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What are the treatment options?
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The advanced breast cancer treatments available at John Muir Health include the full complement of advanced surgical techniques, the most sophisticated radiation therapy options, and the newest chemotherapy and hormonal agents. Many patients receive combination therapy, incorporating two or more types of treatments to increase effectiveness, which is known as combined modality therapy. Determination of your best treatment plan is based on the specific type of breast cancer and its potential for spread; the stage of your cancer - whether it is localized or metastatic - the presence of complex variables such as hormone receptors, as well as your age, other medical conditions, and your preference among the various options.
Surgical Procedures
Surgery is the first treatment approach for almost all breast cancers. A guiding philosophy of the breast cancer program at John Muir Health is preservation of the breast wherever possible, without endangering the patient's long-term prognosis. Our exceptional breast surgeons are highly skilled and experienced in the full complement of advanced surgical techniques for breast cancer. Our surgical team also includes anesthesiologists with special expertise in meeting the anesthesia needs of breast cancer patients during surgery.
We are here for education, support and to help you navigate your way through your diagnosis, treatment and recovery.
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At one time, most women with breast cancer were surgically treated by a procedure known as radical mastectomy - the removal of the entire breast, lymph nodes, underlying muscle and other tissues. Today, women with breast cancer have many more options, including breast-conserving techniques in which as much of the breast as possible is left intact. The most commonly used surgical treatments for breast cancer are:
- Lumpectomy is a breast-conserving option for localized cancer, which entails the surgical removal of the lump and a small amount of normal tissue surrounding the lump (the "margins"). The amount of breast tissue removed depends on the size and location of the tumor. Other breast-conserving options include wide excision (or partial mastectomy), in which a greater amount of normal tissue is removed, and quadrantectomy, in which approximately one-fourth of the breast is removed.
- Breast-conserving surgery is normally followed by a course of radiation treatment to ensure that cancerous cells have not migrated beyond the original site.
- Women with larger cancers who are not candidates for lumpectomy may undergo a Simple Mastectomy, in which all of the breast tissue is removed. The underlying chest muscle remains intact. Many different post-mastectomy breast reconstruction options are now available.
- If cancer has spread to the lymph nodes, a simple mastectomy combined with lymph node removal may be performed, which is known as Modified Radical Mastectomy.
- Radical Mastectomy - which is rarely performed - is a procedure entailing the complete removal of the breast, chest muscles, lymph nodes and other underlying tissues.
- In addition to removing cancer from the breast, surgeons must determine if breast cancer has spread to the adjacent lymph nodes that drain the breast area. At one time, this entailed the removal of a dozen or more lymph nodes in the underarm area (axillary node dissection), an extensive procedure which often led to a disorder called lymphedema, a chronic, painful swelling of the arm caused by fluid accumulation. John Muir Health was one of the first medical centers in the Bay Area to offer an innovative biopsy technique known Sentinel Lymph Node Biopsy. A less invasive alternative to conventional lymph node biopsy, this new technique allows surgeons to examine only one lymph node, the "sentinel node," or the site where cancer cells from a breast tumor would first migrate. If the sentinel node is free of cancer, there is no need to remove any additional nodes, sparing the patient a more invasive surgery.
Chemotherapy and Hormone Manipulation
Women with advanced breast cancer that has spread, or localized cancer with greater potential for spread, may be advised to undergo chemotherapy or hormone therapy. These treatments are considered "systemic therapies," because they target cancerous cells throughout the body.
Chemotherapy - the use of cytotoxic or drugs that kill cancer - may be administered before surgery (neoadjuvant therapy), after surgery (adjuvant therapy), or in combination with radiation therapy. Women may receive a single chemotherapy agent (drug) or a combination of different agents. In some cases of advanced breast cancer, chemotherapy may be the main treatment approach.
Hormone treatment is another systemic therapy that may be used in women whose cancer is said to be hormone-sensitive, because of the presence of estrogen receptors. The female hormone estrogen promotes the growth of breast cancer cells. Hormone treatment works by blocking estrogen receptors at the cellular level, thereby stopping the cancer-promoting effects of the hormone.
Recommendations as to the specific type of chemotherapy and/or hormone therapy, and the duration of treatment, is based on many factors: age, menopausal status, whether the tumor is in situ or invasive; lymph node involvement; and whether the cancer is hormone-sensitive. At John Muir Health, all the latest chemotherapy and hormonal agents are offered, and we make sure that newly approved drugs are made available to our patients as quickly as possible. Through our active research program, with regional and national affiliations, John Muir Health also ensures that patients have access to investigational options.
Radiation Therapy
The use of high-energy x-rays or other types of radiation to kill cancer cells is used in conjunction with breast-conserving surgeries to eliminate any remaining cancer cells. Small doses of radiation are administered to the breast over a number of weeks. John Muir Health is one of northern California's premier centers for radiation therapy, with a reputation for clinical excellence and cutting-edge technology. Our state-of-the-art equipment includes five linear accelerators and two dedicated CT scanners, to ensure the most precise and effective radiation therapy available. Read more...