A lumpectomy is a type of surgery for breast cancer. It is considered "breast-conserving" surgery because in a lumpectomy, only the malignant tumor and a surrounding margin of normal breast tissue are removed. Lymph nodes in the armpit (axilla) may also be removed. This procedure is called lymph node dissection.
Lumpectomy is a surgical treatment for newly diagnosed breast cancer. It is estimated that at least 50% of women with breast cancer are good candidates for this procedure. The location, size, and type of tumor are of primary importance when considering breast cancer surgery options. The size of the breast is another factor the surgeon considers when recommending surgery. The patient's psychological outlook, as well as her lifestyle and preferences, should also be taken into account when treatment decisions are made.
The extent and severity of a cancer is evaluated or "staged" according to a fairly complex system. Staging considers the size of the tumor and whether the cancer has spread directly to adjacent tissues, such as the chest wall, the lymph nodes, and/or to distant parts of the body. Women with early stage breast cancers are usually better candidates for lumpectomy. In most cases, a course of radiation therapy after surgery is part of the treatment. Chemotherapy or hormone treatment may also be prescribed.
Many studies have compared the survival rates of women who have had removal of a breast (mastectomy) with those who have undergone lumpectomy and radiation therapy. The data clearly demonstrate that for women with comparable stages of breast cancer, survival rates are equal between the two groups.
In some instances, women with later stage breast cancer may be able to have lumpectomy. Chemotherapy may be administered before surgery to decrease tumor size and the chance of spread in selected cases.
There are a number of factors that may prevent or prohibit a breast cancer patient from having a lumpectomy. The tumor itself may be too large or located in an area where it would be difficult to remove with good cosmetic results. Sometimes several areas of cancer are found in one breast, so the tumor cannot be removed as a single lump. A cancer which has already attached itself to nearby structures, such as the skin or the chest wall, needs more extensive surgery.
Certain medical or physical circumstances may also eliminate lumpectomy as a treatment option. Sometimes lumpectomy may be attempted, but the surgeon is unable to remove the tumor with a sufficient amount of normal
Because of the need for radiation therapy after lumpectomy, this surgery may be medically unacceptable. A breast cancer discovered during pregnancy is not amenable to lumpectomy, due to the need for radiation therapy as part of the treatment. Radiation therapy cannot be administered to pregnant women because it may injure the fetus. If, however, delivery would be completed prior to the need for radiation, pregnant women may undergo lumpectomy. Women with collagen vascular disease, such as lupus erythematosus or scleroderma, would experience scarring and damage to their connective tissue if exposed to radiation treatments. A woman who has already had therapeutic radiation to the chest area for other reasons cannot have additional exposure for breast cancer therapy.
Some women may choose not to have a lumpectomy for other reasons. They may strongly fear a recurrence of breast cancer, and may consider a lumpectomy too risky. Others feel uncomfortable with a breast that has had a cancer, and they experience more peace of mind with the entire breast removed.
The need for radiation therapy may also be a barrier due to non-medical concerns. Some women simply fear this type of treatment and choose more extensive surgery so that radiation will not be required. The commitment of time, usually five days a week for six weeks, may not be acceptable for others. This may be due to financial, personal, or job-related constraints. Finally, in geographically isolated areas, a course of radiation therapy may require lengthy travel, and perhaps unacceptable amounts of time away from family and other responsibilities.
Lumpectomy is an imprecise term. Any amount of tissue, from 1% to 50% of the breast, may be removed and called a lumpectomy. Other names are no more definite in their meaning, although some idea of the scope of tissue removal may be implied. Breast conservation surgery is a frequently-used synonym for lumpectomy. Partial mastectomy, quadrantectomy, segmental excision, wide excision, and tylectomy are other, less commonly used names for this procedure.
A lumpectomy is frequently done in a hospital setting (especially if lymph nodes are to be removed at the same time), but specialized outpatient facilities are sometimes preferred. The surgery is usually done while the patient is under general anesthetic. Local anesthetic with additional sedation may be used for some patients. The tumor and surrounding margin of tissue is removed and sent to the pathologist. The surgical site is closed.
If axillary lymph nodes were not removed before, a second incision is made in the armpit. The fat pad that contains lymph nodes is removed from this area and is also sent to the pathologist for analysis. This portion of the procedure is called an axillary lymph node dissection; it is critical for determining the stage of the cancer. Typically, 10 to 15 nodes are removed, but the number may vary. Surgical drains may be left in place in either location to prevent fluid accumulation. The surgery may last from one to three hours.
The patient may stay in the hospital one or two days, or return home the same day. This generally depends on the extent of the surgery, the medical condition of the
Routine preoperative preparations, such as having nothing to eat or drink the night before surgery, are typically ordered for a lumpectomy. Information about expected outcomes and potential complications is also part of preparation for lumpectomy, as it is for any surgical procedure. It is especially important that women know about sensations they might experience after the operation, so the sensations are not misinterpreted as signs of further cancer or poor healing.
If the tumor is not able to be felt (not palpable), a pre-operative localization procedure is needed. A fine wire, or other device, is placed at the tumor site, using x ray or ultrasound for guidance. This is usually done in the radiology department of a hospital. The woman is most often sitting up and awake, although some sedation may be administered.
After a lumpectomy, patients are usually cautioned against lifting anything which weighs over five pounds for several days. Other activities may be restricted (especially if the axillary lymph nodes were removed) according to individual needs. Pain is often enough to limit inappropriate motion. Women are often instructed to wear a well-fitting support bra both day and night for approximately one week after surgery.
Pain is usually well controlled with prescribed medication. If it is not, the patient should contact the surgeon, as severe pain may be a sign of a complication, which needs medical attention. A return visit to the surgeon is normally scheduled approximately ten days to two weeks after the operation.
Radiation therapy is usually started as soon as feasible after lumpectomy. Other additional treatments, such as chemotherapy or hormone therapy, may also be prescribed. The timing of these is specific to each individual patient.
The risks are similar to those associated with any surgical procedure. Risks include bleeding, infection, asymmetry, anesthesia reaction, or unexpected scarring. A lumpectomy may also cause loss of sensation in the breast. The size and shape of the breast will be affected by the operation. Fluid can accumulate in the area where tissue was removed, requiring drainage.
If lymph node dissection is performed, there are several potential complications. A woman may experience decreased feeling in the back of her armpit. She may also experience other sensations, including numbness, tingling, or increased skin sensitivity. An inflammation of the arm vein, called phlebitis, can occur. There may be injury to the nerves controlling arm motion.
Approximately 2% to 10% of patients develop lymphedema (swelling of the arm) after axillary lymph node dissection. This swelling of the arm can range from mild to very severe. It can be treated with elastic bandages and specialized physical therapy, but it is a chronic condition, requiring continuing care. Lymphedema can arise at any time, even years after surgery.
A new technique that may eliminate the need for removing many axillary lymph nodes is being tested. Sentinel lymph node mapping and biopsy is based on the idea that the condition of the first lymph node in the network, which drains the affected area, can predict whether the cancer may have spread to the rest of the nodes. It is thought that if this first, or sentinel, node is cancer-free, then there is no need to look further. Many patients with early-stage breast cancers may be spared the risks and complications of axillary lymph node dissection as the use of this approach continues to increase.
When lumpectomy is performed, it is anticipated that it will be the definitive surgical treatment for breast cancer. Other forms of therapy, especially radiation, are often prescribed as part of the total treatment plan. The expected outcome is no recurrence of the breast cancer.
An unforeseen outcome of lumpectomy may be recurrence of the breast cancer, either locally or distally (in a part of the body far from the original site). Recurrence may be discovered soon after lumpectomy or years after
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Robinson, Rebecca Y. and Jeanne A. Petrek. A Step-by-Step Guide to Dealing With Your Breast Cancer. New York:Carol Publishing Group, 1999.
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American Cancer Society. 1599 Clifton Rd. NE, Atlanta, GA30329-4251. (800) 227-2345. <http://www.cancer.org>.
Information about surgeons and institutions participating inclinical trials of sentinel node biopsy is available at the NCI (National Cancer Institute) web site at <http://cancertrials.nci.nih.gov/types/breast/treatment/sentnode> or (800) 4-CANCER.
National Lymphedema Network. 2211 Post St., Suite 404, SanFrancisco, CA 94115-3427. (800) 541-3259 or (415) 921-1306. <http://www.wenet.net/~lymphnet>.
Ellen S. Weber, M.S.N.
—A small mass of tissue in the form of a knot or protuberance. They are the primary source of lymph fluid, which serves in the body's defense by removing toxic fluids and bacteria.