| Overview |
| When a woman
is informed that she has just been diagnosed with breast
cancer, she typically goes into a state of mental shock.
She might think: "You've made a mistake";
"Why me?”; And, "Am I going to live?"
These are just a few of the common thoughts that spin
through a woman's mind. Since every woman is unique, the
approach to guiding a woman through the process of
understanding her diagnosis and her treatment options
must be individualized. However, experience has taught
us that there are a series of helpful steps that
minimize the stress in the journey from just being
diagnosed to the successful completion of treatment.
Within 48
hours of being diagnosed, most women are ready to focus
on their treatment options. Before reviewing these
options, it is essential that a woman has a clear
understanding of her cancer diagnosis. The first
question that must be answered: “Is my cancer invasive
or non-invasive?” With non-invasive cancers, the
initial focus of the discussion is whether or not the
breast can be saved (in most cases, it can). The amount
of time required to eventually make a decision is less
of an issue, since these cancers are almost always
curable.
With invasive cancers time is an issue; however, the
process should not be rushed. It is essential that a
woman take the time to fully understand the nature of
her cancer, as well as all her treatment options. It is
also essential that the treatment team have time to
study the various clinical issues so that the most
accurate treatment recommendations can be made. At the
center, all newly diagnosed breast cancer patients are
presented to a treatment conference in which a
mammographer re-reviews the mammograms, a pathologist
re-reviews the slides, and a surgeon presents the
history and clinical findings. Based on these findings,
the team formulates a treatment plan.
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| Initial
Treatment Options |
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Breast conserving surgery (lumpectomy +
irradiation)
* Mastectomy
(with or without immediate reconstruction)
* Chemotherapy
first (to reduce the size of a larger tumor),
followed by surgery.
Breast conservation :
For most women, breast conservation will be
the treatment of choice since it is less
traumatic, and the survival results are
identical to survival rates with mastectomy.
However, not all women are candidates for
breast conservation, and some women prefer
mastectomy. We believe women should be given
the facts and encouraged to make their own
choices.
Women considering breast conservation must
have a clear understanding of the issue of
'”margins". The goal in breast
conservation is to remove the tumor, along
with a surrounding rim of normal tissue.
Obtaining clear margins all around the tumor
edges can be a challenge. Although the surgeon
attempts to take out the entire tumor at the
time of the initial surgery, in some cases the
tumor cells (which are not visible during the
surgery) are found by the pathologist to
extend to the edge (margin) of the lumpectomy
specimen, and a second operation is required.
Fortunately, the vast majority of women who
initially choose breast conservation will
ultimately achieve a good to excellent
cosmetic result. Long-term survival is equal
to that with mastectomy.
Mastectomy :
Some women are either not candidates for
breast conservation or choose mastectomy for
personal reasons. Women considering mastectomy
should be given the option of immediate
reconstruction. Some women, however, are not
good candidates for immediate reconstruction
because of an underlying medical condition,
such as diabetes. For these women there is
still the option of delayed reconstruction,
and this option should be taken into
consideration at the time the initial
mastectomy
Chemotherapy first (Neoadjuvant
therapy) :
Giving chemotherapy first (neoadjuvant
therapy) is becoming a more common option. In
the past, chemotherapy was given before
surgery in situations where the tumor was too
large to permit a mastectomy. The chemotherapy
was given first to shrink the tumor so that a
mastectomy could be successfully performed. It
is now becoming common practice to give
chemotherapy first to shrink the tumors so
that less tissue is taken at the time of the
lumpectomy, which leads to improved cosmetic
results. We have had extensive experience with
this approach and have now saved hundreds of
breasts that in the past would have required a
mastectomy
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| Featured
RadNet
Locations |
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The Encino Breast Care
Center:
5363 Balboa
Blvd.,
Suite 100
Encino, CA 91316
Phone: 818-784-8799
Fax: 818-784-6597
Modalities: Digital Mammography, Ultrasound, Bone
Density ( DEXA)
(MAP)
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Rancho
Mirage
Breastlink of Rancho Mirage
35-800 Bob Hope Dr.,
Suite #225
Rancho Mirage, CA 92770
Phone: (760) 324-4466
Fax: (760) 324-1287
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Pleasanton
Breastlink of Pleasanton
5924 Stoneridge Dr.,
Suite #108
Pleasanton, CA 94588
Phone: (925) 225-0138
Fax: (925) 225-0850
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| Additional
Treatment Options |
Radiation Therapy
:
A 6-8 week course of irradiation therapy will be
recommended for women undergoing lumpectomy (radiation
therapy may be safely avoided in selected women with
small, non-invasive cancers). The purpose of radiation
is to eliminate any remaining cancer cells in the
breast following lumpectomy, and it is very effective
in lowering the rate of cancer recurrence in the
breast. There is now an alternative to standard
radiation therapy which can be accomplished in just 5
days. Radiation is painless and takes only a few
minutes to perform. It is much like a simple chest
x-ray in that a beam of energy goes through the breast
without the patient being aware that anything is
happening. With breast irradiation, the energy beam is
much stronger then the energy for a chest x-ray. The
most common side effect of breast irradiation is
redness to the skin. There is no hair loss or nausea
with breast irradiation as there is with chemotherapy.
Most women undergoing mastectomy will not require
post-operative irradiation.
Lymph nodes and Sentinel Node Biopsy :
Lymph node removal will be recommended for most women
with breast cancer. Lymph nodes are Lymph node removal
will be recommended for most women with breast cancer.
Lymph nodes are lima bean shaped structures that vary
in size from that of a pea to the size of a marble. A
primary function of a lymph node is to filter unwanted
materials from the body, and this includes cancer
cells. In fact, if breast cancer cells break off from
the main tumor, the first place they are likely to go
is to the lymph nodes under the arm (i.e. the axillary
lymph nodes). One of the most important indicators of
prognosis is the status of the axillary lymph nodes
(i.e. no nodes involved good means prognosis; the more
nodes involved, the worse the prognosis). For this
reason, it was standard therapy in the past to remove
all of the lymph nodes under the arm at the time of
the removal of the breast cancer to determine
prognosis.
It is now standard
practice to remove only the first draining lymph node
(sentinel lymph node) at this time of the lumpectomy
or mastectomy, and have it examined under the
microscope. If the lymph node is free of cancer cells,
no other lymph nodes are removed. By limiting the
number of nodes removed, recovery is accelerated and
the risk of complications (such as lymphedema) are
minimized.
What is my prognosis?
One of the first questions a woman asks after learning
she has breast cancer is :
"Am I going to live?" Or, in other words,
" What is my prognosis?" When a woman asks
her physician this basic question, she is often
frustrated with the vagueness of the response. The
problem is that the treating physician does not have
enough information following the initial biopsy to
make an accurate prediction of survival. Until the
tumor and lymph nodes have been removed and analyzed,
an accurate prediction of survival is not possible.
The most important
predictors of survival are the size of the invasive
component of the tumor, and the status of the regional
lymph nodes. When there is no invasive tumor present
(i.e. only ductal carcinoma in-situ, or DCIS), the
survival rate is 100%. When the invasive tumor is less
than 11 mm in diameter and the nodes are negative, the
10-year survival approaches 95%, and if you make it to
ten years, consider yourself cured.
As the tumor enlarges and the number of involved lymph
nodes increases, the potential for cure is reduced.
However, dramatic improvements have been made in the
medical treatment of breast cancer (i.e. chemotherapy
and hormone therapy), and many new treatments are on
the horizon. There is now reason for optimism in even
the most advanced cases. To calculate your own
prognosis, refer to the following web site: http://www.mayoclinic.com/calcs.
The time that elapses before a woman is informed about
the details of her prognosis is typically 7-14 days
after the removal of the tumor and the under arm lymph
node(s). It usually takes this long to analyze the
tumor and to receive a pathology report on the various
tumor markers that also influence prognosis (see link
to understanding your pathology report). A woman and
her family will usually have a detailed consultation
with the oncologist to discuss her prognosis, and more
importantly, what steps should be taken to maximize
her chances of survival. After this detailed
discussion, a woman chooses the option that is best
for her.
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