Breast Cancer Early Stage : Part 3

by Women's Health Information Center

(Page 3 of 4)

What are the chances of the cancer coming back if I get a lumpectomy with radiation? If it comes back, is it likely to be invasive? If I decide on a lumpectomy/radiation, how can you be sure there are no other "spots" in the breast? Wouldn't a mastectomy eliminate that possibility?

Approximately one of every ten patients who are treated with lumpectomy and radiation therapy will have a recurrence of breast cancer in the same breast within 12 years. Recurrence in the same breast usually requires additional surgery, but does not affect chances of survival compared to mastectomy. However, fear of recurrence of breast cancer is the reason why many women prefer a mastectomy to a lumpectomy. It seems rather obvious that you can't get cancer in your breast if your breast is removed. However, women who have undergone a mastectomy can still experience a recurrence on the chest wall where the breast was removed. Recurrence on the chest wall following a mastectomy is slightly less likely than recurrence in the same breast following a lumpectomy and radiation.

As we explained earlier, recurrence of cancer in the other breast or elsewhere in the body does not differ between mastectomy patients and lumpectomy patients.

What does "margin" mean?

In a lumpectomy, the surgeon removes the cancer (the "lump") and a narrow area of normal breast tissue surrounding the lump (the "margin"). The goal is to obtain "clean margins"-breast tissue around the tumor that is completely free of cancer.

I have heard that some tumors are "estrogen receptor-positive?" What does that mean? If my tumor is estrogen receptor-positive, should that make a difference in my treatment?

Some breast cancers are sensitive to the female hormone, estrogen, and are called "estrogen receptor-positive." The drug tamoxifen interferes with estrogen and when breast cancer cells are sensitive to estrogen, tamoxifen can inhibit their growth.

Studies have shown that tamoxifen improves the chances of survival and helps prevent recurrence of breast cancer, if the cancer cells are estrogen receptor-positive. Tamoxifen is not an effective treatment for breast cancer that is estrogen receptor-negative, and therefore should not be taken for those cancers. Tamoxifen may have unpleasant side effects that are similar to menopause, such as hot flashes, vaginal dryness, irregular periods, and weight gain. Tamoxifen also slightly increases the risk of uterine cancer and blood clots. Studies suggest that Tamoxifen should not be taken for more than five years.

If I choose a lumpectomy, how much of my breast has to be taken out? Will it affect the look of my breast? What will the scar look like?

Breast-conserving surgery is also known as lumpectomy, partial mastectomy, segmental mastectomy, or quadrantectomy. These surgeries remove the cancer but leave most of the breast intact. In a lumpectomy, the surgeon removes the cancer and some normal breast tissue surrounding the lump in order to obtain "margins" around the tumor that are free of cancer. The other types of breast-conserving surgery remove a somewhat larger area of the healthy breast. The appearance of the breast will depend on the size of the breast compared to the size of the cancer and the amount of healthy breast tissue that is removed. The appearance of the scar depends on the type of surgery and the location of the cancer.

What will my breast look like after lumpectomy/radiation? I hear it gets hard.

Depending on the size of the cancer and the margins, and a woman's response to radiation, a breast may look almost identical after a lumpectomy, or it may look quite different. Radiation can cause a skin condition that looks like sunburn. This usually fades, but in some women it never goes away completely. It is also true that some women find that radiation makes their breast feel hard or firm. Again, this may last just a few months, or longer. However, firm or hard breasts are even more common among women who have implants after a mastectomy.

I thought that radiation can cause cancer. Will it increase my risk for other cancers?

Radiation therapy has improved greatly through the years, and the doses are much lower than they used to be. The bottom line is that women who have radiation therapy after lumpectomy are less likely to have a cancer recurrence in the same breast, and they live just as long as women who undergo mastectomy without radiation. There are exceptions: women who are pregnant do not undergo radiation treatment because it is dangerous to the fetus, and radiation can be harmful to women who have certain diseases, such as lupus.

Can I have a mastectomy without removing the nipple?

Most surgeons recommend removal of the nipple because cancer cells can grow there. Although rarely done, it is possible to undergo a subcutaneous mastectomy, and save the nipple, if the cancer is not located near the nipple. A subcutaneous mastectomy is more likely than a total mastectomy to leave breast cells behind that could become cancerous. Neither the nipple nor the breast will have the same sensations after a mastectomy that they do before a mastectomy, because the nerves are cut.

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