The cells that line the ducts or, more rarely, the lobules, can start growing in an uncontrolled way, called a malignant change. The cells look malignant under the microscope and appear in the wrong tissues. At first, they stay inside the ducts or lobules for a time, called in-situ carcinoma. At some later date, they spread through walls of the ducts or lobules into the tissue of the breast. They can pass into the lymph glands and other parts of the body. This is called invasive carcinoma.
Sometimes, the appearance of the lining cells simply suggest that the condition may start turning malignant at some stage in the future, called a premalignant change.
The surface of each breast tumour cell has special places, which female sex hormones such as oestrogen stick to. These places are called oestrogen receptors. A special microscope stain on the removed tissue is used to detect these sites. Future treatment partly depends on how many sites are found on the cells.
The aims
The aim is to treat any malignant disease in the breast. We do this by removing the breast. You will usually end up with a fine scar running across the chest wall. The breast and nipple can always be rebuilt, usually at a later date.
The second aim is to find out whether there are malignant cells in the rest of the body. If so, then treatment with hormones or chemotherapy would be of help. One of the best guides to there being cancer cells throughout the body, is to see if there are any in the lymph glands in the armpit, called the axilla. To do this, we will take out one or more glands from your axilla, called an axillary sample, at the same time as the breast operation. Some surgeons will suggest removing all the glands instead of just a few. This is called axillary clearance.
A recent way of finding the correct glands in your axilla is called a sentinel node biopsy. A dye or a radioactive chemical is injected into the breast an hour or more before the operation. This runs in the lymph ducts from the breast and into the first (sentinel) gland in the axilla. The surgeon can find the node because it is coloured with the dye, or because a scanner detects the radioactive chemical in it. This method may reduce the number of nodes needed and can be less painful than the standard method.
You should be able to come into hospital on the day of the operation, and will need to stay in for 4 or more days.
You will be asleep with a general anaesthetic during the operation.
The whole breast is removed together with the axillary glands using one incision. We send the breast and gland tissue to be looked at under the microscope. It takes about a week to prepare the tissue and to examine it.
If the glands in the armpit are free from cancer cells, you probably do not need any more treatment to the armpit. If there are cancer cells in the glands, you need to consider having x-ray treatment to the glands in the armpit, around the collar bone and behind the breast bone. Your breast specialist will discuss hormone treatment and chemotherapy with you.
The benefits
The operation should start you on the path towards having a cure for the breast cancer. The breast with the cancer will be gone. The tissue that we remove will help us plan the best possible future treatment for you.
Are there any alternatives?
Simply taking out the diseased part from the breast and using x-ray treatment for the rest of the breast is an alternative. It is not a good idea if we cannot get a safe rim of tissue around the tumour, the background tissue has in-situ changes or there is more than one tumour in the breast. Also some patients are not happy about keeping a breast with possible tumour still in it.
X-ray treatment on its own would not be as good as a mastectomy. Neither would drug treatment on its own. The same applies to alternative therapies such as aromatherapy and reflexology.
The breast could be rebuilt with an implant at the time of the mastectomy, but this makes healing risky.
If there is premalignant tissue in the breast, it may be possible to core out the breast tissue and leave the skin and nipple (subcutaneous mastectomy). An implant would rebuild the breast shape.
You need to spend some time with the breast specialist discussing this whole matter. There is no rush to decide.
What if you do nothing?
If you do nothing the problem in the breast will get steadily worse. If there is a cancer, it may spread to other parts of the body.
Author: Mr Michael Edwards FRCSEng FRCSEd. Consultant general surgeon.
© Dumas Ltd 2006
