The Surgeon’s Role in Treating Breast Cancer
By John Mecenas, MD
For more than two decades, National
Breast Cancer Awareness Month in October has helped educate women about breast
cancer detection, diagnosis, and treatment. One of the results of this concerted
national effort has been a slow decline in the overall death rate from breast
cancer, even though breast cancer has become an increasingly common diagnosis
affecting one in eight women.
Diagnosing and treating breast
cancer involves a multidisciplinary team of
health-care specialists working closely with the patient and with each other.
This Health Watch column addresses the role of the surgeon in diagnosing,
staging, and treating breast cancer.
When is the
surgeon first involved in diagnosing breast cancer?
If you discover a lump during
self-breast exam or your radiologist discovers an abnormality on your
mammogram, you are likely to be referred to a surgeon to discuss diagnostic
techniques and subsequent treatment.
How does diagnosis begin?
In diagnosing breast lumps and
abnormal mammographic findings, we typically use minimally invasive techniques,
such as fine needle aspiration or stereotactic breast biopsy, to obtain a small
bit of tissue for examination by a pathologist. Palpable lumps (ones you can
feel with your fingers) often can be biopsied during your first visit to the
surgeon’s office. Smaller abnormalities needing a radiologic-guided biopsy
require an additional appointment, which typically can be scheduled quickly.
Breast tissue samples are then examined by a pathologist in the Laboratory at
Cayuga Medical Center, where 90 percent of the time biopsy results are
available within one working day of receipt in the Lab.
If the diagnosis is cancer, what
Although different surgeons might
have different approaches, in this community we tend to take a
multidisciplinary approach by involving the medical and radiation oncologists
early in the treatment process. This gives a patient the most comprehensive
information, even before completing surgical staging of the cancer and deciding
on surgical treatment.
What is breast cancer staging?
If you have a cancer diagnosis, the
next step is to determine the stage of the cancer: is it early in the disease
process or late? In the case of breast cancer, the stage of the disease is
related to the size of the tumor and whether or not the tumor has extended to
the skin, muscle, or lymph nodes, which is evidence of metastatic disease. Your
surgeon will plan surgery to both gain information about the stage of the
disease and to treat the disease locally, within the breast.
The surgeon typically removes the
tumor using a wide surgical excision and then works with the pathologist to
accurately measure the extent of the cancer. If the surgeon and pathologist
determine that the cancer is localized (limited to the breast), the most common
treatment is to follow removal of the tumor with a course of radiation therapy.
This treatment plan is proven to be as effective as total mastectomy; however, unlike
total mastectomy, this approach conserves breast tissue.
The next step in staging is to
determine if the cancer has spread to the lymph nodes under the arm, which is
the most common path breast cancer travels when it spreads. Traditionally,
surgery has involved the extensive removal of these lymph nodes, which results
in higher risks for complications following surgery, including arm swelling,
pain, and possible nerve injury. However, surgeons at Cayuga Medical Center
have focused on using sentinel lymph node dissection, which utilizes a
water-soluble dye and enables surgeons to identify the primary (first) draining
lymph node to which cancer cells would migrate. When there is no evidence of
cancer in the sentinel lymph node, the patient does not face subsequent, more
If there is evidence of lymph node
involvement, more extensive surgery is typically recommended to remove
additional lymph nodes. In cases of more advanced disease, a mastectomy may be
the recommended treatment. At this time your surgeon will refer you to a
plastic and reconstructive surgeon to discuss reconstruction techniques.
Following surgery, your care is turned over to your medical oncologist.
Can I have all of my breast cancer
All aspects of diagnosis and
treatment, including breast reconstruction, are available locally through
Cayuga Medical Center and its affiliated medical staff. Regrettably, breast
cancer is relatively common in the Finger Lakes, just as it is nationwide. The
good news is that local cancer-care specialists are well trained in the
treatment and diagnosis of this disease, and we have the advantages of an
affiliation with Roswell Park Cancer Institute to even further enhance the care
John Mecenas is a board-certified general surgeon. He is on the medical staff
of Cayuga Medical Center and is in practice with Surgical Associates of Ithaca,
where he can be reached at (607) 273-3161.