The expert staff at the St. Joseph Hospital Comprehensive Breast Center is committed to making each patient's treatment as effective and comfortable as possible. This commitment is supported by the compassion for which St. Joseph Hospital is so well known. Because every woman is different, the program focuses on individualized treatment. Our multi-disciplinary team uses the latest techniques and therapies to give Orange County women not only the highest quality care, but also the best chance at beating their disease.
It is common for women to experience breast changes, such as tenderness or lumps, during their menstrual cycle as a result of fluctuations in estrogen and progesterone levels. Some women have fibrocystic breast changes, or general breast lumpiness, that does not require medical treatment.
Any change in the breasts can raise concerns, but it helps to remember that most breast problems are not caused by cancer. Also, breast cancer is more likely to develop later in life. Your physician can help you manage the symptoms that cause discomfort and guide you in determining the best breast cancer screening regimen. Additionally, your physician can assess and manage your individual risk for breast cancer, giving you the best chance at early intervention and successful treatment.
Chemotherapy is a widely used breast cancer treatment that may help patients live longer and improve their quality of life. Chemotherapy may be used before surgery to shrink a tumor or as adjuvant therapy after surgery to reduce the risk of a recurrence. It may be used as the primary treatment when the cancer has spread to other parts of the body.
Chemotherapy drugs may be given intravenously, by injection, or by mouth. The drugs then travel through the bloodstream to reach cancer cells in most parts of the body. The chemotherapy is given in cycles, usually over a total of six months, with each period of treatment followed by some time for recovery.
Radiation therapy is used after a lumpectomy or mastectomy to kill any cancer cells that may remain in the breast, chest wall or underarm area. This can help reduce the chances of a recurrence. Radiation treatment, which uses high-energy rays or particles to destroy cancer cells, may also be prescribed before surgery to shrink a large tumor or treat cancer that has spread outside the breast. Your radiation oncologist will recommend the type and duration of radiation treatment that are best for you.
- External Beam
The most common type of radiation therapy for breast cancer patients is external beam radiation, which is focused from a source outside the body on the breast, as well as the chest wall and underarm area in some cases. This treatment is usually given in an outpatient center five days a week for about six to seven weeks. Each painless treatment lasts only a few minutes, but patients may develop side effects such as swelling and heaviness in the breast, sunburn-like skin changes in the treated area, and fatigue. Changes to the breast tissue and skin usually disappear in six to 12 months. Your physician or nurse can recommend ways to help prevent or manage these side effects.
- Mammosite Brachytherapy
Brachytherapy is another form of radiation therapy for breast cancer. The latest form of breast brachytherapy is called Mammosite. During Mammosite treatment, a hollow, ball-like device is placed directly into the breast tissue following a lumpectomy. This procedure uses high-dose brachytherapy (HDR), which delivers radiation precisely at the site of the tumor and spares surrounding healthy tissue and organs. Treatments are given twice a day for only one week.
- Intensity Modulated Radiation Therapy (IMRT)
IMRT is a form of radiation treatment that delivers a very targeted dose of radiation based on the size, shape and location of the tumor. Unique planning methodologies are now available with highly sophisticated software to direct the shape of the radiation beam in order to match that of the tumor and desired surrounding area. IMRT makes it possible to deliver higher, more effective doses of radiation while sparing the surrounding healthy tissue.
Because many breast cancers are hormone-dependent, the goal of hormone therapy is to deprive cancer cells of the estrogen that stimulates their growth. Hormone therapy may involve surgery to remove the ovaries (which make female hormones), or drugs such as tamoxifen (which simulate hormones). Tamoxifen is the most common anti-estrogen drug. It is usually prescribed for five years after surgery-taken daily in pill form-to reduce the risk of the cancer returning. Tamoxifen is also used to prevent breast cancer in high-risk women and treat metastatic breast cancer.
In addition to drugs like Tamoxifen, there are aromatase inhibitors (Femara, Arimidex, Aromasin) that stop estrogen production in postmenopausal women. These drugs have fewer side effects than tamoxifen, but can cause osteoporosis and bone fractures. Because these drugs do not stop the ovaries of premenopausal women from producing estrogen, they are prescribed only for postmenopausal women.
Biological therapy, also called immunotherapy, biotherapy or biological response therapy, is a relatively new form of cancer treatment. Biological therapies include immune substances made from a living organism or its products that can be reproduced in a laboratory. These manufactured immune substances trigger the patient's own immune system to react, causing the body's immune system to stop cancer growth, make cancer cells more recognizable as foreign (so the body's own immune system will destroy them), boost the killing power of the body's immune system cells, repair or replace normal cells damaged in treatment, or prevent cancer cells from spreading to other parts of the body. Examples of biotherapies include monoclonal antibodies, cytokines, interleukins, colony-stimulating factors, vaccines and gene therapy.
Surgery is often needed to treat breast cancer. Options include a mastectomy to remove the entire breast or breast-conserving surgery (lumpectomy) followed by radiation treatments. Samples are also taken from the lymph nodes under the arm pits, and breast reconstruction can be done at the time of surgery or later.
Doctors evaluate a number of factors to determine what type of surgery is best for each patient. These include your age, medical history, the extent of the disease, and the size and location of the cancer. For example, if your tumor is large and a significant amount of breast tissue would have to be removed, your surgeon may recommend a mastectomy with reconstructive surgery to restore the appearance of the breast. If the tumor is small, breast-conserving therapy might be the best choice. In discussing treatment options with your surgeon, it is important to consider your self-image and personal feelings about a mastectomy vs. breast-conserving surgery. However, keep in mind that your top priority should be getting the treatment that will give you the best hope of a cure.
- Lumpectomy
This is a surgical procedure to remove a small tumor while preserving the rest of the breast. This procedure is often recommended for women with early-stage breast cancer. The surgeon will also remove a margin of healthy tissue surrounding the tumor to make sure that no cancer cells remain. Patients also go through radiation therapy (see above) following a lumpectomy to prevent local recurrence of cancer in the preserved breast. Oncoplasty is a form of reconstructive surgery. It may be an option for improved cosmetic results following lumpectomy.
- Mastectomy
This surgery involves removal of the entire breast, including as much breast tissue as possible. Radiation therapy may not be needed after a mastectomy, but it may be recommended if there is any concern that cancer cells might still be in the breast area.
Most women who have this surgery have a modified radical mastectomy that involves removal of the breast and some underarm lymph nodes. A radical mastectomy is a more extensive operation that involves removal of the breast, lymph nodes and the pectoral muscles under the breast.
A mastectomy is often recommended when there is a large tumor or the cancer has spread in various small pockets throughout the breast.
- Sentinel Node Biopsy
This procedure eliminates the need to remove a number of lymph nodes under the arm in order to determine whether cancer has spread to the lymph nodes. Instead, surgeons are able to find and remove the "sentinel node," which is the first lymph node into which a tumor drains and the one where cancer cells are most likely to be found. If cancer cells are found, the surgeon will remove additional lymph nodes. If the sentinel node is free of cancer, more extensive lymph node surgery will not be necessary and the recovery process will be easier for the patient. A sentinel node biopsy is not appropriate for every patient. Ask your surgeon whether this is a good option given the size of your tumor and other considerations.
- Reconstructive Surgery
Many women choose to have reconstructive surgery to restore the appearance of the breast after a mastectomy. Options include breast implants or the use of tissue from other parts of your body (autologous tissue reconstruction). Some procedures can be done immediately after a mastectomy, or you may choose to do reconstruction later. If you are thinking about having reconstructive surgery immediately, it is important to consult with a plastic surgeon who is an expert in breast reconstruction before you have a mastectomy. For those who do not choose reconstruction, prostheses are available. These breast forms feel natural and are usually covered by insurance if you have a prescription from your surgeon.