Breast Cancer Treatment Options

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Compassionate Care using the Latest Technology

Thanks to research and medical advances, men and women who face breast cancer now have many treatment options. They include surgery, chemotherapy, radiation therapy, hormone therapy, immunotherapy or, more often, a combination of therapies. The Swedish Cancer Institute offers all of these and tailors treatment to each individual for the most effective outcome.

Our treatment planning may include a "multidisciplinary tumor board." These groups of specialists meet regularly to discuss patient cases and personalized treatment options. This collaboration assures that your care will be based on the latest research and technology, and the best expertise.

At SCI, we will provide you with the best care team for your individual circumstances. Our breast cancer specialists are dedicated to providing compassionate care that is as seamless as possible. Your care team will coordinate appointments and procedures, and make sure you and your family get all of the support you need. SCI has a full array of support services, including our highly popular naturopathic care, counseling and help with finances.

If you are interested in breast reconstruction, SCI has experienced plastic surgeons specializing in implant and microsurgical reconstruction. You can plan for breast reconstruction early in treatment, wait until later or choose not to have reconstructive surgery, if that is best for you.

Surgery

Most men and women who have been diagnosed with breast cancer will undergo some type of surgery as part of their treatment. At the Swedish Cancer Institute, our breast surgeons have years of experience helping patients understand the surgical options, as well as the advantages and disadvantages of each approach.

Most patients will need surgery first, but some will benefit from chemotherapy prior to surgery. Specialists on your care team will collaborate on the timing of various treatments so you can focus on taking care of yourself.

Depending on the location, tumor size, aggressiveness of the cancer and a patient’s personal preference, there are several surgical options:

Lumpectomy/Partial Mastectomy

The cancerous lump and a rim of normal tissue around it are removed. Some of the underarm lymph nodes also may be removed to determine if cancer cells are present. A lumpectomy usually is followed by radiation therapy.

Simple or Total Mastectomy

This is the removal of the entire breast, usually including the nipple-areolar complex. Lymph nodes from the underarm may be removed for evaluation. Radiation therapy usually will not be necessary after a total mastectomy.

Modified Radical Mastectomy (Total mastectomy plus armpit lymph node removal)

The entire breast is removed, as well as underarm lymph nodes, which will be evaluated for breast cancer cells.

Radical Mastectomy

The entire breast is removed, along with the chest-wall muscles under the breast and the armpit lymph nodes. This surgery is rarely performed today.

Skin-Sparing Mastectomy

Much of the skin and possibly the nipple and areola are left intact on the chest wall. The breast tissue is removed through a small incision with the goal of leaving less visible scars after reconstruction.  Your surgeon will decide whether saving the breast skin and nipple areolar complex is right in your particular situation.

Sentinel Node Biopsy

The sentinel lymph nodes are the first lymph nodes that cancer cells are likely to spread to from the primary cancer. With a sentinel node biopsy, the surgeon identifies and removes these lymph nodes from the armpit. A pathologist examines the nodes under a microscope to determine if cancer cells are present. This procedure is done at the time of breast cancer surgery but the full pathology evaluation usually takes several days. Depending on the circumstances, if there are cancer cells in the sentinel nodes, your surgeon may recommend removing additional lymph nodes from the armpit.

Radiation Therapy

At the Swedish Cancer Institute, radiation oncologists are part of the specialized team delivering personalized treatment for each breast cancer patient. Not every patient will need radiation therapy, but our experts are involved in treatment discussions to share their clinical expertise.

Our radiation oncologists are extremely experienced in breast cancer treatment and have been thought leaders in the field by advancing technologies such as Active Breathing Coordinator, accelerated partial breast irradiation, TomoTherapy and CyberKnife radiosurgery.

Radiation therapy involves using targeted, penetrating rays of energy, or radiation, to destroy cancer cells. Radiation therapy typically is used after surgery to kill any remaining cancer cells in the breast and possibly the armpit area.

The number of sessions needed depends on the type of treatment selected. Radiation therapy is available at multiple locations for the convenience of our patients.

We offer these advanced radiation therapies:

External Beam Radiation Therapy

This is the most common radiation treatment. It is delivered by a machine called a linear accelerator, or linac.  It delivers short, targeted bursts of X-rays to the cancer. The Swedish Cancer Institute uses the latest technology to precisely target breast cancer and minimize radiation to normal tissue.

For patients with cancer in the left breast, we can minimize the radiation to the heart by incorporating the Active Breathing Coordinator, or ABC, with external beam radiation.

Each treatment session usually is about 30 minutes. Most patients will undergo treatment five days a week for six to eight weeks. Common side effects include fatigue and skin tenderness.

TomoTherapy

SCI Ballard offers TomoTherapy, an advanced technology that uses 3-D imaging to deliver highly focused radiation with unprecedented accuracy. This accuracy helps protect critical organs from radiation and minimizes damage to healthy tissue. Tomotherapy is particularly helpful for treating breast cancer because of the cancer’s proximity to the heart and lungs.

Each treatment session usually is about 30 minutes. Most patients will undergo treatment five days a week for six to eight weeks. Common side effects include fatigue and skin tenderness.

Accelerated Partial Breast Irradiation (APBI)

Accelerated partial breast irradiation (APBI), commonly known as brachytherapy, is a method of delivering radiation directly to the surgical cavity to kill any remaining cancer cells and treat the tissue immediately adjacent to where the cancer has been removed. At the Swedish Cancer Institute, we offer patients who meet the criteria several options for APBI:

1. One technique uses a device that is placed in the breast. During treatment, the patient lies on their back and a radiation device delivers a high-dose seed to the device in the breast. This delivery is targeted to precise positions. The patient feels nothing and when the treatment is complete, the seed retracts and the radiation device is detached until the next treatment session. Patients undergo treatment several weeks after a lumpectomy over five days, with two sessions each day. Sessions usually are 30 minutes to an hour with a five-hour break in between. This treatment can take up to two weeks from implanting the device to the final treatment. The device is then removed from the breast and steri-strips are applied to the skin. Watch this video to learn more about how this treatment works.

2. The Swedish Cancer Institute is the first and only cancer center in the U.S. that offers permanent breast seed implants to early stage breast cancer patients. Breast Microseed Treatment™ involves the precise placement of radioactive seeds in the breast that slowly release the prescribed dose safely over time. A radiation oncologist uses ultrasound guidance to place low-dose radioactive seeds in the cavity where the tumor was removed. This procedure usually takes about an hour and is done several weeks after surgery. Since the Microseed™ 
radiation sources are permanent, no additional procedures are necessary and the patient can return home immediately after treatment. The seeds treat the area over time and lose all potency by the time treatment is complete. Not every patient is eligible for Breast Microseed Treatment™. Watch this video to learn more about how this treatment works. The first U.S. patient was featured in KOMO news. See the KOMO video.

Accelerated partial breast irradiation therapy using external beam techniques also may be suitable for some patients.

CyberKnife Radiosurgery (Stereotactic Radiosurgery)

The Swedish Radiosurgery Center was the first center in the region to treat breast cancer patients with leading-edge CyberKnife stereotactic radiosurgery. Like APBI, CyberKnife offers an accelerated course of treatment for women meeting the selection criteria.

Stereotactic radiosurgery is not actual surgery, as the name suggests. The treatment uses computerized robotic equipment to deliver high-dose radiation with extreme accuracy and little damage to surrounding tissue.

In real time, the robot tracks the cavity where the cancer was surgically removed and turns the X-ray beam on when the target is in view. This allows for higher doses of radiation over a shorter period of time. Patients usually wear street clothes during treatment and return to normal activities when their treatment is completed.

Learn more about CyberKnife and watch this video

Chemotherapy, Hormone Therapy and Immunotherapy

At the Swedish Cancer Institute, our highly-skilled breast oncologists continue to gain recognition as top doctors in the Seattle area. They are experts in the most advanced therapies for breast cancer, including chemotherapy, hormone therapy and immunotherapy.

Our experts also are leaders in research to develop new treatments. The Swedish Cancer Institute is one of the leading clinical trial sites in the western United States, offering access to novel breast cancer trials, some of which are only available here in the Pacific Northwest. Learn more about our research

Chemotherapy

Chemotherapy is the use of anti-cancer medications to kill or suppress cancer cells in the breast or throughout the body. At the Swedish Cancer Institute, our medical oncologists participate in regular meetings of a wide variety of cancer specialists who together determine the best course of treatment for each patient.

This may include chemotherapy. Some patients receive chemotherapy before breast surgery with the goal of shrinking the tumor and killing cancer cells. This is called neoadjuvant chemotherapy. Other patients may receive chemotherapy after surgery.

Our specialty pharmacists work with patients to ensure the proper use of chemotherapy medication, which is taken by pill or injected into the bloodstream.  Chemotherapy is a systemic treatment, meaning it reaches all parts of the body. Side effects may include nausea and hair loss, but our supportive treatments help minimize these conditions.

Chemotherapy may last for three to six months, or longer in some circumstances. Learn more about chemotherapy

We have multiple convenient locations for patients to receive treatment in Seattle, Ballard, Edmonds, Bellevue and Issaquah. Call 1-855-XCANCER for more information.

Hormone Therapy

Some breast cancers are sensitive to the hormones estrogen and/or progesterone. For these cancers, anti-estrogen hormone therapy can slow the growth of breast-cancer cells. The medicine for this treatment is taken in pill form. When prescribed as a supplemental therapy for early-stage breast cancer, treatment generally lasts at least five years. Learn more about hormone therapy

Immunotherapy

This treatment is called immunotherapy, biological therapy or targeted therapy. Immunotherapy enhances the body's immune-system response to breast cancer. This treatment is administered intravenously. Learn more about immunotherapy