In total (simple) mastectomy, the whole breast is removed with some of
the lymph nodes. In modified radical mastectomy, the whole breast is removed,
the lymph nodes under arm and often the lining over the chest muscles. The
smaller of the two chest muscles is also taken out to help in removing the lymph
nodes (Dollinger, Rosenbaum and Cable, 1991).. In radical mastectomy, also
called Halsted radical mastectomy, the breast is removed, the chest muscles, all
of the lymph nodes under the arm and some additional fat and skin. This
operation was considered standard procedure for many, many years. Thank
goodness, it is only used rarely these days and only in cases where the cancer
has spread to the chest muscles. (Dollinger, Rosenbaum and Cable, 1991). Breast
reconstruction is surgery to rebuild a breast's shape. This option should be
discussed with a plastic surgeon prior to having a mastectomy (Fraker and
Edwards, 1998). Radiation therapy is the use of high energy rays to kill cancer
cells and stop them from growing . These rays can come from radioactive material
outside the body and be directed at the breast by a machine. It can also come
from radioactive material placed directly in the breast in thin plastic tubes.
Some women receive both kinds (McEvilly and Hassey, 1998). Chemotherapy is the
use of drugs to kill cancer cells. It is usually in a combination of drugs. They
may be given orally or by injection. Either way, it is a systemic therapy
because the drugs enter the blood stream and travel throughout the body.
Treatment Choices Treatment choices depend on a number of factors. These include
age, menopausal status, general health, the size, location, stage of the tumor,
lymph node involvement and size of the breast. Certain features of the tumor
cells, such as whether or not they depend on hormones to grow are considered.
But, the most important consideration is the stage of the disease. The stage is
based on the size of the tumor and whether the cancer has spread. The following
is a brief description of the stages of breast cancer and the treatments often
used at each stage according to (Dollinger, Rosenbaum and Cable, 1991): Stage 0
is sometimes called noninvasive carcinoma or carcinoma in situ. Lobular
carcinoma in situ, or LCIS, refers to abnormal cells in the lining of the lobule
These abnormal cells seldom become invasive cancer. They mean there is an
increased risk for developing breast cancer. The risk is increased for both
breasts. Some women with LCIS may choose to take a medication called tamoxifen
in an attempt to prevent cancer or may do nothing at all and have regular check
ups. Ductal carcinoma in situ is called intraductal carcinoma or DCIS. This
refers to the cancer cells in an area of abnormal tissue in the lining of a duct
that have not invaded the surrounding breast tissue. If DCIS lesions are left
untreated, over time cancer cells may break through the duct and spread to
nearby tissue. Patient with DCIS may have a mastectomy or breast sparing surgery
followed by radiation therapy. Underarm lymph nodes are not usually removed.
Stage I , the cancer cells have not spread beyond the breast and the tumor is no
more than an inch across. Stage II, the tumor in the breast is less than one
inch across and the cancer has spread to the lymph nodes under the arms, the
tumor is between 1 and 2 inches with or without spread to the lymph nodes under
the arms or the tumor is larger than 2 inches but has not spread to the lymph
nodes under the arm. Stage III is called locally advanced cancer. The tumor is
large, more than 2 inches across and the cancer is extensive in the underarm
lymph nodes or it has spread to other lymph nodes or issues near the breast.
Inflammatory breast cancer is this type. Usually local and systemic treatment
are given to stop the disease from spreading. Stage IV is metastatic cancer. The
cancer has spread from the breast to other parts of the body. Chemotherapy
and/or hormonal therapy is given to destroy the cancer cells and control the
disease. Recurrent cancer means it has come back in spite of the initial
treatment. Even when a tumor seems to have been completely removed or destroyed,
the disease sometimes returns because undetected cancer cells remained in the
area after treatment or the disease had already spread before treatment. Most
recurrences appear within the first 2 to 3 years after treatment, but breast
cancer can recur many years later.
