Should your biopsy lead to a cancer diagnosis, a team of medical professionals will help you throughout the diagnostic, treatment, and recovery process.
Tumor Conference
Before any decisions are made regarding your treatment, a multidisciplinary panel of physicians and other specialists will review your case, offering their expert opinions based on your test results and your family and medical history. This panel includes surgeons, radiation oncologists, medical oncologists, nurse navigators, a nutritionist, social worker/therapist, and more. Throughout your treatment and recovery process we will continue to keep your primary care physician informed and involved as much as he or she wants. Your primary care physician is welcome to attend your tumor conferences.
Your Nurse Navigator will be your personal advocate and guide, making sure you understand your diagnosis, your treatment options, and all support groups and services that are available to you and your family.
Local vs. Systemic Treatment
Local treatment refers to cancers that are contained within the breast (the tumor) and are usually treated with surgery and/or radiation therapy. Systemic cancer may have spread from the breast into the lymph nodes or blood stream and requires a whole body approach to its treatment. Chemotherapy, hormone therapy, and immunotherapy are systemic treatments. Chemotherapy can also be used to help shrink tumors prior to a lumpectomy. (See neoadjuvant chemotherapy below.)
Surgery: In general, there are 2 surgical options: lumpectomy (breast conservation) and mastectomy. Usually, when you have a single area of disease in your breast, lumpectomy is an option (depending on the size of the tumor and the size of your breast). This is usually followed by radiation therapy.
Mastectomy: If the cancer is in more than one place in your breast, or if the cancer is too big relative to the size of your breast, then mastectomy is the other surgical option.
Neoadjuvant chemotherapy: If a cancer is too big to do a lumpectomy, sometimes consideration is given to giving chemotherapy before surgery. This shrinks the tumor and then lumpectomy is performed with fewer complications. This is called neoadjuvant chemotherapy. Radiation therapy is then performed after the lumpectomy.
Reconstructive Surgery
Either a partial mastectomy (lumpectomy) or total mastectomy are indications for reconstructive surgery. Two main reasons for reconstructing a breast are:
- To help decrease the trauma of cancer and mastectomy or lumpectomy
- To restore a sense of self, wholeness and femininity
A successful breast reconstruction allows the patient to feel more comfortable in clothes or in a swim suit, and to feel more balanced overall.
TRAM Flap: Is a reconstructive surgery technique that refers to segments of abdominal tissues, skin, and fat that are transformed along with muscle (Transverse Rectus Abdominal Muscle) to create a new breast.
Radiation Therapy: Radiation is usually performed in conjunction with either lumpectomy or sometimes mastectomy, delivering high dose x-rays to your breast, which reduces the chance of recurrence.
Lumpectomy followed by radiation is equivalent to mastectomy in terms of survival, cure, and recurrence. Radiation therapy is usually given 5 days a week for 6 weeks. National trials are underway investigating more targeted and shorter courses of radiation. Marin Cancer Institute is participating in these trials investigating partial breast irradiation treatments like the MammoSite Radiation Therapy System and IMRT. More on Clinical Trials…
The Marin Cancer Institute continually seeks and acquires leading edge technologies and equipment to ensure the safest and most comfortable treatments for its patients.
IMRT (Intensity Modulated Radiation Therapy): Intensity modulated radiation therapy is a type of conformal radiation therapy, which shapes radiation beams and changes the intensity of the radiation to closely match the shape of the tumor or treatment area. For partial breast irradiation this maximizes the dose to the tumor while minimizing the dose to the adjacent normal tissues. It is also used for whole breast radiation therapy to ensure a very uniform dose of radiation in the breast, thereby minimizing the risk of side effects.
Respiratory Gating: Respiratory gating makes it possible to time a patient's radiation treatment to her breathing pattern. Varian’s RPM™ gating system uses an infrared camera and a special marker placed on the patient’s chest. Breathing can be monitored while taking CT scans for treatment planning as well as during treatment sessions, allowing doctors to pick the best moment in a patient’s breathing cycle to turn on the beam. As a result, treatment can be timed to the moment when the breast is furthest away from the heart, decreasing the risk of cardiac complications.
Medical Oncology
Chemotherapy | Hormone Therapy | Targeted Therapy
When a breast cancer is found, a biopsy of the lymph nodes under your arm is performed at the time of the lumpectomy or mastectomy. If the cancer has spread, usually the first place it would go is to the nodes under your arm.
Your surgeon will perform a sentinal node biopsy, which removes only a few nodes under the arm. If these nodes do not have tumor cells in them, then there is no need to remove more nodes under the arm. If tumor cells are present in the sentinel nodes, then a more complete lymph node removal is performed to determine how many nodes are involved with tumor.
This will also help guide further therapy, such as chemotherapy and radiation. The sentinel node is "mapped" right before surgery by a small amount of radioactive material which is placed in your breast before surgery and travels to the sentinel nodes so that your surgeon can identify the correct nodes to remove. Your surgeon may also inject some special blue dye at the time of surgery to help identify these same sentinel nodes.
Based on your test results your physician will review several options for treating your systemic cancer.
Chemotherapy: Chemotherapy is any treatment involving the use of drugs to kill cancer cells. Cancer chemotherapy may consist of single drugs or combinations of drugs, and can be administered through a vein, injected into a body cavity, or delivered orally in the form of a pill. Chemotherapy is different from surgery or radiation therapy in that the cancer-fighting drugs circulate in the blood to parts of the body where the cancer may have spread and can kill or eliminate cancers cells at sites great distances from the original cancer. As a result, chemotherapy is considered a systemic treatment.
More than half of all people diagnosed with cancer receive chemotherapy. For millions of people who have cancers that respond well to chemotherapy, this approach helps treat their cancer effectively, enabling them to enjoy full, productive lives. Furthermore, many side effects once associated with chemotherapy are now easily prevented or controlled, allowing many people to work, travel, and participate in many of their other normal activities while receiving chemotherapy.
Hormone Therapy: Hormonal therapy blocks or prevents cancer cells from being exposed to hormones that cause them to grow.
Certain cells in the body, such as prostate and breast, have hormone receptors on their surface. Hormones that naturally circulate in the body bind to these receptors and stimulate the cell to grow. Some cancer cells have many more of these receptors than normal, in this situation, the hormone receptors are said to be "overexpressed." These cells are particularly sensitive to the growth-stimulating effects of hormones. Hormone therapy either reduces the amount of hormone circulating in the body or blocks the receptors so that the hormones cannot bind and stimulate the cell. Thus, hormone therapy prevents some cancer cells from growing, but does not directly kill them.
Targeted Therapy: A targeted therapy is one that is designed to treat only the cancer cells and minimize damage to normal, healthy cells. Cancer treatments that "target" cancer cells may offer the advantage of reduced treatment-related side effects and improved outcomes.
Conventional cancer treatments, such as chemotherapy and radiation therapy, cannot distinguish between cancer cells and healthy cells. Consequently, healthy cells are commonly damaged in the process of treating the cancer, which results in side effects. Chemotherapy damages rapidly dividing cells, a hallmark trait of cancer cells. In the process, healthy cells that are also rapidly dividing, such as blood cells and the cells lining the mouth and GI tract are also damaged. Radiation therapy kills some healthy cells that are in the path of the radiation or near the cancer being treated. Newer radiation therapy techniques can reduce, but not eliminate this damage. Treatment-related damage to healthy cells leads to complications of treatment, or side effects. These side effects may be severe, reducing a patient's quality of life, compromising their ability to receive their full, prescribed treatment, and sometimes, limiting their chance for an optimal outcome from treatment.
Clinical Trials
B-39 Trial (NSABP B-39/RTOG 0413): Another clinical trial that MCI is currently participating in is known as the "B-39" trial. The purpose of this trial is to determine whether limiting radiation therapy to only the tumor site following lumpectomy, a procedure known as partial breast irradiation or PBI, provides equivalent local tumor control and survival compared to conventional whole breast irradiation (WBI) in the local management of early-stage breast cancer. Learn more about the B-39 Trial.
The MammoSite Radiation Therapy System (RTS): is the most widely used method of partial breast irradiation that works by delivering radiation from inside the breast directly to the tissue where cancer is most likely to recur. Radiation therapy with MammoSite RTS can be completed in up to 5 days, allowing you to get back to your life. Learn more about the advantages of MammoSite RTS.
Holistic Approach
Proven healing approaches from around the world are integrated into your conventional medical care. Research has documented the positive effects of certain integrative medicine therapies for cancer patients. These services can help ease the side effects of conventional treatments, relieve stress, and nurture your healthy lifestyle.
Through our Institute for Health & Healing, we offer an array of services to patients and family members. The staff has special training in working with cancer patients.
- Therapeutic Massage - Helps cancer patients improve their neuroendocrine and immune functions as well as reduce insomnia, anxiety and depression.
- Guided Imagery and Expressive Arts - Help to mobilize your inner healer, help you tolerate traditional treatment and stimulate your immune system.
- Nutrition Consultants - Provide guidance for cancer patients who want to enhance their immune functions and prevent some of the side effects of conventional treatments. Sessions are available to help you determine specific needs and create a plan that works.
- Therapeutic Lifestyle Change (TLC) – Teaches practical every day lifestyle skills, fosters learning and self discovery, and provides a supportive, stimulating group environment.
Recovery (Support & Hope)
The breast health program at MCI offers superb support groups and services, and is staffed by incredibly dedicated and kind men and women.
Learn about the services we offer for the patient, spouses, and families. We are always adding more, so if you have any questions, please do not hesitate to call us.
For information about the Breast Health Program, please call Cindi Cantril, RN, OCN (415) 925-7864.
For information about any of MCI’s support groups and services, call Diane Brandon (415) 925-7920.
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