back in the same breast.
• You are right. Breast-conserving surgery leaves behind more breast tissue, so there is a slightly higher chance of cancer coming back in the same breast.
• No, that’s wrong. The right answer is breast-conserving surgery. It leaves behind more breast tissue, so there is a slightly higher chance of cancer coming back in the same breast.
• It may help to go back and read “Get the Facts.” Breast-conserving surgery leaves behind more breast tissue, so there is a slightly higher chance of cancer coming back in the same breast.

How sure do you feel right now about your decision?

Use the following space to list questions, concerns, and next steps.

Additional Markers For Breast Cancer Staging

Additional markers specific to breast cancer will further define your stage, which may be helpful in choosing targeted treatments to fight the cancer.

• ER: The cancer has an estrogen receptor. Estrogen is a hormone, and some cancers have receptors that respond to estrogen.
• PR: The cancer has a progesterone receptor. Progesterone is also a hormone.
• HER2: The cancer makes the protein HER2 .
• G: Grade of cancer refers to how different the cells look from normal. Grade 1 indicates that the cells look fairly normal, while grade 2 cells are growing a little faster, and grade 3 cells look markedly different than normal breast tissue.

These markers, along with the TNM measurements, define your stage.

A cancer recurrence refers to cancer that returns in the same breast, and it requires new staging. This new stage is marked by an R at the end to indicate restaging. If it develops in the other breast, its considered a new cancer.

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Why Might Your Doctor Recommend A Mastectomy Instead Of Breast

Your surgeon may recommend a mastectomy if:

• You have two or more areas of breast cancer in the same breast that are too far apart to be removed with a single cut .
• Your breast cancer is large or is large relative to the size of your breast, and removing it will require removing a lot of breast tissue. You may not be satisfied with the way your breast looks after surgery.
• You have had chemotherapy before surgery to shrink the tumour, but it didn’t reduce the size of the tumour enough to make breast-conserving surgery an option.
• You have a health reason that keeps you from being able to have radiation. Those reasons may include a serious lung disease, a connective tissue disease, or a problem that was already treated with radiation to the breast or chest.

Hormones Involved In Breast Cancer

The presence or absence of the hormones estrogen, progesterone and HER2 are critical in determining how to treat breast cancer.

Patients who test positive for these hormones often have a better prognosis because the cancer is easier to treat. The treatment involves hormone-blocking drugs that help stunt the growth and shrink cancer cells. In some cases, patients are negative for all three proteins, known as triple-negative breast cancer.

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How Quickly Do Breast Cancer Tumors Grow From Stage To Stage

Cancer cells divide and multiply quickly in such a way that as a tumor gets bigger, it divides and grows even faster. The average doubling time for breast cancer tumors is between 50 and 200 days. Breast cancer tumor growth rate is impacted by hormonal factors, such as hormone receptor status and HER2 status.

Breast Cancer Staging Guidelines

The TNM system is the most widely used cancer staging system and looks at the following cancer characteristics:

• Tumor The size of the tumor and whether it has grown into nearby tissue.
• Node Whether the cancer has spread to nearby lymph nodes. And if so, how many.
• Metastasis Indicates whether the cancer has spread to distant organs, like the lungs or liver.

But when it comes to breast cancer staging, the TNM system was expanded to include additional cancer characteristics, including:

• Estrogen-receptor status or progesterone-receptor status Whether the cancer has estrogen or progesterone receptors. A positive status means the cancer can use either hormone to grow.
• HER2 status Whether the cancer produces HER2, a protein that promotes the growth of cancer cells.
• Grade Indicates how much the cancer cells look like healthy cells.
• Oncotype DX recurrence score Indicates how likely a group of genes may respond to treatment, depending on ER, PR and HER2 status.

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Complementary And Alternative Treatments

Some people with breast cancer might be interested in exploring complementary or alternative treatments like vitamins, herbs, acupuncture, and massage.

These treatments are used alongside traditional breast cancer therapies to treat cancer or relieve cancer symptoms and uncomfortable side effects of treatments like chemotherapy. You can explore these treatments at any stage of breast cancer.

Examples of alternative therapy include:

• using massage to relax
• using peppermint tea to reduce nausea
• using cannabis to relieve pain

While some alternative medicine treatments might help you feel more comfortable, its important to keep in mind that many are unproven and could be harmful to your health. To be safe, talk with your doctor about alternative treatments youre interested in pursuing.

Breast cancer that spreads to other parts of the body can cause pain, such as bone pain, muscle pain, headaches, and discomfort around the liver. Talk with your doctor about pain management.

Options for mild to moderate pain include acetaminophen and nonsteroidal anti-inflammatory drugs , such as ibuprofen.

For severe pain in a later stage, your doctor may recommend an opioid such as morphine, oxycodone, hydromorphone, or fentanyl. These opioids have the potential for addiction, so they are only recommended in certain cases.

While breast cancer stage has a lot to do with treatment options, other factors can impact your treatment options as well.