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Weekend Doctor

By SHARON COLE, MD
Breast cancer is a very common cancer. Ideally it is detected in an early stage from a mammogram. Sometimes it is detected as a lump.
If a mammogram shows a suspicious finding, the patient is set up for further studies such as an ultrasound or additional magnification views. If the area is still believed to be abnormal, then a biopsy is recommended. The biopsy is generally done by a radiologist at an outpatient center.
If the patient is diagnosed with breast cancer then a meeting is set up with a nurse navigator. During this meeting, the results are reviewed and appointments are made with a surgeon, a medical oncologist and a radiation oncologist.
At this point a decision is made regarding surgery. Usually a lumpectomy is pursued which generally requires radiation. There are, however, other options. In some cases chemotherapy is given before surgery which is called neo adjuvant therapy. Also in some cases a mastectomy is selected which can be with or without reconstruction.
A lumpectomy means just the tumor and a safety margin is removed. A mastectomy means the breast is removed. Whichever route is decided, a few lymph nodes will be checked for cancer. We call these sentinal lymph nodes because they are the draining basin for the tumor.
After all the information is available a decision is made regarding whether chemotherapy is needed or not. This decision is based on size of tumor, lymph node involvement, grade (which is the aggressiveness score) and something really important called estrogen receptor, progesterone receptor and her 2 neu status. This is important because these tests will help guide the treatment recommendations. Age, health and personal patient preference also are considered. If the decision is still not clear, there is a new test called “oncodx” which gives even greater insight as to how valuable chemotherapy would be for the patient.
The most usual course is surgery first, then chemotherapy if needed. Radiation is the next step, followed by a pill regime for five or more years if the tumor is estrogen positive. Working together, we have seen cure rates go up and side effects from treatments go down.
Whichever path you have to undertake once breast cancer has been detected, please know that treatment options are generally the same at hospitals of all sizes. Due to a commitment to best practices a patient doesn’t have to travel hundreds of miles to receive treatment.
Lastly, if you have a question about breast cancer or your treatment, ask your family physician, medical oncologist or radiation oncologist. They are all working together to provide the best care possible and want you to understand your options.
Dr. Cole works for Orion Cancer Care. Questions for Blanchard Valley Health System experts may be sent to Weekend Doctor, The Courier, P.O. Box 609, Findlay, OH 45839.

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