The Latest News from the Experts in Breast Cancer Treatment

September 10, 2008

Biopsy Technique Reduces Need for Lymph Node Removal

“When breast cancer is discovered, we need to check for the presence of cancer cells in the lymph nodes in the underarm to see if it has spread,” said General Surgeon Julie Hutchinson, MD. “One procedure that is helpful in preserving tissue and minimizing side effects is called a sentinel lymph node biopsy. We inject dye and a nucleotide into the breast and look for the first lymph node to which the dye travels. That is called the sentinel lymph node. We can then remove the node through a very small incision and check for suspicious cells. If there are none, it is likely we can avoid removing the rest of the lymph nodes in the area. Because fewer lymph nodes are removed, there are fewer short- and long-term side effects, such as lymphedema and pain.”

Specialized Technique for Lymph Node Drainage

When a large number of lymph nodes are removed from the underarm area, it can leave the patient with lymphedema, or swelling of the arm, and an increased risk of infection. Shadi Talebi, physical therapist at Floyd Memorial, has advanced training in manual lymph drainage massage. “After I treat the patient for a few weeks, I teach her how to do self-massage so she can do it at home. If necessary, I can also fit the patient for a compression sleeve or garment to help control fluid buildup.”

What Does a Hematologist Do?

“Hematologists treat people who have problems such as anemia with low hemoglobin, low platelet count, or high or low white blood cell counts,” said Medical Oncologist/Hematologist Aftab Chaudhry, MD. ”While these problems can be caused by chemotherapy, leukemia or other cancers, there are many other causes, including some drugs taken for heart problems.”

Three Leading-Edge Developments in Chemotherapy

Chemotherapy is one of the areas in medicine where some of the most dramatic advancements are taking place. Among them are:

Targeted Therapy

One of the most important advances in chemotherapy is targeted therapy. As Dr. Chaudhry explained, “Cancer is made up of rapidly multiplying cells. In targeted therapy, we use drugs that attack specific cancer cells by interfering in various stages of their growth without harming normal dividing cells. By targeting only the cancer cells, we don’t affect healthy cells such as those that produce hair and those in the gastrointestinal tract. This can prevent many of the side effects traditionally associated with chemotherapy.” He added, “Examples of targeted therapy include Herceptin®, which targets a specific receptor site in some types of breast cancer cells, Gleevac® for chronic myelogenous leukemia and Avastin® for lung and colon cancer.”

Supportive Treatments to Ease Side Effects

Chemotherapy is becoming more and more effective against cancer, but what if it makes a person too sick to continue? According to Medical Oncologist/Hematologist Mian Mushtaq, MD, “Supportive treatment has become a significant part of therapy in recent years. Great strides have been made, and new classes of medicine to prevent nausea and vomiting have been developed that weren’t available just 10 years ago. We usually start the medication before the patient even begins chemotherapy.”

Test that Identifies Women Most Likely to Benefit from Chemotherapy

“In certain patients with early stage cancer, we can now do a procedure called an Oncotype DX® assay,” said Dr. Mushtaq. “It analyzes a specific set of genes within a tumor and gives us a number that shows whether the risk of recurrence is low, medium or high. If the risk is low, there would not be much benefit from chemotherapy. In certain patients, a drug like Tamoxifen that limits a cell’s estrogen uptake would be enough. This test gives us additional scientific evidence and helps us make a more informed decision about treatment options.”

Advances in Radiation Make Breast Preservation an Option for More Women

Preserving the breast is no longer just a trend in breast cancer treatment. According to Radiation Oncologist William Spanos, MD, “Breast conservation or preservation for women with reasonably early breast cancer is a very good option. It is appropriate in 75 to 80 percent of all breast cancer patients we see. For some women, mastectomy is still the right decision. But many times, it is an individual preference.” “Compared to the national average,” said Radiation Oncologist Craig Silverman, MD, “fewer women in Louisville and Southern Indiana are opting for breast conservation. They should know that we have 40 years of experience in recognizing that, in many cases, radiation plus lumpectomy is equivalent to having a radical procedure. A big reason for that is the advancement in radiation.” Two of the most important advances are these, both of which are available at the Cancer Center of Indiana:

Intensity Modulated Radiation Therapy (IMRT)

”IMRT allows us to precisely localize radiation within the breast,” said Dr. Silverman. “It eliminates a great deal of radiation that would historically be delivered to surrounding tissue.” According to Dr. Spanos, “This is particularly important in cases of left-sided breast cancer where the heart would see some of the radiation and the patient may have already had chemotherapy that could affect cardiac tissue.”

MammoSite 5-Day Targeted Radiation Therapy

MammoSite therapy involves the implantation of a small device inside the breast at the time of surgery. “It has a hollow channel into which we place a radioactive source and deliver two treatments a day for five minutes at a time for one week,” explained Dr. Silverman. “This is equivalent to six weeks of traditional radiation therapy. It preserves the breast, provides good cosmetic results and is especially helpful for women who do not live close by or do not have access to good radiation treatment where they live.”

Why Early Detection Is More Important than Ever

“Early detection of breast cancer is one reason we are seeing better results,” said Dr. Jose. “It also gives women more options for their treatment. The opportunity for a woman to keep her breast by choosing lumpectomy and radiation is excellent when the cancer is caught before it reaches the later stages. We are currently participating in a clinical trial to study the results of limiting radiation to a smaller portion of the breast to further reduce side effects and provide a better cosmetic outcome.” B. O. Jose, MD Board Certified Radiation Oncologist Cancer Center of Indiana

Risk Factors for Breast Cancer

  • Family history of breast cancer
  • Use of hormone replacement therapy
  • Long-term use of hormone-based birth control
  • Age 35 and over
  • Obesity

“If you have a family history of breast cancer,” said Dr. Bechtel, “we recommend starting annual mammograms 10 years before the age of the person in your family when she was diagnosed with the cancer.” He explained that if there are no risk factors, the following schedule should be followed:

  • Monthly self-exams
  • Annual exams by a healthcare professional
  • Yearly mammograms starting at age 40

John Bechtel, MD Board Certified Radiation Oncologist Cancer Center of Indiana