During the past 20 years there have been many new developments and changes in the approach to the treatment of breast cancer. Knowledge is growing constantly as new treatments are tested, but it takes many years to know the value of a new treatment compared with older treatments in terms of cure, prolonged survival and quality of life.
Some of the new treatments are still the subject of debate. Medical opinion can differ on what type of treatment should be offered to women with different types and stages of breast cancer.
The stages of cancer are defined according to the size and cell type of the cancer and its spread within the breast, the presence and number of axillary (armpit) lymph nodes containing cancer cells, and whether the cancer has spread beyond the breast and axilla.
Another measurement used in making decisions about the type of treatment used is the receptor status of the cancer cells. Breast cancer cells can be tested to see how they respond to ovarian hormones, which helps predict how the cancer will respond to anti-hormonal treatment.
These days women are encouraged to] take part in decisions about treatment of their breast cancer. Your doctors should give you full information about the stags of your cancer, the treatments available and why they believe any one treatment will be better than others in your case. It can be very confusing if you’re given two
different opinions. Another opinion from an oncologist (specialist in the treatment of cancer) may be helpful. You may wan your partner, another family member я close friend to be involved in discussions and decisions about treatment.
Most small cancers, when the breast doesn’t contain or is unlikely to contain other areas of cancer, are now removed’ by local excision, called ‘lumpectomy’ or ‘partial mastectomy’. This surgery is always followed by six weeks of radiotherapy, and some of the glands from the armpit will almost always be removed for examination.
If it is suspected that the cancer has spread within the breast, many doctors still advise mastectomy. A simple mastectomy removes only the breast. Modified radical mastectomy, performed if there я any suspicion of spread, removes the whole breast and the lymph glands in tin armpit, but leaves the major muscles of the chest and armpit. After surgery your appearance when dressed (and wearing a breast prosthesis) is normal, even in a swimming costume.
Whether a breast cancer is suitable for lumpectomy or mastectomy depends on the type and position of the tumour, the age and general health of the woman, the size of the breast and whether a good cosmetic result can be achieved.
It is accepted that radiotherapy to the breast after lumpectomy or mastectomy is necessary to destroy any isolated or small groups of cancer cells that might remain in the breast but be too small to be detected.
The advantage of lumpectomy and radiotherapy is that they preserve an almost normal breast. The lymph glands in the armpit may be removed through a separate incision. Lumpectomy with breast preservation is a great incentive for women to see their doctors early, when breast lumps are still small and the chance of cure is greatest. In the past, when most breast cancer was treated by mastectomy, many women put off seeking diagnosis of breast lumps for fear of losing a breast.
Lumpectomy plus radiotherapy and mastectomy plus radiotherapy have the same rates of success.
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