What Is Breast Cancer
Following a breast cancer diagnosis there are many questions. These include “What is breast cancer”, “Why me?”, “What now?”
As a patient who may require Breast Cancer Surgery, you need to understand the different kinds of breast cancer. You need to know the specific treatments useful for your disease. This is not a situation in which one size fits all.
Some cancers arise from the milk ducts. Some from the lobules. Some have characteristics of both, and some grow with a strong inflammatory component. All of these tumors have different growth characteristics, varied risks, and different treatment considerations.
Sometimes, the most aggressive sounding treatment is no better than a simpler less intrusive treatment.
Friends may try to help by telling you their experience and suggesting how you should proceed. But all cancers are unique. They may have had a very different cancer than you.
Getting reliable scientifically valid information is key to treatment success. Dr. Hyams and his staff will make sure that you get all the information you need to make informed decisions about your care. You are unique, and so is your cancer.
What Is Breast Cancer
Following a breast cancer diagnosis there are many questions. These include “What is breast cancer”, “Why me?”, “What now?”
As a patient, you need to understand the different kinds of breast cancer. You need to know the specific treatments useful for your disease. This is not a situation in which one size fits all.
Some cancers arise from the milk ducts. Some from the lobules. Some have characteristics of both, and some grow with a strong inflammatory component. All of these tumors have different growth characteristics, varied risks, and different treatment considerations.
Sometimes, the most aggressive sounding treatment is no better than a simpler less intrusive treatment.
Friends may try to help by telling you their experience and suggesting how you should proceed. But all cancers are unique. They may have had a very different cancer than you.
Getting reliable scientifically valid information is key to treatment success. Dr. Hyams and his staff will make sure that you get all the information you need to make informed decisions about your care. You are unique, and so is your cancer.
Understanding Invasive Breast Cancer
Invasive breast cancer implies cancer that has grown through the milk producing lobule, or through the milk duct. It can spread via the blood stream or lymph vessels to other parts of the body.
Invasive breast cancer requires surgery for cure. The type of surgery performed depends upon the nature and extent of disease.
Surgery of invasive breast cancer usually involves sampling of lymph nodes using sentinel lymph node biopsy technique.
Invasive lobular cancer (ILC) derives from the milk lobules. It has receptors to estrogen (ER+) and may respond to hormone blocking drugs, chemotherapy, and radiation therapy. ILC grows in a more diffuse manner and may occur in multiple areas.
Invasive ductal cancers (IDC) arise in the milk ducts and are the most common form of breast cancer. IDC may be responsive to the hormones estrogen (ER+) and progesterone (PG+), or may have lost these receptors (ER-, PR-). Only ER+ cancers are treated with estrogen blocking drugs.
Nearly 20% of IDC over-express a growth protein called HER2/neu. These tumors are very aggressive. But, with modern preoperative drug therapy, these tumors respond very well to treatment. Surgery usually follows to assure adequate treatment.
IDC that are ER-, PR-, and HER2-, are called triple negative. These may be very aggressive and are usually treated with chemotherapy before or after surgery.
Two-thirds of early stage breast cancers are ER+, and two-thirds of those will neither require nor benefit from chemotherapy. Modern gene expression testing helps us avoid unnecessary chemotherapy.
Understanding LCIS and DCIS
Lobular Carcinoma In Situ (LCIS) snd Duct Carcinoma In Situ (DCIS) suggest cancers that have not invaded through the wall of the milk lobule or duct.
Neither condition poses an immediate threat to life.
Most LCIS is no longer considered true cancer. Rather, it is a “risk indicator” for future cancer in either the same or the opposite breast. As a result, this common form of LCIS does not need to be removed. However, LCIS does suggest a need for enhanced screening and may be an indication for medication-based prevention strategies.
DCIS is different. It is a true cancer. But it itself is NOT life-threatening. DCIS can evolve and, if untreated, may become invasive breast cancer which IS a life-threatening disease. Inadequately treated DCIS may recur, and when it does, may do so as life-threatening invasive breast cancer
Surgery, drug therapy, and radiation may all minimize risk of recurrence. But not all patients need all treatments.
Understanding Sentinel Lymph Node Biopsy
Lymphatics are vessels that return tissue fluid to the circulation. Lymph nodes are filtering stations along the lymphatics that trap bacteria, foreign debris, and cancer cells traversing the lymphatics.
The presence of cancer cells in a lymph node increases the stage and risk of a cancer, and may lead to more aggressive postoperative treatment.
A protein-based dye, either colored or radioactive, make it possible to identify a specific lymph node draining a specific body area, such as the breast.
By identifying the “most likely lymph node”, we can remove it and subject it to very detailed pathology analysis without having to remove large numbers of nodes.
If this so-called “sentinel lymph node” is negative, studies have shown that 94% of the time, remaining lymph nodes in that area would be free of disease as well.
When positive, other lymph nodes may be positive and may be treated with either removal or with radiation therapy.
Oncoplastic Breast Conservation Surgery and Radiation Therapy
Some DCIS, ILC, and even ordinary IDC may be difficult to remove with optimally clear margins using standard lumpectomy techniques. The results of such surgical efforts may be cosmetically unappealing.
After surgery, many patients depend on postoperative radiation therapy for local control of their cancer. Depending upon the circumstance some may need to go on to total mastectomy.
Using good oncoplastic technique, a much wider field of access, may lead to a more effective removal of cancer in a larger population of patients. This may have other benefits.
Studies have shown that selected women with DCIS may reasonably avoid radiation therapy without ill effect. A decision to avoid radiation therapy may be influenced by type of surgery and gene expression profiling of the tumor.
Additional studies have shown that women over 70, with invasive cancer of moderate grade and size, may also be managed without radiation therapy. Such decisions, however, depend upon the adequacy of surgery.
Oncoplastic surgery can minimize the need for postoperative radiation therapy after breast conservation surgery… and result in a better cosmetic appearance.
Indications for Mastectomy and Breast Reconstruction
Long term studies have shown that breast conservation surgery is a safe and effective treatment for breast cancer in suitably selected patients.
However, some patients present with strong family history, specific high-risk gene mutations, or tumors that are too large or too extensive to make a conservation operation appropriate. For these women, mastectomy may be the optimal approach.
But mastectomy doesn’t have to be the mutilating operation it once was. Modern oncoplastic techniques allow removal of more than 90% of breast tissue, while saving the overlying skin envelope and nipple.
Skin and nipple-sparing mastectomy, combined with immediate reconstruction, can preserve the anatomic and aesthetic component of the breast, while removing the underlying glandular tissue at risk.
Studies have shown a 90% reduction in risk of new breast cancer after mastectomy, underscoring the value of the operation. However, these data also reaffirm the importance of ongoing monitoring to identify even the smallest possibility of future disease.
Having a surgical oncologist, who is also experienced in breast reconstruction, allows the cancer operation to be planned with the reconstructive procedure in mind. This minimizes preoperative visits for patients, facilitates surgical scheduling, and optimizes intraoperative care.
Understanding Breast Cancer Risk
As with most cancers, the development of disease is due to a combination of genetic predisposition and environmental impact. Some, but not all, genetic alterations have been tabulated and can be measured using a simple test of cells in your saliva.
For patients concerned about their risk, or that of their family, there are environmental and behavioral modifications that may reduce risk. These include minimizing alcohol consumption to no more than one drink per day, maintaining optimal body weight, minimizing the length of time post menopausal hormonal replacement therapy is used, and avoiding a sedentary lifestyle.
Elevated genetic risk does not automatically mean that bilateral mastectomy is necessary. In some cases, patients may have more intensive follow-up and screening. In some cases, genetic analysis will identify other organ systems at risk for cancer development. Managing these risks is important.
Some women are best served by bilateral mastectomy. Others may simply utilize enhanced screening. Discussing and managing these risks is an important part of oncology prevention.
Blood relatives may also carry the genetic predisposition. Testing and consultation may be indicated for them as well.
Dr. Hyams can answer your most concerning questions and design a followup program for you. He can also manage prevention strategies with drugs or surgery. Finally, he can refer you to a genetic counselor who can answer additional questions and provide professional perspective.
Understanding Benign (Non-cancerous) Conditions
There are many benign conditions of the breast which cause worry or symptoms. These range from diffuse fibronodular disease to large cysts or even solid tumors. There are also borderline conditions, not themselves cancerous, but which may be associated with an increased risk of future cancer.
Some of these conditions require no treatment. Some require simple symptomatic interventions, and for some complex management is indicated. Some high-risk benign conditions may be suitable for drug therapy in order to prevent future cancer development.
Dr. Hyams can explain these diagnoses and can design a follow-up plan and prevention program tailored to patients with benign disease and elevated risk.
Understanding Invasive Breast Cancer
Invasive breast cancer implies cancer that has grown through the milk producing lobule, or through the milk duct. It can spread via the blood stream or lymph vessels to other parts of the body.
Invasive breast cancer requires surgery for cure. The type of surgery performed depends upon the nature and extent of disease.
Surgery of invasive breast cancer usually involves sampling of lymph nodes using sentinel lymph node biopsy technique.
Invasive lobular cancer (ILC) derives from the milk lobules. It has receptors to estrogen (ER+) and may respond to hormone blocking drugs, chemotherapy, and radiation therapy. ILC grows in a more diffuse manner and may occur in multiple areas.
Invasive ductal cancers (IDC) arise in the milk ducts and are the most common form of breast cancer. IDC may be responsive to the hormones estrogen (ER+) and progesterone (PG+), or may have lost these receptors (ER-, PR-). Only ER+ cancers are treated with estrogen blocking drugs.
Nearly 20% of IDC over-express a growth protein called HER2/neu. These tumors are very aggressive. But, with modern preoperative drug therapy, these tumors respond very well to treatment. Surgery usually follows to assure adequate treatment.
IDC that are ER-, PR-, and HER2-, are called triple negative. These may be very aggressive and are usually treated with chemotherapy before or after surgery.
Two-thirds of early stage breast cancers are ER+, and two-thirds of those will neither require nor benefit from chemotherapy. Modern gene expression testing helps us avoid unnecessary chemotherapy.
Understanding LCIS and DCIS
Lobular Carcinoma In Situ (LCIS) snd Duct Carcinoma In Situ (DCIS) suggest cancers that have not invaded through the wall of the milk lobule or duct.
Neither condition poses an immediate threat to life.
Most LCIS is no longer considered true cancer. Rather, it is a “risk indicator” for future cancer in either the same or the opposite breast. As a result, this common form of LCIS does not need to be removed. However, LCIS does suggest a need for enhanced screening and may be an indication for medication-based prevention strategies.
DCIS is different. It is a true cancer. But it itself is NOT life-threatening. DCIS can evolve and, if untreated, may become invasive breast cancer which IS a life-threatening disease. Inadequately treated DCIS may recur, and when it does, may do so as life-threatening invasive breast cancer
Surgery, drug therapy, and radiation may all minimize risk of recurrence. But not all patients need all treatments.
Understanding Sentinel Lymph Node Biopsy
Lymphatics are vessels that return tissue fluid to the circulation. Lymph nodes are filtering stations along the lymphatics that trap bacteria, foreign debris, and cancer cells traversing the lymphatics.
The presence of cancer cells in a lymph node increases the stage and risk of a cancer, and may lead to more aggressive postoperative treatment.
A protein-based dye, either colored or radioactive, make it possible to identify a specific lymph node draining a specific body area, such as the breast.
By identifying the “most likely lymph node”, we can remove it and subject it to very detailed pathology analysis without having to remove large numbers of nodes.
If this so-called “sentinel lymph node” is negative, studies have shown that 94% of the time, remaining lymph nodes in that area would be free of disease as well.
When positive, other lymph nodes may be positive and may be treated with either removal or with radiation therapy.
Oncoplastic Breast Conservation Surgery and Radiation Therapy
Some DCIS, ILC, and even ordinary IDC may be difficult to remove with optimally clear margins using standard lumpectomy techniques. The results of such surgical efforts may be cosmetically unappealing.
After surgery, many patients depend on postoperative radiation therapy for local control of their cancer. Depending upon the circumstance some may need to go on to total mastectomy.
Using good oncoplastic technique, a much wider field of access, may lead to a more effective removal of cancer in a larger population of patients. This may have other benefits.
Studies have shown that selected women with DCIS may reasonably avoid radiation therapy without ill effect. A decision to avoid radiation therapy may be influenced by type of surgery and gene expression profiling of the tumor.
Additional studies have shown that women over 70, with invasive cancer of moderate grade and size, may also be managed without radiation therapy. Such decisions, however, depend upon the adequacy of surgery.
Oncoplastic surgery can minimize the need for postoperative radiation therapy after breast conservation surgery… and result in a better cosmetic appearance.
Indications for Mastectomy and Breast Reconstruction
Long term studies have shown that breast conservation surgery is a safe and effective treatment for breast cancer in suitably selected patients.
However, some patients present with strong family history, specific high-risk gene mutations, or tumors that are too large or too extensive to make a conservation operation appropriate. For these women, mastectomy may be the optimal approach.
But mastectomy doesn’t have to be the mutilating operation it once was. Modern oncoplastic techniques allow removal of more than 90% of breast tissue, while saving the overlying skin envelope and nipple.
Skin and nipple-sparing mastectomy, combined with immediate reconstruction, can preserve the anatomic and aesthetic component of the breast, while removing the underlying glandular tissue at risk.
Studies have shown a 90% reduction in risk of new breast cancer after mastectomy, underscoring the value of the operation. However, these data also reaffirm the importance of ongoing monitoring to identify even the smallest possibility of future disease.
Having a surgical oncologist, who is also experienced in breast reconstruction, allows the cancer operation to be planned with the reconstructive procedure in mind. This minimizes preoperative visits for patients, facilitates surgical scheduling, and optimizes intraoperative care.
Understanding Breast Cancer Risk
As with most cancers, the development of disease is due to a combination of genetic predisposition and environmental impact. Some, but not all, genetic alterations have been tabulated and can be measured using a simple test of cells in your saliva.
For patients concerned about their risk, or that of their family, there are environmental and behavioral modifications that may reduce risk. These include minimizing alcohol consumption to no more than one drink per day, maintaining optimal body weight, minimizing the length of time post menopausal hormonal replacement therapy is used, and avoiding a sedentary lifestyle.
Elevated genetic risk does not automatically mean that bilateral mastectomy is necessary. In some cases, patients may have more intensive follow-up and screening. In some cases, genetic analysis will identify other organ systems at risk for cancer development. Managing these risks is important.
Some women are best served by bilateral mastectomy. Others may simply utilize enhanced screening. Discussing and managing these risks is an important part of oncology prevention.
Blood relatives may also carry the genetic predisposition. Testing and consultation may be indicated for them as well.
Dr. Hyams can answer your most concerning questions and design a followup program for you. He can also manage prevention strategies with drugs or surgery. Finally, he can refer you to a genetic counselor who can answer additional questions and provide professional perspective.
Understanding Benign (Non-cancerous) Conditions
There are many benign conditions of the breast which cause worry or symptoms. These range from diffuse fibronodular disease to large cysts or even solid tumors. There are also borderline conditions, not themselves cancerous, but which may be associated with an increased risk of future cancer.
Some of these conditions require no treatment. Some require simple symptomatic interventions, and for some complex management is indicated. Some high-risk benign conditions may be suitable for drug therapy in order to prevent future cancer development.
Dr. Hyams can explain these diagnoses and can design a follow-up plan and prevention program tailored to patients with benign disease and elevated risk.
