Choosing treatment for early stage breast cancer

What are the treatment choices for early-stage breast cancer?

Every women and cancer is different, therefore what’s best depends on the exact case scenario. Generally however, breast cancers in the early stages need two types of treatments:

  • Local treatment (treatment directly to the breast)
    • Surgery
      • Mastectomy: complete removal of breast followed by breast reconstruction
      • Lumpectomy (breast conserving therapy): in which the cancerous section along with surrounding healthy tissue (called a margin) is removed, allowing them to keep the healthy part of breast. This might require follow up with radiotherapy to kill remaining tissue.
    • Radiation
  • Systemic treatment (Treatment to whole body)
    • Chemotherapy
    • Hormone therapy
    • Both

Patients undergoing mastectomy or lumpectomy also undergo axillary lymph node removal. Lymph nodes are small bean shaped organs that trap and filter material, including cancer cells. Usually during the breast surgery, a small number of lymph nodes that are identified as the ones most likely to drain the breast, are removed and sent to the laboratory to check for signs of cancer spread. If they do show signs of cancer, further lymph node removal may be needed.

Based on the spread of cancer and its type, patients may need systemic treatment too, using medicines to prevent or slow down the cancer growth such as chemotherapy or hormonal treatments.

Will my choice of surgery affect how long I live?

Studies have shown that patients undergoing lumpectomy and mastectomy have similar life expectancies.

Will my choice of surgery affect the chances of cancer coming back?

Patients undergoing lumpectomy has a higher chance of recurrence than mastectomy. However the recurrence can usually be treated successfully.

Is lumpectomy always an option?

No, lumpectomy isn’t an option in patients:

  • Having multiple tumors in different parts of same breast
  • In which breast cancer has spread throughout breast tissue and invaded through the normal tissue margin
  • Not fit for radiation therapy (e.g. pregnant patients, those with some forms of skin cancer, etc.)
  • Already had radiotherapy and it can’t be repeated

How do I decide between the 2 surgery options?

Read and discuss in detail with your doctor and make sure that you understand the facts about different treatment options. Choose the type of surgery you prefer based on:

The way you will look

See pictures of women having each kind of surgery including reconstruction after mastectomy. Choose the one you’re more comfortable with. You might also be comfortable being flat on one side of chest along with a plastic breast in your bra for dressing.

The risk of recurrence

Although life expectancy doesn't seem to be affected by which procedure you choose, recurrence is. Patients undergoing lumpectomy have a higher chance of recurrence than mastectomy (if the lumpectomy is not combined with radiation). Patients whose cancer reappears after lumpectomy has to undergo mastectomy eventually.

Time involved and side effects of radiation

Lumpectomy is usually followed by radiation therapy, that consists of treatment for 5 days a week for almost 3 to 6 weeks depending on the patient’s requirements and factors like age. This radiation therapy won't make patients sick or cause hair to fall out, but it can cause skin to tan and the chest skin to be burned like a sunburn. This goes away quickly. Patients might feel tired at the end of radiotherapy, however it’s very uncommon and doesn’t last long.

Recovery from surgery

Patients undergoing lumpectomy are usually discharged on the same day with advice to avoid sports and activities which cause stress to the upper body like swimming and lifting weights for at least 1 to 2 weeks.

Patients undergoing mastectomy remain in the hospital for 1 to 2 days and might have to stay up to 3 to 4 days if they choose to have breast construction in the same operation. The drains are placed for around 2 weeks and can easily be drained at home. The drains are removed in the outpatient department without any major surgical procedure. If fluid builds up in the surgical space after drains are removed, it may need to be drained manually using a needle in the doctor's office. Patient's needs to avoid any sports and activities like swimming or heavy lifting during all this process and additionally for a few weeks after that. Even after complete recovery, patients undergoing mastectomy don’t have normal sensations in the chest. The breast reconstruction can be performed right away in the same session or later too.

Lymph node biopsy

Patients need to undergo lymph node biopsy, regardless of which surgical procedure they chose. It’s usually a simple procedure, however in some cases it may cause swelling in the arm, stiffness or pain in shoulder or a nerve injury. Patients might need physiotherapy to recover from any of these complications.

How do I work with my doctor to make a decision?

Ask your doctor about the treatment options in detail and advise about your opinion and preference. Discuss in detail if there’s anything that worries you specifically. Always discuss with your treating doctor any concerns to come up to the best possible management plan specific to your case.