- Who Is/Is Not a Candidate for Lumpectomy?
- How is Lumpectomy Performed?
- Radiation Therapy After Lumpectomy
Lumpectomy, also known as breast-conserving surgery, is the surgical removal of a cancerous lump (or tumor) in the breast, along with a small margin of the surrounding normal breast tissue. Lumpectomy may also be called wide excision biopsy, breast conserving therapy or quadrantectomy (this latter term is used when up to one fourth of the breast is removed). The procedure is often performed on women with small or localized breast cancers and can be an attractive surgical treatment option for breast cancer because it allows women to maintain most of their breast after surgery. Several studies have shown that women with small breast tumors have an equal chance of surviving breast cancer regardless of whether they have a lumpectomy, followed by a full course of radiation therapy, or mastectomy (complete breast removal, which generally does not require post-operative radiation treatment).
After a patient has been diagnosed with breast cancer, physicians will stage the cancer to determine the extent of the disease and help decide the most appropriate course of treatment. Lumpectomy is often a suitable treatment option for patients with the following breast cancers:
- Ductal carcinoma in situ (DCIS)
- Stage I
- Stage II
- Stage III
Click here to learn more about these types of breast cancers.
Lumpectomy involves removing the cancerous breast lump and a surrounding margin of normal breast tissue. In addition to the lumpectomy, a separate incision may be required to include a sampling or removal of the axillary (underarm) lymph nodes. This part of the surgery, which may be a sentinel node biopsy, an axillary lymph node sampling, or an axillary lymph node dissection, is performed to determine whether the cancer has begun to spread out of the breast itself (see the section below on lymph node removal for more information).
After the lumpectomy is performed, the pathologist will check to make sure the surgeon removed the entire cancerous tumor by seeing if the tissue margins are "clear" (in other words, if there is no cancer present in the outermost edges of the breast tissue sample). A preliminary check of the tissue margins may be performed while the patient is still in the operating room and may allow the surgeon to obtain "clear margins" during the same operation. However, this is only a preliminary reading, and the final results, available over the course of a few days, may reveal residual cancer cells (known as a "positive" margin). If the margins of the removed breast tissue do contain cancer cells, then additional surgery (re-excision) is usually necessary to attempt to remove the remaining cancer. If it is not possible to clear the margins on re-excision, then a mastectomy is usually offered as an alternative.
Lumpectomy is often combined with adjuvant (additional) therapy, either local or systemic. Most commonly, lumpectomy is followed by at least six weeks of radiation therapy to ensure that all cancer cells in the remaining breast have been destroyed. Newer studies are beginning to show that shorter radiation times may be equally effective in preventing local tumor recurrence for many patients after lumpectomy; however, this is still under investigation. Other types of adjuvant therapy that may be given in addition to lumpectomy include agents designed to help control the systemic spread of breast cancer. These agents include chemotherapy, the drug tamoxifen (brand name, Nolvadex), or a combination of hormonal or drug therapies.
Several studies have shown that lumpectomy is a viable treatment option for most women with small, localized breast cancers. In fact, there is no statistically significant difference in overall survival rates between women who undergo lumpectomy (and radiation) and those who undergo mastectomy, although a slightly higher local recurrence rate was reported in some larger studies in women who undergo lumpectomy instead of mastectomy. More recently, a large study conducted by Yale researchers found that women with very early-stage breast cancers who undergo lumpectomy followed by radiation therapy are no more likely to develop a second cancer than women who undergo mastectomy, as long as candidates are selected appropriately and the edges of the surgical sample are free of cancer cells.
There are some women who are not good candidates for lumpectomy. The American Cancer Society suggests that women who have already undergone radiation in the breast/chest area, women with two or more areas of cancer in the same breast (known as multicentric disease), women whose previous lumpectomy did not completely remove the cancer, women with connective tissue diseases such as scleroderma (which make tissue sensitive to radiation), or women who would be pregnant at the time of radiation therapy (possibly harming the fetus) should not consider lumpectomy as advisable treatment. In addition, women with cancers more than five centimeters in diameters (two inches) or women with larger cancers within relatively small breasts may not be suitable candidates for lumpectomy. The following chart summarizes conditions for which lumpectomy may not be the most suitable choice:
|Poor Candidates for Lumpectomy|
Source: American Cancer Society
Women who have been diagnosed with breast cancer should carefully discuss their treatment options with their surgeon and other members of their cancer treatment team. Lumpectomy is becoming an increasingly suitable option for many women with early stage breast cancers. While some women are clearly not candidates for lumpectomy (and would benefit more from mastectomy), studies have shown that the type of breast cancer surgery a patient receives is sometimes influenced by her surgeonâ€™s personal preference, geographical location, age, or insurance coverage. It is very common and usually recommended that patients seek a second opinion before undergoing any type of surgery.
Rates of Breast-Conserving Surgery by U.S. Region