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5 Things You Should Do Before Undergoing Breast Cancer Surgery

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It’s completely understandable to feel like your cancer diagnosis is a crisis that requires an urgent solution. “Get the cancer out of me quickly,” is a common request. However, you should resist the urge to treat cancer as an “emergency”. Having the cancer removed quickly may help your anxiety, but “rushing” to surgery will not improve your chances of surviving breast cancer or avoiding a recurrence. For the best possible outcome, it is essential that you learn about all of your treatment options to avoid making hasty decisions that might compromise your outcome. This sometimes means completing chemotherapy BEFORE surgery. It is completely safe to take a few weeks to figure out what approach is best for you and your cancer.

Choosing a surgeon to treat your breast cancer is among the most important decisions you will make in your fight against breast cancer. This decision will not only influence how you emotionally handle your cancer diagnosis, it will also greatly affect the kinds of treatments you are offered, the success of your breast cancer operation, and the kinds of side-effects you
will deal with in your life after breast cancer treatment. Even if affect the kinds of treatments you are offered, the success of tumor to chemotherapy to ensure that the chemotherapy is
your breast cancer operation, and the kinds of side-effects you will deal with in your life after breast cancer treatment. Even if you are happy with your current surgeon, obtaining a second opinion will make you a smarter consumer and reassure you that you are on the right path to recovery. Second opinions may also help you identify more effective or safer options that might have not been offered to you. Don’t be ashamed to ask for a second opinion. It is your right as a patient.

The treatment of the lymph nodes in breast cancer patients has evolved considerably in recent years. The main goal of this evolution has been to reduce the burden and complications of lymph node surgery, especially the complication of lymphedema or chronic arm swelling. While lymph nodes surgery remains an important component of breast cancer surgery, advancements in lymph node surgery have significantly reduced the extent of lymph node surgery as well as the side effects of the procedure.

Today, most patients require removal of only one or 2 lymph nodes instead of 20 or 30 lymph nodes. Even women with proven cancer in their lymph node may often avoid extensive lymph node removal if treated with chemotherapy prior to surgery. For the subset of women that do require extensive lymph node surgery, axillary reverse mapping is a special technique performed by Dr. Holmes to preserve arm lymphatic drainage and reduce the risk of lymphedema resulting from lymph node surgery.

When chemotherapy is required, the traditional approach has been to administer chemotherapy after surgery. However, there are multiple advantages to receiving chemotherapy prior to surgery including 1) clearing cancer from lymph nodes to reduce the extent and side effects of lymph node surgery, 2) shrinking the breast tumor to reduce the extent of breast surgery, improve surgical margins, and improve breast appearance, 3) accessing new medications that are only approved for administration prior to surgery, and 4) allowing monitoring of the response of the tumor to chemotherapy to ensure that the chemotherapy is effective. If you have been advised to receive chemotherapy, be sure to ask if you would benefit from receiving chemotherapy prior to surgery.

Many women diagnosed with early stage breast cancer are eligible for newer treatments that greatly reduce the burden and side effects of breast cancer care. For example, women with breast cancer measuring 1.5 cm or smaller may qualify for cryoablation, a type of cancer treatment in which the cancer is frozen to death with a small needle instead of being removed with surgery. Some patients treated with cryoablation may also avoid breast radiation and lymph node surgery. Another treatment available to women with early stage breast cancer is targeted intraoperative radiotherapy (TARGIT), a type of radiation administered at the time of lumpectomy. TARGIT delivers radiation as a single treatment to the lumpectomy site during surgery instead of the usual 3-6-week course of daily radiation treatments to the entire breast after surgery. TARGIT is available to women with breast cancer measuring 3 cm or smaller and no evidence of lymph node spread.

Dennis R. Holmes, M.D.

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