Breast Cancer as we all know is a disease that needs surgery. And again, we all know the surgery involves removal of the breast and in some fortunate women just the lump. But many are not aware that surgery for breast cancer also involves operation in the axilla (arm pit).
In this article let us try to understand the logic behind the Breast cancer surgery and how the doctors decide what type of surgery is offered. More importantly as a patient we are asked to choose from a range of combinations of surgical procedures. Total removal of breast vs lumpectomy. Complete axillary
surgery vs Sentinel lymph node surgery. Completion axillary surgery following sentinel lymph node surgery and so on…
It is a tsunami of overwhelming information overload to comprehend while coming to terms with the diagnosis of breast cancer.
Fact : Surgery is the current standard of care for breast cancer. It is a myth that cancer spreads faster when operated upon.
Having accepted this, let us move forward with confidence to choose the right combination for our individual needs.
Breast cancer which as we all know starts in a single cell and these cells multiply innumerable times to become a lump that we can feel with our fingers. Breast cancer cells also have a tendency to enter blood and spread to liver and lungs too while few cells reach the armpit to form lumps, called nodes. So, the treatment(surgery) consists of removing the lump in the breast as well as the nodes in the axilla. When only the lump in the breast is removed it is called Lumpectomy and it is called mastectomy when the lump is removed along with the entire breast.Surgery for the nodes in the arm pit is called axillary dissection (axillary lymph node dissection).
When the lump is small (2-5 cms) while the relative size of the breast is large (C, D Cup) a lumpectomy can be planned. Doctors wish to give a good margin around the lump and also suggest lumpectomy only when the shape of the breast is not going to be awful after removal of the lump.
When a good margin cannot be achieved as the lump is large or breast is relatively small, Doctors encourage the patient for a mastectomy. Mastectomy is also suggested when the type of cancer is aggressive (High Grade) or the cancer is hormone receptor negative (ER, PR). This is important because hormone receptor positive tumors are less aggressive, and they can be controlled by giving hormone therapy. Similarly HER2 neu positive tumors are again aggressive and spread easily. They have higher chance of recurrence ( Disease coming back) and hence doctors feel the entire breast tissue should be removed.
So, the decision for just lumpectomy vs mastectomy is based on the
- age of the patient (assuming younger patients are more keen to retain the breast)
- The nature of the cancer ( mild or aggressive based on Grade)
- The size of the lump in relation to the cup size of the breast
- ER, PR receptor status (Her2neu status too) and
- Most Importantly – What you prefer! Your choice plays an important role in the decision making.
Be aware, conservative breast surgery (aka., lumpectomy) is as good as mastectomy when all the above criteria are taken in to consideration for decision making. A word of caution: You should choose lumpectomy only when you are willing for post surgery radiation to the entire breast!
Radiation will be compulsorily given as we need to treat the remaining breast tissue left behind after the lumpectomy to prevent recurrence in that breast. Please remember breast cancer develops because of changes in the DNA of the cells of the breast. So such changes could be present in the remaining cells of the breast tissue left behind. If we do not want to remove the remaining susceptible cells (breast tissue) by surgery (Mastectomy) then we need to treat those cells through Radiation.
Hence lumpectomy is always followed by Radiation treatment.
To know more about surgery for the armpit click here!