Breast Cancer Surgery
Usually the first approach to breast cancer is surgery to remove the malignant tumour in the breast. There are various types of surgery and the type a patient has will be dependent on each unique situation. The main types of surgery are lumpectomy, mastectomy and segmentectomy. Lumpectomy is removal of the lump only, mastectomy is the removal of the whole breast and a segmentectomy is removal of part of the breast. Conservative surgery is a lumpectomy combined with segmentectomy. There are many other types apart from these.
The doctor will always discuss what type of procedure is best for each particular case, and the final decision always lies with the patient. In some cases it might be difficult for a doctor to make a definite diagnosis until the lump is actually removed and examined. Conservative surgery, and in some cases with a mastectomy, surgery may be followed by radiotherapy. This is to kill any cancer cells that may be left in the breast after surgery. This decision is usually only made after surgery when the test results and staging information is available.
Various Types of Breast Cancer Surgery
Lumpectomy
This procedure, also referred to as wide local excision, takes away the lump and a small amount of surrounding tissue. This is to ensure that no cancer cells remain in the healthy breast tissue. The lump and tissue that is removed is sent to the pathologist who will examine it under a microscope to check if the border of healthy flesh around the tumour is clear from cancer cells. If so then this is referred to as either a ‘clear margin’ or a ‘healthy margin’.
Segmentectomy
A segmentectomy or quadrantectomy is a similar procedure to a lumpectomy but more of the surrounding breast tissue is removed with the lump.
Mastectomy
A mastectomy may be considered if there is a large lump in the breast, a lump in the middle of the breast or more than one area of cancer in the breast. There are different types of mastectomy. A simple mastectomy removes only the breast tissue whereas a radical mastectomy removes the muscles on the chest wall as well as the breast. A modified radical mastectomy is a procedure that removes the breast and underarm lymph nodes without removing the chest wall muscles.
Axillary Clearance
The lymph nodes under the arm should be checked after diagnosis of breast cancer. If the cancer spreads it usually spreads to the lymph nodes. An ultrasound scan will reveal any abnormal looking nodes. A fine needle aspiration is done whereby a needle is inserted into the suspicious nodes and fluid and cells are extracted. This procedure is also called a biopsy. If cancer cells are found in any of the nodes then usually all the nodes are removed from the underarm.
Most of these surgical procedures are followed by radiotherapy which is treatment of the area using radiation to kill any remaining cancer cells in the tissue.