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McKesson Clinical Reference Systems: Women's Health Advisor 2002.2
Breast Cancer, Operable
What is breast cancer?
Breast cancer is the development of abnormal cells in the
breast. These cells grow and replace normal healthy tissue.
They can also spread beyond the breast.
Cancer of the breast is one of the most common cancers in
women. Men also can have breast cancer although it is much
less common in men.
If the cancer is found early enough, a surgeon can remove
(resect) just the lump and a small amount of breast tissue.
However, surgery may involve removing all of the breast.
How does it occur?
When abnormal cells grow uncontrollably, they are called
cancers. It is not known why many cancers occur.
Some women are more likely to have breast cancer than
others. You are at a greater risk of having breast cancer
if:
- You have a close relative, such as a mother, sister,
maternal aunt, or maternal grandmother with breast
cancer.
- You have never breast-fed a baby or you had your first
child after age 30.
- You started your menstrual period very early or you went
through menopause very late.
Taking birth control pills and oral estrogen does not seem
to increase the risk of breast cancer.
What are the symptoms?
The first symptom for about 80% of women with breast cancer
is a lump in the breast. Most women find the lump
themselves during a breast self-exam. Usually the lump is
painless and it may be difficult to feel at first.
Sometimes the skin over the lump is dimpled or creased.
There may be a bloody discharge from the nipple or the
nipple may start to turn inward.
How is it diagnosed?
Most breast lumps are found by women during a breast
self-exam. Sometimes the cancer is discovered by a health care
provider during a routine physical exam or mammogram. A
mammogram is a special x-ray of the breast to look for
breast cancer.
After the age of 40 you should have a mammogram every 1 or 2
years, according to the schedule recommended by your health
care provider. At age 50 and thereafter, you should have a
mammogram every year. If you are at high risk for breast
cancer, you should start having mammograms at age 35 or
earlier.
Other tests health care providers use for diagnosis are
ultrasound scans and sometimes magnetic resonance imaging
(MRI).
If you have a suspicious lump you will need a biopsy.
Sometimes a needle is used to withdraw cells from the lump,
through the skin, and into a syringe. This is called a
needle biopsy or aspiration. A surgical biopsy may be used
to remove the lump. With either type of biopsy, you will be
given a local anesthetic to numb the area of the breast that
is being tested. The cells from biopsies are sent to a
pathology lab to be examined for cancer.
How is it treated?
The treatment for breast cancer is based on many factors,
including your age and family history. In general, surgical
treatment for breast cancer depends on the size of the tumor
and the risk for spread to the lymph nodes. Medical
treatment with hormones or chemotherapy may be advised.
In most cases a surgeon will remove the tumor and some
portion of the breast. A lumpectomy is removal of the lump
and some of the breast tissue around it. A mastectomy is
removal of the whole breast. There are different types of
mastectomies, depending on the amount of tissue removed, for
example:
- Simple mastectomy: The breast is removed.
- Modified radical mastectomy: The breast and lymph glands
under the armpit are removed.
Before you have a mastectomy, discuss with your surgeon the
options for breast reconstruction. A mastectomy is usually
followed by hormone therapy or chemotherapy or both.
A lumpectomy is usually followed by radiation treatments,
chemotherapy, and/or hormone therapy. During radiation
therapy, high doses of radiation are given to the breast and
surrounding areas to kill any cancer cells not removed by
surgery. You may have chemotherapy before or after surgery.
In chemotherapy, anticancer drugs are given to kill cancer
cells.
Can treatment cure breast cancer?
The chances for a complete cure or many years of good health
are very good if a tumor is removed while it is still small
and before it has spread to other parts of the body.
Modern detection and treatment methods have greatly
increased the chances of surviving breast cancer. Also, the
side effects of new drugs are much less unpleasant than
those of earlier types of drugs.
How can I take care of myself?
Be sure you have a healthy diet, follow an exercise program
your health care provider has suggested, and quit smoking.
Breast surgery, especially mastectomy, is emotionally
traumatic for most women. Women usually worry about their
appearance, the effects on their relationship with their
sexual partner, and their general physical limitations, if
any. Young women are also concerned about future pregnancy
and nursing. You should discuss these issues with your
health care provider(s). You might also discuss them with a
breast cancer support group.
There are many support groups for women who have had
mastectomies. These support groups are usually made up of
former breast cancer patients and can provide emotional
support after surgery. They can also help with practical
matters such as finding comfortable bras and bathing suits.
Ask your health care provider for information about the
support group nearest you.
Losing a breast is usually emotionally traumatic. Many
breast cancer patients feel disfigured after surgery.
However, you can recreate your breast's shape. Some women
have an artificial breast implanted. Other women wear a
prosthesis inside their bra, which is matched to their other
breast. Discuss your choices with your health care
provider.
What can be done to help prevent a recurrence?
After treatment your health care provider will recommend
checkups every 3 to 12 months. It is important to continue
doing breast self-exams regularly and report anything
abnormal to your health care provider immediately. If the
cancer recurs, it can often be kept from spreading for many
years by drugs, radiation, and possibly more surgery.
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