Breast cancer treatment worksheet 11.10.pages

Breast Cancer Treatment Worksheet
Patient name: _____________________________ Date: ___/___/___ Age: _____ Diagnosis:

Non-invasive cancer: DCIS (Ductal Carcinoma In-Situ) Estrogen receptor: positive negative
Imaging Studies:

Mammography ___________________________________________________ _________________________________________________________________ Ultrasound _______________________________________________________ _________________________________________________________________ Other ____________________________________________________________ __________________________________________________________________ Comments: __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Treatment Options:
A. Breast Conservation (generally referred to as a Lumpectomy):

In order to be a candidate for breast conservation the cancer needs to be localized to a small area of the breast so that we can encompass it with a lumpectomy. The components of Breast Conservation include: (performed as an outpatient under twilight anesthesia) 1. Lumpectomy: (with preoperative wire localization if not palpable). About
15% of the time the margins are found to be positive on final pathologic review
and a second (30-45 min) procedure is necessary to remove more tissue and clear
the margins. Pathology results are available 4-5 days after surgery.
2. Sentinel lymph node biopsy: (using blue and radioactive dye). Sentinel node
biopsy is not necessary for most noninvasive cancers (DCIS). Please note that the
blue dye will cause the urine to be blue for approximately 24 hours after surgery.
Generally, 1-3 sentinel nodes are removed. If the nodes do not contain cancer
then no further surgery under the arm is necessary. If the nodes are positive for cancer cells then a follow-up axillary dissection may be necessary, however the trend is to do fewer axillary dissections.
3. Axillary Dissection: This is the removal of additional lymph nodes and may be
required if your sentinel nodes contain cancer. If performed, a small drain will be
placed under the arm and it will remain in place for 10-14 days. This procedure
raises the risk of lymphedema (arm swelling) to approximately 15-20%,
compared to sentinel node biopsy alone which has a 1-2% risk of lymphedema.
4. Radiation Therapy: Lumpectomy patients generally require postoperative
radiation therapy, which is given 5 days/week for 6-7 weeks. You may be a
candidate for a newer technique called Partial Breast Irradiation (PBI).
Patients with small, low-grade DCIS may not require radiation. You will consult
with a Radiation Oncologist regarding post-operative radiation therapy and your
options.
5. Chemotherapy: Chemotherapy is a combination of drugs given intravenously
to kill any cells that may have escaped to other parts of the body prior to surgery.
The recommendation for chemotherapy is made by the Medical Oncologist and
depends on a number of factors such as patient age, size of tumor, lymph node
involvement, grade, estrogen receptor status, etc. Radiation therapy and
chemotherapy have different goals and are not mutually exclusive.
B. Mastectomy:

Patients who have very large cancers or cancer cells scattered over a large portion of the breast are not candidates for breast conservation and therefore require a mastectomy: Some patients may prefer a mastectomy even if they are candidates for breast conservation. Radiation is usually not necessary after a mastectomy. Mastectomy options include: 1. Skin-sparing mastectomy with immediate reconstruction: After the
mastectomy and sentinel lymph node biopsy is completed (and follow-up axillary
dissection if the sentinel lymph node contains cancer) the Plastic Surgery team
comes into the operating room and performs the first phase of the immediate
reconstruction. You will meet with the Plastic Surgeon prior to the day of surgery
to decide the appropriate reconstruction technique (options include temporary
expander followed by permanent implant, TRAM flap or Latissimus Dorsi flap).
2. Traditional mastectomy without reconstruction: If a patient chooses this
option she will have a flat chest on the side of the mastectomy and can wear a
prosthesis that fits inside her bra.
When a mastectomy is performed, postoperative radiation is generally not necessary unless the cancer is more than 5 cm. in diameter or there are positive lymph nodes. The recommendation for chemotherapy is the same whether the patient chooses breast conservation or a mastectomy. A mastectomy without reconstruction or with expander reconstruction generally requires an overnight stay in the hospital. When the reconstruction is performed with your own tissue (TRAM flap or Latissimus flap) the hospital stay is generally several days.
The overall survival is exactly the same whether breast conservation or a mastectomy is performed. The risk of the cancer returning within the affected breast or on the chest wall is approximately 5-6% for breast conservation and 2-3% for a mastectomy. If the cancer recurs in the breast after a lumpectomy a mastectomy is then generally required at the time of the recurrence.
Timeline:
Preoperative imaging, biopsy, consultations.
Chemotherapy
Radiation therapy
Endocrine Therapy
Breast cancer is NOT a medical emergency but it is often an emotional emergency. You
have time to gather all the necessary information, obtain a complete breast imaging
evaluation and seek second opinions if you wish. You need to make sure that you are
comfortable with your physicians and your decisions before proceeding.
Follow-up Care
Following the treatment of your breast cancer you will be seen approximately every 3-4 months the first two years and every 6 months for years 2-5. You may have three different Oncologists-Surgical, Medical (in charge of chemotherapy and perhaps hormonal therapy) and Radiation. We will generally try to stagger your visits so that you’re not seeing all of us at short intervals. If you underwent breast conservation surgery (lumpectomy) you will obtain a mammogram on the affected breast about 3 months after completion of radiation and at 6-month intervals for 2 years and if everything is fine at this point then you will go on a yearly schedule.

Source: http://www.drbethke.com/wp-content/themes/drbethke/breast_cancer_treatment_options.pdf