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Treatment

The Center for Breast Care encourages a multidisciplinary approach to the management of breast cancer.This means that most patients will meet with a number of specialists during the course of their treatment. These may include breast surgeons, plastic surgeons, medical oncologists, radiation oncologists, physical therapists, nurses, and others. Regular multidisciplinary tumor board conferences are held which are attended by members of all specialties. Recent cases are reviewed and strategies are discussed to arrive at the best treatment plan for each patient.

Surgery
The majority of breast cancer patients will undergo some type of surgical procedure for removal of their tumor. At The Center for Breast Care, surgeons meet with patients to map out an individualized plan which is most appropriate for that particular patient's tumor. Surgical options include: 
  • Lumpectomy
  • Sentinel Lymph Node Biopsy
  • Modified Radical Mastectomy
  • Simple Mastectomy
  • Skin Sparing Mastectomy
  • Prophylactic Mastectomy

Breast Reconstruction
When appropriate, a plastic surgeon will meet with the patient prior to surgery to outline various methods of breast reconstruction. Most patients undergoing a mastectomy will be candidates for reconstructive surgery should they so desire. Breast reconstruction can be performed with implants or with the patient's own tissues (autologous reconstruction).The latter includes such procedures as TRAM flaps or latisimus flaps.

Chemotherapy
Medical Oncologists may recommend chemotherapy (drug therapy) to kill cancer cells which might have spread beyond the breast to other areas of the body.  The medication is usually administered intravenously at The Infusion Center at Calvert Memorial Hospital.  Most patients receive a combination of two or three medications.The choice of medications is individualized to patient's specific tumor, stage, and the patient's age. Most treatment regimens which are utilized have been found to be effective based on the results of large national and international studies.

In most cases, the chemotherapy will be administered after the patient has healed from surgery. In the case of a very large tumor, extensive lymph node involvement, or what is termed Inflammatory Breast Cancer, the chemotherapy may be started prior to surgery.

Endocrine Therapy
The majority of breast cancers are estrogen receptor positive. This means that the cancer cell expresses an estrogen receptor on its surface. Such cancers are often receptive and sensitive to estrogen and may stop growing or die when they are treated with medications which stop the binding and/or the availability of estrogen. Such medications are administered orally and taken by the patient at home, usually for a number of years.

Tamoxifen is a drug which blocks the effects of estrogen on the breast and other estrogen sensitive tissues in the body. It is typically administered for five years although research is ongoing to determine if a longer duration of treatment is more beneficial.This drug can be used by women both before and after menopause. Common side effects include hot flashes, headaches, and vaginal discharge or dryness.

Arimidex (Anastrozole) and Femara (Letrozole) are examples of a class of drugs referred to as aromatase inhibitors.  These drugs stop the production of estrogen in postmenopausal patients. This means that less estrogen is available to stimulate the growth of estrogen sensitive breast cancer cells. They are not appropriate for women who are still having menstrual periods. Common side effects include hot flashes, joint pain and stiffness, and bone thinning.

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