According to Dr. Jessica L. Vinsant, MD, a General Surgeon with Premier Surgical Associates’ Tennova North Knoxville office, many women are often surprised when they discuss their options for treating breast cancer. “Women have a lot of more options than they realize about what they want to do when it comes to breast cancer surgery,” Dr. Vinsant says.
Most women assume that as soon as they’re diagnosed they have to have a mastectomy to have the best chance of survival, but this isn’t not always true. Dr. Vinsant notes that studies have shown that a partial mastectomy—also known as a lumpectomy—followed by radiation typically has the same long term outcome as a full mastectomy. However, it’s not the same outcome if a patient doesn’t do the post-surgery radiation.
“Sometimes we talk with patients who saw their grandmother or someone during the 60’s or 70’s go through breast cancer treatment, and that’s what they assume it’s like today. But advances in technology have given us many better options,” Dr. Vinsant explains. Breast cancer patients may be eligible for short-duration, breast-conserving, targeted radiation therapies.
“Now there’s also another class of drugs known broadly as endocrine therapy,” she says, “which is easier to tolerate than chemotherapy.” Women don’t lose their hair with endocrine therapy, for example. Patients typically stay on it for 5-10 years, taking one pill a day, to treat anything microscopic that may remain of the cancer and to decrease the chance of a recurrence.
Endocrine therapy works by targeting specific receptors, so the decision to utilize it is related to which hormone receptors are available on the patient’s specific breast cancer. For example, a patient with “triple negative” breast cancer has no receptors that would receive the therapy, so she would not be a candidate. Dr. Vinsant explains that in the case of a very sick patient that can’t undergo surgery or radiation, endocrine therapy may be given to prevent progression of their cancer.
The surgical method of checking lymph nodes to see if the cancer has spread beyond the breast has also evolved. Dr. Vinsant says the standard procedure now is called sentinel lymph node biopsy. The sentinel node or nodes are the first lymph node or first few nodes that filter fluid draining from the breast. If cancer cells are traveling in the lymph system, the sentinel node is more likely than the others to contain them. So, rather than remove 10 or more nodes, surgeons remove only the first node, or a cluster of two or three, which is most likely to have cancer. If the sentinel node is clean, chances are the other nodes are clean, too.
“This type of lymph biopsy carries less risk of long term fluid buildup and swelling from lymph vessels that are unable to adequately drain fluid, and decreases the risk of nerve damage.” Dr. Vinsant says.
She adds that many patients are not aware that insurance is required to cover reconstructive surgery for breast cancer and that many hospitals have associated businesses that work with patients to get the right breast prosthesis, wigs, headscarves. There’s even a product that helps women keep their eyebrows and eyelashes if they start taking it before their first chemo treatment. There are also a variety of patient advocate services and support systems that operate in the hospital systems.
While each patient’s treatment approach varies, Premier Surgical Associates in Knoxville is dedicated to timely diagnosis and comprehensive treatment for all breast problems. Our women’s health team empowers patients and their families to take an active role in the decisions regarding cancer treatment and management. Visit Premier Surgical Associates breast cancer resource page for more information.