I have written two previous articles about breast cancer treatment, about methods of detection, and surgery. These have all emphasized the need for a team that can work well together, as there are at least five different specialties that must coordinate care. At present this team may be near optimal on the Henry Mayo campus as all specialists are available, and among the best in each of their fields. Yet the size is small enough that the communication is excellent. An attempt is made to discuss all breast cancer patients treated in any substantial way by members of the team, regardless of where the surgery is done. We also rely heavily on our Facilitator, Mindy Burgess RN, to make sure nothing gets left out of the treatment equation and that treatment gets done as fast as good care allows.
Incidentally we are using this approach for other types of cancer treated on the hospital campus, but we try to give objective advice about where a particular cancer can be treated. For some cancers still involve getting at least part of the treatment at a tertiary care hospital.
So the next members of the treatment team to be needed are the radiation oncologists. Once a breast cancer has been detected and removed surgically, radiation therapy to the breast will be needed if all of the breast tissue has not been removed. In a previous article, I discussed the best surgical techniques, which involve either a wide excision (lumpectomy) or a skin sparing mastectomy. The latter does not require treatment with radiation therapy unless the tumor was large or there were four or more lymph nodes involved by cancer. Lumpectomy does require radiation to the remaining breast tissue to sterilize it of tumor cells. Treatment is given only to the breast and a part of the underarm, is aimed tangentially, so does not go anywhere else in the body. Generally one cannot cosmetically tell that radiation has been given after several months. The radiation treatments are usually given Monday through Friday, taking just a few minutes of actual treatment time each day, for about six weeks. There are several different approaches in use that give treatments over a shorter period or in some cases of very small tumors treat just part of the breast.
Overall, however, the radiation treatments are seldom difficult to endure and the goal is always to have both the highest rate of sterilization of tumor cells and the best cosmetic outcome. So getting quality advice from radiation oncologists who are knowledgeable about all the choices is mandatory. It is also critical that they be active members of the treatment team so that they understand each woman’s particular situation, as many factors may require special care or altered approaches. Robert Zimmerman and Nancy Ellerbroeck are excellent doctors who have the newest type of equipment called Tomotherapy and they are always at our conferences to help arrive at the best plan.
Surgery and radiation constitute local treatment, meaning treatment of the breast only. Medical Oncologists provide additional body wide treatment of breast cancer using chemotherapy or anti-estrogen and other targeted or biological therapies, which will be discussed in future articles.
UCLA Cancer Center – Santa Clarita is located at 23929 McBean Parkway, Suite 215 in Valencia. For more information, please call 661-255-5350 and visit www.cancer.med.ucla.edu.