Mt. Vernon Register-News

October 31, 2012

Breast cancer treatment has many steps


MT. VERNON — From mammogram to chemotherapy, the process of diagnosing and treating breast cancer is a many-step process for the women (and men) who go through it.

Dr. Jackie Trechk-Bahn of Crossroads Community Hospital said the process begins with a mammogram that has results indicating an abnormal growth in the breast.

“If there’s something we see, we bring the patient back and do an ultrasound with additional mammography,” she said. “At that point, we talk with the patient about their options, such as surgical biopsy and stereotactic breast biopsy.”

Trechk-Bahn said stereotactic breast biopsy is a much less invasive form of biopsy offered at hospitals now.

“There is a table, and the patient lies down, so they are relatively comfortable,” she said. “There is a computer setup that’s similar to mammography. A core biopsy is taken with a vacuum-powered instrument that pulls tissue into a needle. A surgical clip is placed at the site of the biopsy, because in many cases, a biopsy will come back negative for cancer. That way we know we have tested that area.”

She said the surgical clip is only a few millimeters long and stays in the breast forever.

The technique leaves no scarring and is more affordable compared to surgical open biopsy, Trechk-Bahn added.

“After a couple of months, you can’t even tell there was a biopsy,” she said. “It’s like having blood drawn.”

She added that no anesthesia is needed during the stereotactic breast biopsy.

During either type of biopsy, enough tissue is removed from the suspicious area to test for all markers of breast cancer, she said.

“Breast cancer is many diseases,” she said. “Testing tells you what chemotherapy or techniques would work against it.”

She said after the discovery of cancer in a patient’s breast, they may undergo a lumpectomy or mastectomy, and then chemotherapy, followed by radiation if necessary.

Dr. Graeme Fisher of Mt. Vernon Radiation Center said breast cancer patients usually receive adjutant treatment after a lumpectomy.

He said radiation typically takes about six to seven weeks, and depending on the severity of the cancer, areas from the breast, to the armpit, shoulder and chest wall area can be treated with radiation as well.

“It’s trying to sterilize the area from any microscopic parts of the disease left over after lumpectomy or mastectomy,” Fisher said, adding, “Breast cancer is getting caught earlier than it used to be.”

Jennifer Thompson, a physical therapist and center manager at Nova Care Rehabilitation, is trained to provide treatment for a condition that can occur after cancer treatment, including breast cancer. A condition called lymphedema can occur in patients whose lymph nodes have been removed during cancer treatment, causing localized swelling, which in turn can cause infection, Thompson said.

“Lymph nodes remove excess fluid in your body, and when they’re removed, depending on how many are removed, the patient could be at risk of arm swelling,” she said. “The doctor is saving their life, of course, but this is something that could happen after.”

Fisher said more people are keeping their lymph nodes because the status of their lymph nodes helps decide whether they should get chemotherapy.

Breast cancer patients who get lymphedema in their arms undergo massage treatments followed by medical compression bandages, Thompson said. The process takes daily treatments for a few weeks, she said. After that, patients must wear a medical sleeve to discourage the condition from returning.

“If someone doesn’t get treatment, the swelling can and will get worse,” she said. “That area of the body is at risk for infection. I tell my patients it’s like stagnant pond water — it’s an area where infection breeds.”

Cancer patients who have had lymph nodes removed must avoid infection, muscle strain, burns, overheating and constriction of the areas, or they may be at risk for lymphedema, Thompson said.

“It’s not painful, it’s just swelling,” she said. “It can happen to lots of types of cancer patients.”

Trechk-Bahn said despite the arduous process of cancer treatment, for breast cancer patients, the survival rate is “wonderful.”

“We’ve got so many options now,” she said. “We know the molecular identity of each cancer; we basically have cures. That’s the best thing about it. We pick it up early, treat it, and people have a normal life expectancy, which wasn’t the case years ago.”