Surgery is considered the primary route when it comes to breast cancer treatment. For a long time, the standard surgical procedure would involve removal of all breast tissue, including the lymph nodes in the armpit area as well. However, nowadays, physicians are able to carry out surgery and preserve as much of the breast tissue as possible, by removing just the cancerous area and a small amount of normal tissue surrounding the cancer. This is known as breast conserving surgery. 

 

Axillary (underarm) lymph node removal, which originally involved the removal of all the axillary lymph nodes, now offers patients a few more options as well. The surgeon can now remove only the lymph nodes most susceptible to the cancer. To identify these lymph nodes, the surgeon will inject a dye into the tissue near the tumor to locate the position of the sentinel lymph nodes (the first lymph nodes cancer cells are most likely to spread to). Only a few of these lymph nodes will need to be removed and examined. If cancer is found and confirmed, the rest of the sentinel lymph nodes will be removed too; if no cancer is found in the sentinel nodes, it is very unlikely that the cancer has spread to other lymph nodes, so no further lymph node surgery will be necessary. The benefits of this procedure include a lower risk of potential side effects from surgery, such as arm swelling and the inability to raise the arms. 

 

Through breast conserving surgery and new the methods in axillary lymph node surgery, patients are able to retain much of the natural shape of the breast. This method has been found to be just as effective as previous methods. However, for this option to be considered, the right conditions must be present – the cancer must be relatively small in size, and breast size must be large enough to retain its appearance following surgery. 

 

 

Physicians may recommend the patient to consider additional therapy in combination with surgery to maximize effectiveness and reduce the chance of cancer recurrence: 

 

Chemotherapy – In cases where the cancer is advanced and has spread to a number of lymph nodes, chemotherapy is necessary in treatment. However, in early stage cancers, chemotherapy is only an option the doctor may consider along other courses of treatment, depending on the conditions. For instance, chemotherapy may not be necessary for patients with only a 2-3 percent chance of recurrence within a 10 year period. One way to test cancer recurrence is through testing the patient’s tumor molecular profile.

 

Radiation Therapy – This is a targeted approach. For this, the doctor will only select patients with cancer that has spread to the regional lymph nodes (node-positive breast cancer). Doctors may not recommend radiation therapy for very early-stage cancer patients, unless undergoing breast conserving surgery, in which case, radiation therapy may be necessary to ensure all areas are thoroughly targeted.

 

Hormonal Therapy – Once a cancerous tumor has been tested and found to be estrogen receptor-positive (ER-positive), doctors will consider hormonal therapy, which aims to reduce or block estrogen hormones that could stimulate cancer cell growth. Hormonal therapy medications are divided into 2 groups: those that block the effect of estrogen on breast cancer cells, and those that lower the amount of estrogen created in the body. 

  

Targeted Therapy – This uses drugs to interfere with specific molecular targets involved in the growth and progression of the cancer, such as the HER2 protein. Doctors can also combine breast cancer targeted therapy with chemotherapy for greater effectiveness in treatment.  

 

 

By Dr. Harit Suwanrusme, Oncologist, Horizon Cancer Center, Bumrungrad Hospital

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