In the recent century, the main treatment for brest cancer has been mastectomy, removal of the entire breast. But, studies carried out recently show that it is possible to obtain the same results without requiring mastectomy.
Life expectency is already high at early stage of breast cancer, so it is possible to improve life expectancy of the patient and get a cosmetically good result with partial surgery instead of mastectomy. Here, there are 2 possible methods; breast conserving surgery and oncoplastic surgery (it is used when the tumor is relatively big).
Locally Advanced breast cancer means tumor in breast and axillary area. It is one further step from early stage. At this stage, to shrink the tumor with adjuvant treatment such as chemotherapy or radiotherapy, and then to operate is the procedure. For these patients, mastectomy may not safe at all. For a patient who is appropriate for mastectomy, it is possible to perform breast conserving surgeries in which breast is conserved better and cosmetically good results are obtained.
In short, the procedure in locally advanced breast cancer is firstly to shrink tumor with adjuvant treatments such as radiotherapy, chemotherapy or endocrine treatment, then to perform surgery.
If breast cancer tumor spreads other parts of the body, it is called metastatic breast cancer. In this case, surgery is the second option. Firstly, tumor on the other parts is treated to be removed/cleaned by radiotherapy, chemotherapy or endocrine treatment. After these complementary treatments are performed, surgery is the option.
Inflammatory breast cancer is one of the most critical type of breast cancers. In inflammatory breast cancer, the breast is red and swollen, which can be confused by inflammation. The critical decision is not to diagnose the symptoms as inflammatory and send back the patient. Some additional tests should be performed even if the patient is given antibiotics or antienflammatory medicine. If breast cancer cells are detected, the treatment should be arranged accordingly.
In inflammatory breast cancer cases, firstly non-surgical treatments (radiotherapy, chemotherapy, endocrine treatment and so on) are applied. After these complementary treatments are performed, surgical treatment comes to the stage.
There are surgical treatments for breast cancer which are applied on breast and on axillary area on the same side. However, there have been big changes in these treatment options in the recent century. In the past, breast and surrounding tissues and even muscles were completely removed; however, today these operations have reached to oncoplastic levels. For axillary area, full axillary lymph nodes dissection was the only option. But nowadays, doctors prefer more limited dissection or not a dissection at all.
Mastectomy is the surgery where breast is completely removed. In the beginning of 20th century, these surgeries were performed as completely removing breast and its muscles. However, at present, they are performed less.
Scientific studies show that mastectomy does not increase the life expectancy of patients. So, mastectomy constitutes 20% of all breast cancer surgeries.
Prophylactic mastectomy is to perform mastectomy on one or both sides before having breast cancer. For example, Angelina Jolie had mastectomy before getting the disease because she had genetic mutation (in this case, the possibility of breast cancer is 60-70% after 40 years old). Her both breasts’ inner tissues were removed but the outer form of her breasts were protected. In short, mastectomy surgery can be performed as a precaution.
It has been found out that life expectancy of patients is not affected positively by surgery when the cancer is at an early stage. So, with breast-conserving surgery, to increase life expectancy, to protect breast’s appearance and to enhance patient’s life quality are possible.
Breast-conserving surgery is performed on early stage breast cancer. However, for advanced stage cancers, it can be also performed after appropriate complementary treatments (radiotherapy, chemotherapy, etc.) are applied and cancer regresses.
Oncoplastic surgery, which has been improved in recent years, can be defined as a step forward after breast-conserving surgery. While breast-conserving surgery gives good results with a limited surgery, oncoplasty provides good results even if the tumor is bigger and not suitable for breast-conserving surgery; both tumor is treated and aesthetically good results are obtained.
In breast cancer treatment, surgeries are separately applied on breast and axilla because breast cancer spreads via lymph nodes and the first area of spreading is axilla.
For metastatic spreading, lymph nodes in axillary area used to be removed completely, but nowadays, the approach is to remove the leading lymph nodes and examine them, and then to treat them accordingly. If there is no sign for cancer in these nodes, other lymph nodes are not removed.
If there is a limited involvement, doctor will choose between surgery and radiotherapy. So, surgeries applied to axilla is decreasing.
Chemotherapy is basically a medical treatment and is applied by oncologists. It can be applied before or after the surgery. Before the surgery, it is used for regression of cancer at advanced stage or inflammatory breast cancer.
After surgery, it is used with the aim of treatment when there is a certain risk of metastasis or there is metastasis.
Radiotherapy is a treatment which is applied by radiation oncologists. The aim is to control the disease at certain locations and it is not a systematic treatment like chemotherapy. It is applied to treat the area of the tumor and metastases (bones, etc.). The main aim of radiotherapy is to prevent the recurrence of cancer on breast, and it is used when the patient has breast-conservative surgery.
Not all of breast cancer cells are test positive for hormones. In other words, receptors of estrogen and progesterone is not always positive. If they are positive, an additional treatment of hormones is quite important.
Sometimes, hormonal treatment can be applied before surgery like chemotherapy for locally advanced breast cancers. Or, it can be applied after surgery while radiotherapy and chemotherapy are being applied, if the cells are test positive for hormones. There are different options in hormonal treatment. The aim of this treatment is to prevent cancer recurrence in hormone positive patients.