Comprehensive Care for Breast Cancer
The Breast Center at Dana-Farber/Brigham and Women’s Cancer Center provides comprehensive evaluation and treatment for patients with breast cancer. The multidisciplinary medical staff includes breast surgeons, radiation oncologists, medical oncologists, reconstructive surgeons, pathologists, physicists, radiologists, nurse specialists, social workers and dietitians.
Working closely together, the team provides expert diagnostic services and leading edge, innovative treatment options for patients with breast cancer. There are different types of treatment for patients with breast cancer, including surgery, radiation therapy, chemotherapy and hormone therapy.
Preoperative, pre-surgical treatment
Physicians at Dana-Farber/Brigham and Women’s Cancer Center are leaders in the use of chemotherapy prior to surgery. In the past, adjuvant therapy was given to women after surgical removal of the tumor. By giving the drugs prior to surgery, it is possible to shrink some tumors to allow for more limited surgery (for instance, a lumpectomy and not a mastectomy). It is also possible to assess the impact of chemotherapy on the tumor (that is, if it is shrinking and by how much), which may be important in the future. Large studies have shown the safety of preoperative treatments. One subtype of breast cancer is the HER2-positive cancer, which displays a unique protein (called HER2) on the surface of the malignant cells.
Very effective drugs, like trastuzumab (Herceptin®) are available to treat HER2-positive breast cancer. Clinical studies at Dana-Farber/Brigham and Women’s Cancer Center have pioneered the use of combination therapy with Herceptin® and chemotherapy, given prior to surgery in a preoperative program. These treatments are not only highly effective, but are determining the best drugs to combine with Herceptin®.
Surgery
Most patients have surgery to remove cancer cells from the breast. Lymph nodes from under the arm also are usually removed for evaluation to see if they contain cancer cells. Breast-conserving surgery, an operation to remove the cancer but not the breast itself, includes the following:
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Lumpectomy/partial or segmented mastectomy: This surgery removes the tumor and some normal tissue surrounding the tumor. Some of the lymph nodes under the arm may be removed. Lumpectomy is usually followed by radiation therapy to the breast. Lymph node removal is a separate procedure and not necessarily part of a lumpectomy procedure, though it can be performed at the same time.
Other types of surgery include the following:
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Total or simple mastectomy: This surgery removes the entire breast, but does not disturb the lymph nodes under the arm.
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Modified radical mastectomy: This surgery removes the entire breast and some of the lymph nodes under the arm. The operation is carried down to the chest muscle (the pectoralis muscle), but does not disturb the muscle.
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Radical mastectomy: This surgery removes the entire breast, chest muscles, and all of the lymph nodes under the arm. This surgery is used only when the tumor is very large, and is very rarely, if ever, used at Dana-Farber/Brigham and Women’s Cancer Center. However, more extensive surgeries may be performed by our surgical oncologists, and frequently include advanced procedures done by our plastic surgeons.
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Breast reconstruction: This surgery, done at the time of the mastectomy or delayed until a future time, uses a breast implant or the woman’s own tissue to rebuild the breast’s shape. Surgical oncologists work closely with expert plastic surgeons for women seeking full reconstructive surgery following mastectomy. Surgeons at the Center are also performing new oncoplastic techniques during surgery to preserve the natural shape of the breast, while removing tissue segments containing disease.
Even if the surgeon removes all of the identifiable cancer cells, the patient usually receives some combination of radiation therapy, chemotherapy, or hormone therapy after surgery to try to eliminate any cancer cells that may remain, or may have spread from the breast to distant sites in the body. Treatment given after surgery to increase the chances of a cure is called adjuvant therapy.
Radiation therapy
This therapy uses x-rays or other types of radiation to kill cancer cells and shrink tumors. Radiation therapy may use external radiation (using a machine outside the body) or internal radiation. Internal radiation involves putting radioisotopes (materials that produce radiation) through thin plastic tubes into the area where cancer cells are found. Radiation may be used after surgery in addition to chemotherapy, and hormone therapy. Breast cancer is usually treated with external radiation.
Chemotherapy
This cancer treatment uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. The way the chemotherapy is given depends on the type and stage of the cancer being treated. Chemotherapy can be taken by mouth, but is usually administered by inserting a needle into a vein or catheter and given intravenously. Treatments like chemotherapy are also called systemic treatment because the drugs enter the bloodstream, travel through the body, and can eliminate cancer cells throughout the body.
Hormone therapy
Hormones are produced by endocrine glands in the body and are circulated in the bloodstream. Estrogen and progesterone are hormones that affect the way some breast cancers grow. If tests show that the cancer cells have estrogen and progesterone receptors (molecules found in some cancer cells to which estrogen and progesterone will attach), hormone therapy is used to block the effect that a woman’s own hormones has on the cancer. This may be done by using drugs that block the way hormones work.
Hormone therapy with tamoxifen (a drug used to treat breast cancer) is often given to patients with early stages of breast cancer to prevent a recurrence. More recently, medications called aromatase inhibitors - that further lower a woman’s estrogen levels – have been given to postmenopausal women either instead of tamoxifen or after a course of tamoxifen.
Metastatic breast cancer treatment
Sometimes breast cancers spread from the confines of the breast and its adjacent lymph nodes to grow in distant sites (the bone marrow, the liver, etc). To do this, breast cancer cells access the blood stream, and are carried to distant body sites where they implant and begin to grow. This process is called metastasis, and patients with breast cancer that is growing at a distant site are said to have metastatic breast cancer. Even though the cancer is growing in, for instance, the bone marrow cavity, it is not bone cancer. It is still breast cancer that has spread through the blood stream to grow in the bone, and the patient has metastatic breast cancer in his or her bone. Metastatic breast cancer must be treated by chemotherapy, hormonal therapy or sometimes radiation. It is rarely treated by surgery. Physicians at Dana-Farber/Brigham and Women’s Cancer Center have pioneered new treatments for metastatic breast cancer, including the use of angiogenesis agents (drugs that target tumor blood vessels), Herceptin® combined with chemotherapy, and new targeted or “smart” drugs that attack the molecular pathways of cancer cells. Some patients with metastatic breast cancer may live for many years, and expert attention, proper drugs and supportive care improve their lives.
In addition to the full range of clinical services, Dana-Farber/Brigham and Women’s Cancer Center offers a wide range of support services for patients.
These include:
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Integrative therapies: At the Center for Integrated Therapies, leading cancer experts combine new approaches to cancer care with traditional treatments by offering massage therapy, acupuncture, nutritional guidance, and other services.
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Pain and Palliative Care Program: This unique program specializes in the management of pain and other physical, emotional, social, and spiritual concerns that patients and their families face as they cope with cancer.
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One-to-One: The Cancer Connection: Composed of cancer survivors and their family members who have completed specialized training, One-to-One brings together those who have already dealt with the complex issues surrounding cancer diagnosis and treatment with those who wish to speak to someone who has had a similar experience.
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Information resource rooms: The resource centers and their satellite resource rooms at Dana-Farber Cancer Institute and Brigham and Women's Hospital are staffed by professionals and volunteers and provide comfortable places to learn. Each site offers books, brochures, computers, videotapes, and audiotapes.
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