The smaller lymph node procedure helps lower the risk of several possible side effects. Those side effects include swelling of the arm called lymphedema , numbness, and arm movement and range of motion problems with the shoulder. Importantly, the risk of lymphedema increases with the number of lymph nodes and lymph vessels that are removed or damaged during cancer treatment.
This means that women who have a sentinel lymph node biopsy tend to be less likely to develop lymphedema than those who have an axillary lymph node dissection see below. This is often done if your lymph nodes can be felt during clinical examination or if you are having treatment with chemotherapy before surgery. However, ASCO does not recommend doing this if your cancer is small and your lymph nodes are not able to be felt during clinical examination. To find the sentinel lymph node, the surgeon usually injects a radioactive tracer and sometimes a dye behind or around the nipple.
The injection, which can cause some discomfort, lasts about 15 seconds. The dye or tracer travels to the lymph nodes, arriving at the sentinel node first.
If a radioactive tracer is used, it will give off radiation which helps the surgeon find the lymph node. If dye is used, the surgeon can find the lymph node when it turns color.
The pathologist then examines the lymph nodes for cancer cells. If the sentinel lymph node s are cancer-free, research has shown that it is likely that the remaining lymph nodes will also be free of cancer.
This means that no more lymph nodes need to be removed. In general, for most women with early-stage breast cancer with tumors that can be removed with surgery and whose underarm lymph nodes are not enlarged, sentinel lymph node biopsy is the standard of care. However, in certain situations, it may be appropriate to not undergo any axillary surgery.
You should talk with your surgeon about whether this may be the right approach for you. Axillary lymph node dissection. In an axillary lymph node dissection, the surgeon removes many lymph nodes from under the arm. These are then examined for cancer cells by a pathologist. The actual number of lymph nodes removed varies from person to person.
Women having a lumpectomy and radiation therapy who have a smaller tumor less than 5 cm and 2 or less sentinel lymph nodes with cancer may avoid a full axillary lymph node dissection. Also, some women receiving a mastectomy may avoid an axillary lymph node dissection. This helps reduce the risk of side effects and does not decrease survival. If cancer is found in the sentinel lymph node, whether additional surgery is needed to remove more lymph nodes depends on the specific situation.
Usually, the lymph nodes are not evaluated for people with DCIS and no invasive cancer, since the risk of spread is very low. However, for patients diagnosed with DCIS who choose to have or need a mastectomy, the surgeon may consider a sentinel lymph node biopsy. If some invasive cancer is found with DCIS during the mastectomy, which happens occasionally, the lymph nodes will then need to be evaluated.
However, a sentinel lymph node biopsy generally cannot be performed. In that situation, an axillary lymph node dissection may be recommended. Most people with invasive breast cancer will have either a sentinel lymph node biopsy or an axillary lymph node dissection. For most people younger than 70 with early-stage breast cancer, a sentinel lymph node biopsy will be used to determine if there is cancer in the axillary lymph nodes, since this information is used to make decisions about treatment.
For most patients 70 and older with hormone receptor-positive and HER2-negative disease and no clinically apparent cancer in the lymph nodes, ASCO does not recommend sentinel lymph node biopsy. Patients over age 70 with other types of breast cancer or with clinically apparent lymph nodes will generally be recommended to have evaluation of their axillary lymph nodes. No chemotherapy before surgery, and no cancer in the sentinel lymph nodes. For most people in this situation, ASCO does not recommend an axillary lymph node dissection.
A small group of patients with tumors located in specific places or with high-risk features may be offered radiation therapy to the lymph nodes. No chemotherapy before surgery, but there is cancer in the sentinel lymph nodes.
For most people in this situation, ASCO recommends radiation therapy instead of axillary lymph node dissection. However, an axillary lymph node dissection may be combined with radiation therapy for people who have 3 or more sentinel lymph nodes containing cancer.
For some people in this group, additional radiation therapy to the lymph nodes may be recommended after surgery if the tumors are located in specific places or have high-risk features.
Chemotherapy is given before surgery. Treatment for people who have received chemotherapy before surgery depends on whether the chemotherapy has destroyed the cancer in the lymph nodes. Therefore, after chemotherapy patients are re-staged by sentinel lymph node biopsy.
If there was no evidence of cancer in the lymph nodes either before or after chemotherapy, radiation therapy is not recommended. If there was evidence of cancer in the lymph nodes before chemotherapy and there is no longer evidence of cancer in the lymph nodes after chemotherapy, radiation therapy is recommended. If there is evidence of cancer in the lymph nodes after chemotherapy, then both an axillary lymph node dissection and radiation therapy are recommended. Women who have a mastectomy or lumpectomy may want to consider breast reconstruction.
This is surgery to recreate a breast using either tissue taken from another part of the body or synthetic implants. Reconstruction is usually performed by a plastic surgeon. A person may be able to have reconstruction at the same time as the mastectomy, called immediate reconstruction. They may also have it at some point in the future, called delayed reconstruction.
For patients having a lumpectomy, reconstruction may be done at the same time to improve the look of the breast and to make both breasts look similar. This is called oncoplastic surgery.
Many breast surgeons can do this without the help of a plastic surgeon at the same time as the lumpectomy. Surgery on the healthy breast at the same time as the lumpectomy may also be suggested so both breasts have a similar appearance. A breast implant uses saline-filled or silicone gel-filled forms to reshape the breast. The outside of a saline-filled implant is made up of silicone, and it is filled with sterile saline, which is salt water.
Silicone gel-filled implants are filled with silicone instead of saline. They were thought to cause connective tissue disorders, but clear evidence of this has not been found. Before having permanent implants, a woman may temporarily have a tissue expander placed that will create the correct sized pocket for the implant. Implants can be placed above or below the pectoralis muscle.
Talk with your doctor about the benefits and risks of silicone versus saline implants. The lifespan of an implant depends on the woman. However, some women never need to have them replaced.
Other important factors to consider when choosing implants include:. Saline implants sometimes "ripple" at the top or shift with time, but many women do not find it bothersome enough to replace. Saline implants tend to feel different than silicone implants. They are often firmer to the touch than silicone implants.
There can be problems with breast implants. Some women have problems with the shape or appearance. The implants can rupture or break, cause pain and scar tissue around the implant, or get infected. Implants have also been rarely linked to other types of cancer, including a type called breast implant-associated anaplastic large cell lymphoma BIA-ALCL. Although these problems are very unusual, talk with your doctor about the risks. Tissue flap procedures. These techniques use muscle and tissue from elsewhere in the body to reshape the breast.
There are several flap procedures:. Transverse rectus abdominis muscle TRAM flap. This method, which can be done as a pedicle flap or free flap, uses muscle and tissue from the lower stomach wall. Latissimus dorsi flap.
This pedicle flap method uses muscle and tissue from the upper back. Implants are often inserted during this flap procedure. Deep inferior epigastric artery perforator DIEP flap. The DIEP free flap takes tissue from the abdomen and the surgeon attaches the blood vessels to the chest wall.
Gluteal free flap. The gluteal free flap uses tissue and muscle from the buttocks to create the breast, and the surgeon also attaches the blood vessels. Transverse upper gracilis TUG , which uses tissue from the upper thigh, may also be an alternative. Because blood vessels are involved with flap procedures, these strategies are usually not recommended for a woman with a history of diabetes or connective tissue or vascular disease, or for a woman who smokes, as the risk of problems during and after surgery is much higher.
The DIEP and other flap procedures are longer procedures with a longer recovery time. However, the appearance of the breast may be preferred, especially when radiation therapy is part of the treatment plan. Talk with your doctor for more information about reconstruction options and a referral to a plastic surgeon. When considering a plastic surgeon, choose a doctor who has experience with a variety of reconstructive surgeries, including implants and flap procedures.
They can discuss the pros and cons of each procedure. An external breast prosthesis or artificial breast form provides an option for women who plan to delay or not have reconstructive surgery. These can be made of silicone or soft material, and they fit into a mastectomy bra.
Breast prostheses can be made to provide a good fit and natural appearance for each woman. Read more about choosing a breast prosthesis. Removal of cancer in the breast: Lumpectomy or partial mastectomy, generally followed by radiation therapy if the cancer is invasive. Mastectomy may also be recommended, with or without immediate reconstruction. Women are encouraged to talk with their doctors about which surgical option is right for them.
Also, talk with your health care team about the possible side effects from the specific surgery you will have. More aggressive surgery, such as a mastectomy, is not always better and may cause more complications.
The combination of lumpectomy and radiation therapy has a slightly higher risk of the cancer coming back in the same breast or the surrounding area. However, the long-term survival of women who choose lumpectomy is exactly the same as those who have a mastectomy.
Even with a mastectomy, not all breast tissue can be removed and there is still a chance of recurrence or a new breast cancer. Women with a very high risk of developing a new cancer in the other breast may consider a bilateral mastectomy, meaning both breasts are removed.
Women with BRCA1 or BRCA2 gene mutations should talk with their doctor about which surgical option might be best for them, as they have an increased risk of developing breast cancer in the opposite breast and of developing a new breast cancer in the same breast compared to those without these mutations.
ASCO recommends that women with a BRCA1 or BRCA2 gene mutation who are being treated with a mastectomy for the breast with cancer should also be offered a risk-reducing mastectomy for the opposite breast, including nipple-sparing mastectomy. This is because getting a risk-reducing mastectomy in the opposite breast is associated with a decreased risk of getting cancer in that breast.
However, not everyone will be a good candidate for nipple-sparing mastectomy. For those with large breasts and little nipple projection, for example, a breast reduction may be done first to get the nipple in a better position. To assess your risk of developing cancer in the opposite breast and determine whether you might be eligible for a risk-reducing mastectomy, your doctor will consider several factors:.
The likelihood of recurrence of your breast cancer or other cancers you may have, such as ovarian cancer. Women with a moderate-risk gene mutation, like CHEK2 or ATM , should also talk with their doctor about their risk of developing breast cancer in the opposite breast and whether undergoing a risk-reducing mastectomy, including a nipple-sparing mastectomy, may be right for them. Women with a high-risk mutation who do not have a bilateral mastectomy should have regular screening of the remaining breast tissue with an annual mammogram and breast MRI for enhanced surveillance.
Although the risk of getting a new cancer in that breast will be lowered, surgery to remove the other breast does not reduce the risk of the original cancer coming back. Survival is based on the prognosis of the initial cancer. In addition, more extensive surgery may be linked with a greater risk of problems.
Read more about talking with your doctor about breast surgery options. Please note that this link takes you to a separate ASCO website. Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist.
There are several different types of radiation therapy:. External-beam radiation therapy. This is the most common type of radiation treatment and is given from a machine outside the body. This includes whole breast radiation therapy and partial breast radiation therapy, as well as accelerated breast radiation therapy, which can be several days instead of several weeks. Intra-operative radiation therapy.
This is when radiation treatment is given using a probe in the operating room. This type of radiation therapy is given by placing radioactive sources into the tumor. Although the research results are encouraging, intra-operative radiation therapy and brachytherapy are not widely used. Where available, they may be options for a patient with a small tumor that has not spread to the lymph nodes.
Learn more about the basics of radiation therapy. A radiation therapy regimen, or schedule see below , usually consists of a specific number of treatments given over a set period of time, such as 5 days a week for 3 to 6 weeks.
Radiation therapy often helps lower the risk of recurrence in the breast. Survival is the same with lumpectomy or mastectomy. If there is cancer in the lymph nodes under the arm, radiation therapy may also be given to the same side of the neck or underarm near the breast or chest wall.
Adjuvant radiation therapy is given after surgery. Most commonly, it is given after a lumpectomy, and sometimes, chemotherapy. Patients who have a mastectomy may or may not need radiation therapy, depending on the features of the tumor. Radiation therapy may be recommended after mastectomy if a patient has a larger tumor, cancer in the lymph nodes, cancer cells outside of the capsule of the lymph node, or cancer that has grown into the skin or chest wall, as well as for other reasons.
Neoadjuvant radiation therapy is radiation therapy given before surgery to shrink a large tumor, which makes it easier to remove. This approach is uncommon and is usually only considered when a tumor cannot be removed with surgery. Women with a TP53 mutation are at higher risk of complications from radiation therapy, and therefore should undergo mastectomy instead of lumpectomy and radiation.
Those with an ATM mutation or other related mutations should talk with their doctor about whether adjuvant radiation therapy is right for them. Currently, there is not enough data to recommend avoiding radiation therapy in all women with ATM mutations. Your doctor can recommend topical medication to apply to the skin to treat some of these side effects.
Very rarely, a small amount of the lung can be affected by the radiation therapy, causing pneumonitis, a radiation-related swelling of the lung tissue. This risk depends on the size of the area that received radiation therapy, and it tends to heal with time. In the past, with older equipment and radiation therapy techniques, women who received treatment for breast cancer on the left side of the body had a small increase in the long-term risk of heart disease.
Modern techniques, such as respiratory gating, which uses technology to guide the delivery of radiation while a patient breathes, are now able to spare the vast majority of the heart from the effects of radiation therapy.
Many types of radiation therapy may be available to you with different schedules see below. Talk with your doctor about the advantages and disadvantages of each option. After a lumpectomy. If you have inflammatory breast cancer: Stage III cancers also include some inflammatory breast cancers that have not spread beyond nearby lymph nodes.
Treatment of these cancers can be slightly different from the treatment of other stage III breast cancers. You can find more details in our section about treatment for inflammatory breast cancer. Most often, these cancers are treated with neoadjuvant chemotherapy before surgery. For HER2-positive tumors, the targeted drug trastuzumab Herceptin is given as well, sometimes along with pertuzumab Perjeta. This may shrink the tumor enough for a woman to have breast-conserving surgery BCS.
Nearby lymph nodes will also need to be checked. Often, radiation therapy is needed after surgery. If breast reconstruction is done, it is usually delayed until after radiation is complete. In some cases, additional chemo is given after surgery as well. After surgery, some women with HER2-positive cancers will be treated with trastuzumab with or without pertuzumab for up to a year. Many women with HER2-positive cancers will be treated first with trastuzumab with or without pertuzumab followed by surgery and then more trastuzumab with or without pertuzumab for up to a year.
If after neoadjuvant therapy, any residual cancer is found at the time of surgery, trastuzumab may be changed to a different drug, called ado-trastuzumab emtansine, which is given every 3 weeks for 14 doses.
For people with hormone receptor-positive cancer in the lymph nodes who have completed a year of trastuzumab, the doctor might also recommend additional treatment with an oral drug called neratinib for a year.
Women with hormone receptor-positive ER-positive or PR-positive breast cancers will also get adjuvant hormone therapy which can typically be taken at the same time as trastuzumab. Sorry something went wrong with your subscription Please, try again in a couple of minutes Retry. Request an Appointment at Mayo Clinic. Share on: Facebook Twitter. Show references Chemotherapy for breast cancer. American Cancer Society.
Accessed Dec. Breast cancer. National Comprehensive Cancer Network. Sikov WM, et al. General principles of neoadjuvant management of breast cancer. What to expect when having chemotherapy. National Cancer Institute. Taghian A, et al. Overview of the treatment of newly diagnosed, invasive, non-metastatic breast cancer.
Fertility concerns and preservation for women. Accessed Aug. Chemotherapy to treat cancer. Long-term side effects of cancer treatment. Sikov WM. Neoadjuvant therapy for patients with HER2-positive breast cancer. Inflammatory breast cancer.
Coping with cancer: A new normal. Kinoshita T, et al. Efficacy of scalp cooling in preventing and recovering from chemotherapy-induced alopecia in breast cancer patients: The HOPE study.
Frontiers in Oncology. Hair loss or alopecia. An KY, et al. Effects of exercise dose and type during breast cancer chemotherapy on longer-term patient-reported outcomes and health-related fitness: A randomized controlled trial. International Journal of Cancer. Accessed Jan. Member institutions. Alliance for Clinical Trials in Oncology. Translational Breast Cancer Research Consortium. Member institution lists. NRG Oncology. Related Breast cancer Breast cancer chemoprevention Common questions about breast cancer treatment Inflammatory breast cancer Infographic: Scalp Cooling Therapy for Cancer Invasive lobular carcinoma Male breast cancer Paget's disease of the breast Recurrent breast cancer What is breast cancer?
A chemo combination sometimes given this way is doxorub i cin Adriamycin and cyclophosphamide Cytoxan , followed by weekly paclitaxel Taxol. Chemo drugs can cause side effects. These depend on the type and dose of drugs given, and the length of treatment. Some of the most common possible side effects include:. These side effects usually go away after treatment is finished. There are often ways to lessen these side effects.
For example, drugs can be given to help prevent or reduce nausea and vomiting. Other side effects are also possible. Some of these are more common with certain chemo drugs. Ask your cancer care team about the possible side effects of the specific drugs you are getting. For younger women, changes in menstrual periods are a common side effect of chemo. Premature menopause not having any more menstrual periods and infertility not being able to become pregnant may occur and may be permanent.
Some chemo drugs are more likely to cause this than others. The older a woman is when she gets chemotherapy, the more likely it is that she will go through menopause or become infertile as a result.
When this happens, there is an increased risk of bone loss and osteoporosis. There are medicines that can treat or help prevent bone loss. Even if your periods have stopped while you are on chemo, you may still be able to get pregnant. Getting pregnant while on chemo could lead to birth defects and interfere with treatment. Women who have finished treatment like chemo can safely go on to have children, but it's not safe to get pregnant while on treatment.
If you think you might want to have children after being treated for breast cancer, talk with your doctor before you start treatment.
Learn more from our section on fertility concerns for women with cancer. If you are pregnant when you get breast cancer, you still can be treated.
0コメント