Breast Cancer Guidelines
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Best Wishes from Jean
Types of Breast Cancer Treatment
Choosing Between Lumpectomy and Mastectomy
The advantage of lumpectomy is that it preserves the appearance of the breast. A disadvantage for some women is the need for several weeks of radiation therapy. However, some women who have a mastectomy will still need radiation therapy.
Most women who choose lumpectomy and radiation can expect the same survival rates as those who choose mastectomy. Although most women and their doctors prefer lumpectomy and radiation therapy, what you choose will depend on a number of factors, such as:
How do you feel about losing your breast?
How far would you have to travel for radiation therapy?
If you wish to have breast reconstruction, would you be willing to undergo more surgery after having a mastectomy?
Do you prefer mastectomy, thinking of it as a way to 'get rid of as much cancer as quickly as possible?'
(Actually, mastectomy offers no such guarantees.)
Reconstructive Breast Surgery
These procedures won't treat cancer but they restore the breast's appearance after mastectomy. Breast reconstruction can be done at the same time as mastectomy (immediate reconstruction) or at a later time (delayed reconstruction). Surgeons may use implants, or tissue from other parts of the body; they call the latter autologous tissue reconstruction. How do a woman and her doctor decide on the type of reconstruction and when to undergo the procedure? The answer to that depends on the woman's personal preferences, the size and shape of her breasts, and details of her medical situation, such as how much skin is removed and whether she needs chemotherapy.
About Clinical Trials
When studying promising new or experimental treatments, researchers want to know
Does this new type of treatment work better than other treatments already available?
What side effects does the treatment cause?
Do the benefits outweigh the risks, including side effects?
Which patients will the treatment most likely help?
During your treatment for breast cancer, your doctor may suggest that you take part in a clinical trial of a new treatment. You should know that scientists only conduct clinical trials when they have reason to believe that the treatment under study may indeed be superior to other treatments. No one will receive a placebo (sugar pill) if a proven treatment is already available.
During testing of a new drug that the Food and Drug Administration has not yet approved, some people will receive the standard treatment while others will get the experimental drug. A computer randomly assigns participants to each group. Whether the experimental treatment will work better than the standard treatment must be proved. The new therapy may have some side effects, which your doctor will discuss with you before you enter the trial.
There are three phases of clinical trials in which treatments are studied before they are eligible for approval by the Food and Drug Administration. The purpose of a Phase I study is to find the best way to give a new treatment, and how much of it can be given safely. Physicians watch patients carefully for any side effects. While treatments tested in a Phase I study have been well tested in laboratory and animal studies, the side effects in patients are not completely predictable.
Phase II trials determine the effectiveness of a research treatment after safety has been evaluated in a Phase I trial. Doctors closely observe patients for an anti-cancer effect by carefully measuring cancer sites present at the beginning of the trial. In addition to monitoring patients for response, any side effects are carefully recorded and assessed.
Phase III trials require a large number of patients, sometimes thousands. A "control group" of patients may receive standard (the most accepted) treatment while another group, randomly assigned, may receive the treatment or drug under study. In this way researchers can compare the two to find out whether the new treatment is more beneficial to survival and quality of life. Doctors carefully monitor all patients in Phase III trials for side effects. The trial is discontinued if the side effects are too severe.
Taking part in any clinical trial is completely voluntary. Your doctors and nurses will explain the study to you in detail and will give you a form to read and sign. This informed consent document states that you understand the potential risks and want to participate. Even after you sign the form and the trial begins, you may leave the study at any time, for any reason. Participating in a clinical trial is an appropriate option women at any stage of breast cancer. Taking part in the study does not prevent you from getting other medical care you may need. But you should check with your health insurance company to find out whether it will cover the costs of your taking part in a clinical trial.
Participating in a clinical trial may help you directly, and it may help other women with breast cancer in the future. For these reasons, the NCCN and the ACS are committed to conducting clinical trials and helping people with cancer learn more about these studies.
There are two separate issues that need to be addressed for all women treated for breast cancer. These are the treatment of the breast itself, and the treatment for cancer cells that may have spread to other parts of the body. Doctors use the term "local therapy" to refer to treatment of the breast (usually a combination of surgery and radiation therapy), and the term "systemic therapy" to refer to chemotherapy or hormone therapy to control cancer cells that may have spread.
Breast Conserving Surgery
Nearly all women with breast cancer will have some type of surgery. Lumpectomy removes only the breast lump and the surrounding area, or margin, of normal tissue. If cancer cells are present at the margin (the edge of the excisional biopsy or lumpectomy specimen), a re-excision can usually be done to remove the remaining cancer. In almost all cases, 6 to 7 weeks of radiation therapy follow lumpectomy. Doctors call this combination (of lumpectomy and radiation) breast conserving therapy. It's an option for most, but not all, women with breast cancer. Those who probably should not undergo lumpectomy, or breast conserving therapy include:
Women who have already had radiation therapy to the affected breast or chest.
Women with two or more areas of cancer, in the same breast, too far apart to be removed in one incision.
Women whose initial excisional biopsy
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