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Wednesday, October 03, 2012 - After a breast cancer diagnosis ─ Questions to ask your surgeon

By Cynthia Kocsis, M.D., F.A.C.S.

After a breast cancer diagnosis ─ Questions to ask your surgeon

Medicine has made remarkable strides over the past few decades in treating breast cancer, but one in eight American women are still diagnosed with breast cancer yearly.  Early diagnosis is the most important part of ensuring a long survival after diagnosis. If you or a loved one is diagnosed, your surgeon will play an important role in overseeing your treatment plan. Initially, you will meet with several cancer treatment specialists, including medical oncologists, surgeons and radiation oncology professionals, in order to collectively decide on the best course of care. To assist with these consultations, I have listed some questions you should ask in order to determine an individualized plan that works best for you.

 

What kind of breast cancer do I have?

The two main types of breast cancer include those confined to the ducts or lobules (in situ cancers or DCIS) where the cancer remains at its site of origin and has not spread to neighboring tissue, or invasive or infiltrating cancer, which presents as a tumor with the potential to spread to the lymph nodes (known as invasive ductal carcinoma or IDC). Many DCIS cancers can now be diagnosed microscopically and are often curable. Although we cannot prevent cancer, through early diagnosis, doctors can often successfully treat the disease. In the case of breast cancer, early diagnosis can help a woman avoid chemotherapy or loss of the entire breast.

 

What stage is my cancer?

Ranging from stage 0 to 4, the stage assesses whether the cancer is invasive or in situ, the size of the tumor, lymph node involvement, and whether the cancer has spread beyond the breast. The stage can only be determined after the tumor and lymph nodes are removed and the body has been imaged.

 

What are the best surgical options for me?

A lumpectomy (medically referred to as partial mastectomy) removes the tumor with a margin of normal breast tissue. A mastectomy removes all the breast tissue including the nipple. Women who choose lumpectomy must have the breast treated post-operatively with radiation to equal the safety of removing the breast completely. The patient’s cancer and personal preference will determine which of these surgical routes are appropriate.

In most cases, both procedures will be combined with sentinel lymph node biopsy, a surgical procedure that removes the sentinel node tissue from under the arm to see if the cancer has spread. If the cancer has not spread here, then no other nodes need to be removed. The drastic change in not routinely removing all of the lymph nodes has had a great impact on post-op pain and function.

 

Will I need chemotherapy, radiation or both?

It now depends on multiple issues best discussed with a multidisciplinary team of doctors from medical oncology, pathology, radiation oncology, and surgery. In some cases, the tumor cells are tested on a genetic level which individualizes care for each cancer. The latest oncologic research reveals that different breast cancers at the same “stage” can act differently and genetic information from the tumor itself will help determine if chemotherapy is even needed. This valuable new information has led to fewer women needing chemotherapy.

 

What kind of reconstructive surgery do you recommend in my case?

In the event of a mastectomy, reconstruction of the breast can be done by a general surgeon and a plastic surgeon working together. Most women, regardless of age and stage of disease, benefit from immediate reconstruction. Symmetry surgery is covered by medical insurance. Reconstruction can be a staged procedure but can also be started at the time of the mastectomy.

Treating breast cancer is not a simple process. Begin by selecting a surgeon with experience in breast cancer and who is affiliated with a hospital accredited by the Commission on Cancer (CoC) and offers a comprehensive cancer care program.

The Cancer Center at CentraState Medical Center is accredited by the American College of Surgeons (ACoS) Commission on Cancer (CoC) for quality excellence and is designated as a Community Hospital Comprehensive Cancer Program. It is one of only 60 locations nationwide approved as a clinical trial site by the Cancer Trials Support Unit of the National Cancer Institute. The Cancer Center’s breast cancer team is led by an outstanding group of board-certified physicians specializing in surgery, radiation oncology, and medical oncology. Trained at leading academic medical centers, these doctors combine their expertise to evaluate and treat all stages of the disease. The Center’s comprehensive and advanced cancer treatment options give you the kinds of choices you’d find in the most respected medical centers in every major city – but closer to home.

For more information about all of the cancer services offered at CentraState, visit www.CentraStateCancerCenter.com or call (855) 411-CANCER.

 

Dr. Cynthia Kocsis is a board-certified general surgeon on staff at CentraState Medical Center in Freehold. She can be reached at Kocsis Surgical Services by calling (732) 453-7200.