Lumpectomy

O ne procedure for some types of breast cancer patients/DCIS is a lumpectomy or removal of the affected area of the breast and surrounding breast tissue.  Again, I defer to www.breastcancer.org to give a more thorough explanation:

“Standard treatment options for DCIS include:

  • Lumpectomy followed by radiation therapy: This is the most common treatment for DCIS. Lumpectomy is sometimes called breast-conserving treatment because most of the breast is saved.
  • Mastectomy: Mastectomy, or removal of the breast, is recommended in some cases.
  • Lumpectomy alone
  • Hormonal therapy after surgery: These treatments, which block or lower the amount of estrogen in the body, are typically used if the DCIS tests positive for hormone receptors.

Chemotherapy, a form of treatment that sends anti-cancer medications throughout the body, is generally not needed for DCIS. DCIS is non-invasive and remains within the breast duct, so there is no need to treat cancer cells that might have traveled to other areas of the body.

Each individual situation is different. You and your doctor will decide what treatment is best for your situation. If the DCIS is large, high-grade, and comedo type, for example, it is likely to be more aggressive, and your doctor may recommend more extensive treatment. The same holds true if you are under age 40, since younger age may increase the risk of recurrence.

At a Glance

Before surgery: Finding the exact location of DCIS

Before surgery, you may need to have a diagnostic test to “localize” the tumor. When DCIS can only be seen by a mammogram or ultrasound and cannot be felt, the exact location of the tumor has to be pinpointed before the surgeon can remove it. A localizing needle is placed near the area of concern and then guided to the cancer with the aid of mammogram or ultrasound. If the DCIS is only seen by MRI (magnetic resonance imaging), it may need to be localized with the help of an MRI machine.

Lumpectomy followed by radiation therapy

Most people with DCIS have a lumpectomy followed by radiation therapy. This is usually a very good option if the DCIS only appears in one area of the breast and can be completely removed with clear margins of healthy tissue. A clear margin is a rim of healthy tissue around the tumor that is completely free of cancer cells. How wide do these margins need to be? Doctors are still debating the answer, but a width of 2 to 3 mm is common.

Lumpectomy, and in some cases a second procedure called re-excision lumpectomy, is used to completely remove the cancer.

  • Lumpectomy removes the entire area of DCIS as well as a margin of normal, healthy breast tissue around it. The whole area that contained cancer cells is removed, even when there’s no lump present.
  • Re-excision lumpectomy is a second surgery that may be necessary after lumpectomy to remove extra tissue in order to ensure that there is a clear margin of healthy tissue around the tumor. If your doctor finds that the margins of healthy tissue taken were too narrow, or there is even some cancer present in the margins, a re-excision may be recommended.

If the DCIS has been removed with lumpectomy, radiation is usually given to reduce the risk of cancer returning. Your doctor may discuss a couple of radiation options with you:

  • External radiation is given to the entire breast by a machine called a linear accelerator. Radiation treatment is usually given as daily treatments 5 days per week over 5 to 7 weeks. Treating the whole breast with radiation after lumpectomy remains the standard of care. In cases of DCIS, radiation therapy can reduce the risk of the cancer coming back by about 60%. For example, after lumpectomy alone, the risk of the cancer returning is about 30%, although it may be lower or higher, depending on the situation. Radiation can reduce that risk to 10% or less for a return of invasive cancer and to about 15% for a return of DCIS.
  • Internal partial-breast irradiation is a form of treatment in which radioactive materials such as seeds or pellets are temporarily placed in the breast. There’s a lot of interest in partial breast radiation for DCIS, because treatment is shorter and side effects occur in a smaller part of the breast. However, its effectiveness is still being studied.
  • External partial-breast irradiation is a method of therapy that zeroes in on the area around where the cancer was. This area is at highest risk of recurrence. Partial-breast radiation takes only 5 to 10 days for treatment, versus 5 to 7 weeks for whole breast radiation. Researchers are studying partial-breast radiation for use after lumpectomy to see how the benefits compare to the current standard of radiation to the whole breast.Women may be able to take part in a clinical trial studying external partial-breast radiation if they have only one area of DCIS that’s completely removed with clear margins. The trial is called NSABP B-39 and is available in many cancer centers. Ask your doctor for more information about this trial if you feel you might qualify. You can also visit our Clinical Trials section to learn more about how trials work.”
NOTE:  My husband and I first thought a lumpectomy was the route to take for me.  After more research and taking into consideration my personal medical conditions (since I’m on Cumadin I cannot take Tamoxifin to further reduce risk of reoccurrence) our path led to a mastectomy.  Your path may be different and that’s just fine.

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