Pedro Lombardi / Institut Curie
Breast cancer: local treatments
Once the breast cancer has been detected and qualified, physicians will establish the treatment protocol that is best suited to the patient. It varies according to the cancer type, as well as its stage of advancement and the patient’s overall condition. Surgery is almost always the first line of treatment for non-metastatic breast cancer: it is performed in 80% of cases if the patient’s condition allows. There is a dedicated and appropriate surgical technique for each area of the breast.
- Tumorectomy is the least invasive form of surgery: the tumor is removed, but the mammary glands are preserved as far as possible. This is known as conservative surgery, and represents 75% of cases. This technique is sufficient if the cancer is at an early stage. Treatment is generally on an outpatient basis; the patient is not admitted to the hospital and may return home the same day.
- Mastectomy involves complete removal of the mammary glands while preserving the pectoral muscles. This may be required if the tumor is large, if there are several tumor formations, or pre-cancerous lesions spread throughout the breast. This more complex surgery generally requires a hospital stay of two or three days.
- The sentinel lymph-node technique now allows us to avoid removing all lymph nodes in the area if they are not affected. For tumors measuring less than 2 cm, when removing the tumor the surgeon also removes the first lymph node found in the lymphatic system draining the tumor. This is the first one to be affected if the tumor cells are circulating within the lymphatic system. “If it is affected, the entire lymph-node chain is removed,” explains Dr Séverine Alran. “This is known as lymph-node or axillary dissection. The surgeons, pathologists and nuclear physicians then adapt the post-surgery treatment.” If the sentinel lymph node is healthy, the chain is not removed and the patient thus avoids complex after-effects, such as potential lymphedema, a build-up of lymph in the arm on the side of the surgery.
- Radiotherapy is also almost always part of the treatment protocol for breast cancer, in particular after conservative surgery. The aim is to destroy any residual tumor cells via targeted radiation.