The first step in treating MpBC is often surgery. The surgical options depend on the size and spread of your cancer. Surgery can include everything from a breast conserving lumpectomy to a modified radical mastectomy. Additionally, during the operation to remove your visible tumor the surgeon often will do a Sentinel Lymph Node Biopsy (SLNB) or Axillary Lymph Node Dissection (ALND). Metaplastic patients will be offered surgical options based on the standard protocols for all breast cancers. Newly diagnosed patients should carefully consider their options and fully discuss the pros and cons of each choice.
Breast conserving surgery has become very popular over the years. A lumpectomy allows for the patient to keep their breast but remove the tumor. Recent studies indicate that a lumpectomy is just as effective for many women as a mastectomy. In this procedure the tumor is removed along with some of the surrounding healthy tissue. This healthy tissue is referred to as the “margin.” The pathologist will test the tissue in the margin to be sure that no cancer cells can be found in this tissue. This assures the surgeon that the entire tumor has been removed. If cancer cells are found close to the edge of the “margin.” Your surgeon may decide to perform a second surgery to ‘clean up the margins’ or take additional tissue in the surrounding area. This will ensure that the entire tumor has been removed. (Think of a hard boiled egg. The yellow is the tumor and the white is the margin. The pathologist would test the whites of the egg to be sure that there is no cancer in this area. This allows for the patient and doctor alike to feel some assurance that no cancer cells remain.)
Mastectomy was once the treatment of choice for all breast cancers but with the advent of new technologies and techniques it is no longer the only option for women with breast cancer. A mastectomy is the removal of all of the breast tissue including the breast tissue in the axilla, under your arm. Women who chose mastectomy are offered a range of options from nipple sparing to skin sparing to modified radical mastectomy.
The options you will be given will depend on your tumor and it’s spread, size and location in your breast. You may not be a good candidate for nipple sparing mastectomy, for example, if the tumor is close to the nipple or if there is skin involvement with the tumor. Radical mastectomies, once very common, are rarely done these days. The radical mastectomy would include the removal of some muscle on the chest wall but new techniques no longer require that extreme procedure.
These days women are also offered a variety of choices for reconstruction. The reconstructive surgery can be done immediately following the mastectomy or at a later date. The specifics of your condition may dictate if and when you can have reconstruction and what type for which you may be a good candidate.
Your choices for reconstruction include Tram Flapp, Diep Flapp, and implant reconstruction with tissue expanders. There are many more types to chose from with specific pros and cons. It is always a good idea to find other women who have undergone these procedures to learn more about what each entails. The specifics of your condition will dictate your choices and you should always consult your surgeon and a plastic surgeon about what would be best for you. A recent study on reconstruction.
The Lymph system is like your blood vessel system only it removes toxins and foreign particles from your body. Because of this role it plays in removing debris from your body the lymph system is often the first place cancer cells will travel if they escape the confines of your breast. For this reason during your surgery you surgeon will check the lymph nodes to see if your disease has progressed.
A sentinel lymph node biopsy is the primary method used to check fro disease progression during surgery. In this procedure the surgeon will inject a blue die into the system and visually follow the flow of the die to your sentinel node. The sentinel node should represent the first lymph node in the system. Then the surgeon will remove that node along with two or three additional nodes. These will be checked for disease during the procedure. If the nodes are free of disease, no other nodes will be removed. If the nodes are positive for more cancer more lymph nodes will be removed.
An Axillary Lymph Node Di-section is the complete removal of all of the lymph nodes in the axilla (underarm). The lymph nodes in the under arm are the first place a cancer cell will travel to if it has moved from the breast tissue into other areas of the body. An ALND will be preformed if the sentinel node or any of the other nodes removed during an SLNB come back positive. This is considered a “regional spread” of your disease.
It is important for MpBC patients to remember that the lymphatic system is not the only way cancer spreads. Cancer can also spread through the blood vessels. Studies have shown that MpBC has a lower incidence of lymph node involvement but a higher incidence of recurrence and spread. This contradiction is due to the spread of the disease through the blood stream in some cases. And while it is good news to know that cancer has not spread into your lymphatic system, it is important to understand this is not a guarantee that the disease has not or will not spread in other ways.