Methodist Healthcare - October 14, 2019

Methodist Healthcare describes treatment and surgery options for patients diagnosed with breast cancer.

A cancer diagnosis does not mean you will automatically lose your breast(s). Several factors play a role in determining the best treatment options for your individual case. According to the American Cancer Society, approximately 35% of women diagnosed with invasive breast cancer had a mastectomy.

Factors That Help Doctors Determine Optimal Treatment

After completing a breast biopsy and receiving your diagnosis, your doctor will order additional imaging and pathology tests to determine the size and characteristics of the cancer. These tests will establish the stage of your cancer and help guide treatment recommendations.

Methodist Healthcare provides a detailed description of breast cancer stages that help determine optimal treatment options.

Breast cancer stages range from 0 to IV:

  • Stage 0 – Abnormal cells are located in the duct lining or sections of the breast. This is non-invasive cancer.
  • Stage I – Tumor is less than one inch in diameter.
  • Stage II – Tumor is between and 1 and 2 inches in diameter and may have spread to nearby lymph nodes.
  • Stage III – Tumor is larger than 2 inches and has spread to the auxiliary lymph node. You may experience dimpling, inflammation or color changes in the skin.
  • Stage IV – Cancerous cells have spread to other organs in the body.

Your physician will assign a cancer stage in combination with the Tumor, Node, Metastasis (TNM) Classifications. In addition, as prognostic factor such as ER, PR and HER2 status will be included. These factors help to determine what is driving the cancer and play a large role in determining treatment recommendations.

The TNM staging system for breast cancer is an internationally accepted system used to determine the disease stage and is attached to the stage numbers.

  • T – The size and extent of invasion to nearby tissue
  • N – Whether the cancerous cells have spread to the surrounding lymph nodes
  • M – If it has spread to other organs in the body (referred to as metastasis)

The ER, PR and HER2 statuses indicate if the cancer cells contain certain estrogen or progesterone receptors which heightens cancerous cell growth.

  • ER- Whether the cancer cells carry proteins called estrogen
  • PR – Whether the cancer cells carry proteins called progesterone receptors.
  • Her2 – The status of the cancer cells ability to produce excessive amounts of a protein called Her

Breast Cancer Treatment Options

The goal of surgery in early stage (0-II) breast cancer includes complete removal of the tumor to reduce risk of recurrence. When the primary tumor is large or when regional lymph nodes are involved (stages III-IV) the doctor may attempt to shrink the tumor before surgery. This is done with chemotherapy, immunotherapy or hormonal therapy. After completing treatment, your physician will determine the surgical options available to you and proceed with either a lumpectomy or mastectomy.

Treatments Available To Reduce Tumor(s):

  • Radiation therapy – Uses high-energy X-rays to kill cancer cells in the breast. Women who had a lumpectomy will most often be given radiation therapy to the remaining breast tissue and underarm area after surgery. Women who had a mastectomy may or may not require radiation therapy depending on the extent of disease.
  • Chemotherapy – Uses powerful medication administered intravenously or in pill form to shrink or kill the cancer cells. For larger tumors, or if cancer is found in lymph nodes, chemotherapy is typically administered before surgery in order to reduce the tumor size & activity. When chemo is given after surgery, it is designed to treat any potential microscopic disease and to reduce risk of recurrence. Chemotherapy causes side effects that can include fatigue, nausea, hair loss, hot flashes and early menopause.
  • Hormonal therapy – Uses drugs to block the effects of estrogen & progesterone in breast tissue in ER positive breast cancers
  • Targeted Immunotherapy – Used to treat HER2 positive breast cancer by targeting & blocking receptor proteins on cancer cells as well as prompting the immune system to identify and destroy cancer cells

Surgery Options

Surgery – An operation where doctors remove cancer tissue. The surgical options include a lumpectomy or mastectomy.

Graphical representation of sections removed during a lumpectomy.

Lumpectomy – Attempts to preserve as much of the breast as possible while removing the tumor and a small border of normal tissue. It may require the removal of some lymph nodes. This is typically done on an outpatient basis and the patient can return home the same day.

Graphical representation of sections removed during a mastectomy.

Mastectomy – Removes the entire breast and may include the nipple, areola and overlying skin. If breast reconstruction is desired, the patient will have a consultation with a plastic surgeon to determine the options available in her specific situation. A prophylactic bilateral mastectomy is recommended for women who have tested positive for gene mutations such as the BRCA1 and BRCA2. A mastectomy usually requires an overnight hospital stay. When reconstruction is performed at the same time, the hospital stay can be 1-3 days.

You will generally work with a cancer care team that includes:

  • Primary care doctor who manages general health
  • Medical Oncologist who prescribes and oversees chemotherapy & hormone medicines
  • Surgeons who surgically removes cancer tissue
  • Plastic surgeon who performs reconstruction (if desired)
  • Radiation Oncologist who use high-energy X-rays to kill cancer cells
  • Nurse Navigator who acts as your medical system advocate to help you understand your diagnosis and the resources available to you

Call the Methodist Healthcare HealthLine at (210) 575-0355 or toll-free at 1-800-333-7333 to learn more.