Sanford Comprehensive Breast Team
Additional Resources
Treatment Options
 When deciding on a treatment plan, we address breast cancer patient’s concerns about their appearance without compromising the effectiveness of treatment.With the recent technological advances, patients today have a choice when facing surgery for breast cancer. Options include lumpectomy (breast conservation) or mastectomy (breast removal). Also, immediate reconstructive (plastic) surgery is possible in nearly all patients. The most important point, however, is choice. Our breast surgeons strive to help a woman understand the disease and make the best-education choice with her. State-of-the-Art Technology Sanford Cancer Center rapidly invests in new technologies that have been shown to improve cancer diagnosis and treatment, ensuring that our patients have access to the best care possible. For example, our digital mammography service enables CAD analysis of mammograms which has been proven to increase diagnostic accuracy, and our PET/CT scanners allow doctors to simultaneously view anatomical and biological tumor information, providing a greater ability to pinpoint a cancer's location than ever before. Plastic Surgery  Many women desire breast reconstruction after a mastectomy and some do not want reconstruction at all. For women who desire reconstructive surgery, the plastic and reconstructive surgeon works with a woman’s goals, medical history and body composition to decide on the best type of reconstruction that can be designed for her needs.At Sanford Clinic Reconstructive and Plastic Surgery, breast reconstruction can be done using a water filled tissue expander placed in the site of the removed breast at the time of the mastectomy, subsequent expansion of the skin to replace the skin removed with the mastectomy followed by placing a permanent breast implant in the cavity created by the expander. Another method of reconstruction available at Sanford Clinic Reconstructive and Plastic Surgery is transferring tissue from the abdomen or back to fill the defect. Dr. Karu has expertise in performing skin-sparing mastectomies where the entire breast skin surface can be saved. Survivorship Thanks to new, improved therapies, an increasing number of people are living beyond cancer and enjoying a full life after treatment. After your treatment, you may have questions regarding your health. You may also be reflecting on your cancer experience, and have concerns and questions that you are now ready to consider. As part of the continuum of care for survivors, Sanford Health offers a wide range of educational programming, support services and informational resources. Survivors can attend a variety of workshops, participate in our annual survivor-specific events or meet one-on-one with social workers with expertise in the issues facing survivors. In addition, Radiation as therapy The goal of radiation therapy is to kill cancer cells without harming the surrounding healthy tissue. Some forms of cancer, such as prostate and larynx cancer, can be successfully treated with radiation therapy as the sole or primary therapy. In other types of cancer, such as breast cancer, radiation therapy is a complementary treatment used along with surgery, chemotherapy, or immunotherapy (biologic therapy). In these cases, radiation therapy represents an extremely important additional, or adjuvant, therapy to the other treatment(s) because of its ability to target specific cells. Even when surgery may remove the cancer completely, or when chemotherapy eliminates detectable cancer cells, the risk remains that a few cancer cells survived and can again cause disease. In cases where successfully treating the cancer is not possible, radiation therapy can be used to shrink tumors and reduce the pressure, pain, and other symptoms of cancer. This is called palliative radiation. More than half of all people with cancer undergo some form of radiation therapy. Types of radiation therapy External-beam radiation therapy. The most widely used type of radiation therapy delivers high-energy x-rays or electrons from a machine external to, or outside of, your body. The machine most commonly used is called a linear accelerator, or sometimes, a linac. External-beam radiation therapy allows large areas of the body to be treated, if required. Special software helps direct the beam to effectively treat tumors while sparing the normal tissue surrounding the cancer cells. The treatments occur at the hospital, but require only short visits (approximately 30 minutes) and can be performed on an outpatient basis. External-beam radiation therapy will not make you radioactive. Three-dimensional conformal radiation therapy (3D-CRT). This new treatment uses special computers to generate detailed three-dimensional pictures of the cancer. More accurately aimed radiation allows higher doses to be used, while reducing radiation damage to healthy tissue. Studies have shown that 3D-CRT can result in decreased risk of complications. The beneficial impact on survival has not been proven. Proton beam therapy. This type of external-beam radiation therapy makes use of protons rather than x-rays to treat certain cancers. Protons are parts of atoms and possess enough energy to destroy cancer cells when directed to a particular site of cancer in the body. The proton's energy has only a very local effect, such that normal cells in front of and behind the tumor are left mostly unharmed. Although still new, treatment using protons promises to deliver more radiation to the cancer, while reducing the damage to nearby, healthy tissue. Because this therapy requires highly specialized equipment, it is currently only available in a few medical centers. Neutron beam therapy. Neutron beam therapy uses particles called neutrons from the center of atoms. The effectiveness of neutron beam therapy means that comparedwith conventional radiation therapy, less than half the radiation sessions are required. This makes neutron beam therapy especially useful with certain inoperable and fast-growing brain tumors. Stereotactic radiation therapy. Stereotactic radiation therapy delivers a large, precise radiation dose to a small tumor area. Because of the precision involved in this type of treatment, the patient must remain extremely still. Head frames or individual body molds may be made to keep the patient from moving. Although often performed as a single treatment, fractionated radiation therapy, where patients receive multiple treatments, may be necessary. Internal radiation therapy. Also known as brachytherapy, which means short-distance therapy, internal radiation therapy involves placing radioactive material into the cancer itself or into tissue surrounding it. These implants may be permanent or temporary (lasting several minutes to a few days). Sealed devices containing the radioactive sources can be in the form of thin wire or tubes, ribbons, or capsules (seeds). Internal radiation therapy may require a hospital stay. The sealed sources deliver most of the radiation around the area of the implant, but some radiation can be emitted (sent) from your body. Your whole body does not become radioactive, but certain precautions should be taken to protect hospital staff and visitors from radiation exposure (see Safety for the patient and family). Hormone therapy Hormone therapy is useful to manage a tumor that tests positive for either estrogen or progesterone receptors. This type of tumor uses hormones to fuel its growth. Blocking the hormones usually limits the growth of the tumor. If it is determined that the tumor is hormone receptor-positive (uses estrogen or progesterone to grow, than hormone treatment may be used alone or along with chemotherapy. Examples of hormone therapy used as adjuvant therapy are tamoxifen, anastrozole (Arimidex), letrozole (Femara), and exemestane (Aromasin). Chemotherapy Chemotherapy is the use of drugs to kill cancer cells. Systemic chemotherapy is delivered through the bloodstream, targeting cancer cells throughout the body. Chemotherapy may be given orally (by mouth) or intravenously (injected into a vein) and is usually given in cycles. Chemotherapy generally does not require a hospital stay; it is given in an outpatient setting. Chemotherapy may be neoadjuvant therapy (given before surgery to shrink a large tumor) or adjuvant therapy (given after surgery to reduce the risk that the cancer returns). Patients in clinical trials may be offered new drugs or new combinations of existing drugs. Different drugs are useful for different cancers, and research has shown that combinations of certain drugs are more effective than individual ones. Research has shown that a combination of targeted drugs could shut down a tumor's backup plan, resulting in much more effective treatments. A number of these so-called targeted cancer drugs work by blocking the activity of various protein switches that tell the cell to grow. They are known as receptor tyrosine kinases or RTKs. Targeted Therapy Herceptin is a very effective treatment against HER2-positive breast cancer in women with stage II, III and IV disease. It is admitted in the bloodstream once every one to three weeks. Herceptin is called a targeted therapy because it targets breast cancers that make too much of the HER2/neu gene or HER2 protein. These cancers are called HER2-positive. Herceptin is also called an immune treatment because it is made of an immune system–like antibody that blocks the HER2 protein in cancer cells. Blocking the protein helps stop the growth of HER2-positive cancer cells. About one out of every four breast cancers is HER2-positive. Lapatinib is another targeted therapy that works against breast cancers that have extra HER2 genes. Lapatinib has been approved by the FDA to be given in combination with Xeloda (chemical name: capecitabine) to treat advanced, HER2-positive breast cancer that has stopped responding to anthracyclines, taxanes, and Herceptin. Avastin is an antiangiogenesis targeted therapy that has been approved by the U.S. Food and Drug Administration (FDA) to treat advanced cancers of the lung, colon and rectum. Antiangiogenesis medicines choke off the blood supply to cancer cells. Antiangiogenesis medicines have been shown to improve survival in people with advanced colon and lung cancers. Unique Attention to Patients Technology isn't the only thing that makes Sanford Cancer Center unique. We also place a strong emphasis on patient convenience and well-being. From a warm and uplifting environment, to patient-focused amenities, such as our breast oncology care coordinators, the staff of the Sanford Cancer Center provides a highly supportive environment for overcoming cancer. Links and Resources Sanford Cancer Center Oncology Clinic www.breastcancer.org www.breastcancerprevention.com www.cancer.gov |
