Lumpectomy Health Article

Definition

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.

Purpose

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.

Precautions

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 tissue surrounding it. This may be termed "persistently positive margins, " or "lack of clear margins, " referring to the margin of unaffected tissue around the tumor. Lumpectomy is not used for women who have had a previous lumpectomy and have a recurrence of the breast cancer.

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.