Breast Cancer – Lumpectomy vs Mastectomy

Lumpectomy

Lumpectomy is also called breast conserving or saving surgery. The surgeon removes the part of the breast containing a tumor or lump, and some of the normal tissue that is around it. All the tissue that is removed from the breast is carefully examined to see if there are cancer cells in the normal tissue that was removed around the tumor or lump. The outer edge of this tissue is also called the margins. If cancer cells are found in this tissue within the margins, more surgery is needed to remove the rest of the cancer. After lumpectomy, it is generally advised that women receive 5 to 7 weeks of radiation treatment to get rid of any cancer cells that may be in the remaining breast.

The size of the lump is a key issue in deciding between lumpectomy and mastectomy. While different studies show different results, in general, lumpectomy is more likely to be effective when the lump is less than 1 to 2 cm is size. Before a woman decides between lumpectomy and mastectomy (removal of the entire breast), she should consult a doctor who specializes in breast care, and get a second opinion from another breast care expert. It is also important to select a surgeon who is skilled in doing breast surgery.

Mastectomy

Mastectomy is removal of the whole breast by the surgeon, usually because of breast cancer. Different kinds of mastectomies are used for different situations. The basic types are:

  • Simple or total mastectomy – Removal of the whole breast by the surgeon, without removing the lymph nodes under the arm, or the muscle tissue under the breast. (Lymph nodes are numerous small round, oval or bean-shaped bodies located along lymphatic vessels throughout the body, and the lymphatic vessels carry lymph, which is a clear fluid collected from the body tissues, into the blood system).
  • Modified radical mastectomy – Removal of the whole breast by the surgeon, plus removal of some of the lymph nodes under the arm. This is the most common type of mastectomy done for women who decide to have the entire breast removed.
  • Radical mastectomy – This lengthy procedure involves the surgeon removing the whole breast, the lymph nodes under the arm, and the chest muscled under the breast. Radical mastectomy is no longer common for two main reasons: 1. because of the change in physical appearance and side effects, and 2. because modified radical mastectomy has been proven to be as effective as radical mastectomy.


Chemotherapy

Chemotherapy is treatment with anticancer drugs. They may be given by vein (intravenously) or by mouth. The drugs travel through the blood to reach cancer cells in the body. When chemotherapy is taken after the lumpectomy or mastectomy, it reduces the risk of the breast cancer returning. The chemotherapy is given in cycles with a recovery period after each treatment. The usual full period of treatment is 6 months.

Chemotherapy can also be used to treat cancer that has already spread beyond the breast and underarm area. This kind of spread is called metastasis. The length of treatment varies from woman to woman, and depends on how much the cancer shrinks. Chemotherapy is also sometimes used to shrink a large breast cancer before surgery. For example, it may shrink it enough to permit lumpectomy instead of mastectomy.

The side effects of chemotherapy vary depending on the type of drugs, the dose, and the length of treatment. Temporary side effects may include fatigue or tiredness, nausea and vomiting, loss of appetite, hair loss, and mouth sores. Anemia or a low blood cell level may also develop because of damage to blood-producing cells of the bone marrow. Damage to the white blood cells can also increase a person’s chance of infection, and due to a shortage of blood platelets, there may be bleeding or bruising after minor cuts or injuries. Changes in the menstrual cycle may be temporary or permanent.

There are effective treatments for many of the temporary side effects, like nausea and vomiting. A group of drugs called growth factors can help the patient’s bone marrow recover after chemotherapy and can treat problems caused by low blood counts.

Premature menopause (not having menstrual periods) and infertility (not being able to become pregnant) are potential permanent complications of chemotherapy. The older a woman is when she receives chemotherapy, the more likely it is that she will develop infertility or become menopausal. The premature menopause may also lead to bone loss from osteoporosis.

Radiation Therapy or Radiotherapy

A treatment process that uses high-energy rays to stop cancer cells from growing and dividing. It is often used to destroy any remaining cancer cells in the breast, on the chest wall, or under the arm in the affected side. In the case of breast cancer, at least 7 weeks of radiotherapy is usually given to women after they have had a lumpectomy and the tissue has had time to heal. Radiation therapy is also sometimes given before surgery to shrink the size of the tumor.

Temporary fatigue or extreme tiredness is the most common side effect of radiotherapy. Other temporary side effects are:

  • Loss of appetite
  • a sharp decrease in the number of white blood cells
  • swelling or tenderness of the breast
  • feeling of heaviness of the breast
  • sun-burn-like appearance of the breast

These signs usually gradually disappear after completion of the radiotherapy. Generally, pregnant women are not given radiotherapy in order to avoid damage to the fetus.

Other key resources for breast cancer information are:

The web sites of each of these organizations can be visited directly from ourRelevant Resources section.

Also Visit Aetna’s Women’s Health Online, for additional information about general breast health and what you can do to reduce your risk of breast cancer.