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Cancer Treatment Options
BREAST SURGERY
After a diagnosis of breast surgery, or if strong genetic markers show an increased risk of
developing breast cancer, surgery is usually the first line of attack against breast cancer.
Decisions about surgery depend on many factors. You and your doctor will determine the kind of
surgery that’s most appropriate for you based on the stage of the cancer, the "personality" of the
cancer, and what is acceptable to you in terms of your long-term peace of mind.
Lumpectomy
Lumpectomy is the removal of the breast tumor (the "lump") and some of the normal tissue that
surrounds it. Lumpectomy is a form of “breast-conserving” or "breast preservation" surgery. There
are several names used for breast-conserving surgery: biopsy, lumpectomy, partial mastectomy, reexcision, quadrantectomy, or wedge resection. Technically, a lumpectomy is a partial mastectomy,
because part of the breast tissue is removed. But the amount of tissue removed can vary greatly.
Quadrantectomy, for example, means that roughly a quarter of your breast will be removed. Make
sure you have a clear understanding from your surgeon about how much of your breast may be
gone after surgery and what kind of scar you will have.
Mastectomy
Mastectomy is the removal of the whole breast. There are five different types of mastectomy:
"simple" or "total" mastectomy, modified radical mastectomy, radical mastectomy, partial
mastectomy, and subcutaneous (nipple-sparing) mastectomy.
"Simple" (partial) or "total" mastectomy
Simple or total mastectomy concentrates on the breast tissue itself:
• The surgeon removes the entire breast.
• The surgeon does not perform axillary lymph node dissection (removal of lymph nodes in
the underarm area). Sometimes, however, lymph nodes are occasionally removed because
they happen to be located within the breast tissue taken during surgery.
• No muscles are removed from beneath the breast.
Who usually gets simple or total mastectomy?
A simple (partial) or total mastectomy is appropriate for women with multiple or large areas of
ductal carcinoma in situ (DCIS) and for women seeking prophylactic mastectomies — that is, breast
Cancer Treatment Options
removal in order to prevent any possibility of breast cancer occurring.
Modified radical mastectomy
Modified radical mastectomy involves the removal of both breast tissue and lymph nodes:
• The surgeon removes the entire breast.
• Axillary lymph node dissection is performed, during which levels I and II of underarm lymph
nodes are removed (B and C in illustration).
• No muscles are removed from beneath the breast.
Who usually gets a modified radical mastectomy?
Most people with invasive breast cancer who decide to have mastectomies will receive modified
radical mastectomies so that the lymph nodes can be examined. Examining the lymph nodes helps
to identify whether cancer cells may have spread beyond the breast.
Radical mastectomy
Radical mastectomy is the most extensive type of mastectomy:
• The surgeon removes the entire breast.
• Levels I, II, and III of the underarm lymph nodes are removed (B, C, and D in illustration).
• The surgeon also removes the chest wall muscles under the breast.
Who usually gets a radical mastectomy?
Today, radical mastectomy is recommended only when the breast cancer has spread to the chest
muscles under the breast. Although common in the past, radical mastectomy is now rarely
performed because in most cases, modified radical mastectomy has proven to be just as effective
and less disfiguring.
Partial mastectomy
Partial mastectomy is the removal of the cancerous part of the breast tissue and some normal tissue
around it. While lumpectomy is technically a form of partial mastectomy, more tissue is removed in
partial mastectomy than in lumpectomy.
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Subcutaneous ("nipple-sparing") mastectomy
During subcutaneous ("nipple-sparing") mastectomy, all of the breast tissue is removed, but the
nipple is left alone. Subcutaneous mastectomy is performed less often than simple or total
mastectomy because more breast tissue is left behind afterwards that could later develop cancer.
Some physicians have also reported that breast reconstruction after subcutaneous mastectomy can
result in distortion and possibly numbness of the nipple. Because subcutaneous mastectomy is still
an area of controversy among some physicians, your doctor may recommend simple or total
mastectomy instead.
Reconstruction (Oncoplasty)
Breast reconstruction is a surgical procedure to rebuild the contour of the breast, along with the
nipple and areola, if desired.
There are two common types of reconstruction:
Saline breast implants and muscle flap reconstruction (using your own tissue). Typically, the
surgery is done in two phases—during removal of the tumor site an expander is inserted
temporarily for 3-6 months, and then replaced with an implant. Dr. Ivanov and the plastic surgeon
will discuss the options that suit each patient best.
Nearly 100% of patients have reconstructive surgery as an option. However, most patients who are
eligible for breast reconstruction surgery after cancer treatment don’t realize this is an option. As
part of the multidisciplinary approach, Dr. Ivanov works very closely with a plastic surgeon that
performs the breast reconstruction surgery in tandem with the cancer surgical treatment.
Cancer Treatment Options
CHEMOTHERAPY
Chemotherapy treats cancer with powerful drugs that can destroy cancer cells, control their growth
and relieve pain symptoms by interfering with cell division. The treatment of chemotherapy works
by stopping or slowing the growth of cancer cells, which can grow and divide quickly.
Chemotherapy may involve one drug, or a combination of two or more drugs, depending on the
type of cancer, its stage and its rate of progression. Chemotherapy can be used in combination with
other treatments such as surgery or radiation, to make sure all cancer cells have been eliminated.
Depending on your type of cancer and how advanced it is, chemotherapy can:
• Destroy cancer cells to the point that the doctor can no longer detect them in the patient’s
body and they will not grow back
• Keep cancer from spreading or slows its growth
• Ease cancer symptoms by shrinking tumors that are causing pain or pressure
Sometimes, chemotherapy is the only cancer treatment used. But more often, a patient will get
chemotherapy along with surgery, radiation therapy or biological therapy. For instance,
chemotherapy can make a tumor smaller before surgery, or destroy cancer cells that may remain
after surgery or radiation therapy.
Your doctor will decide which chemotherapy drugs to use based on:
• The type of cancer
• Whether the patient has had chemotherapy before
• Whether other health problems, such as diabetes or heart disease, exist
• Chemotherapy is administered in three ways:
• IV Infusions
• By Mouth (Oral Chemotherapy)
• Injections
• IV Infusions
Intravenous (IV) is by far the most common method. A needle is inserted into a vein and attached
with tubing to a plastic bag holding the chemotherapy drugs. The needle is taken out at the end of
each treatment.
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For some patients who undergo several chemotherapy sessions, a catheter, another type of plastic
tubing, is inserted into one of the large veins and left in place during the entire chemotherapy
regimen. Some patients have a metal or plastic disc known as a "port" implanted under the skin, to
serve as an IV connection device.
IV bags are attached to a tall metal stand with wheels, providing some mobility. Some patients wear
a small pump outside the body, with minimal interference to their normal routine. Other patients
may have a drug pump surgically inserted into their body.
By Mouth (Oral Chemotherapy)
Oral chemotherapy drugs are taken by mouth, either in pill or liquid form.
Injections
Injections are administered into the muscle, under the skin or directly into a cancer lesion,
depending on the type or location of the cancer.
Side effects vary from patient to patient and with the type of chemotherapy drugs used. The good
news is that there are therapies to help patients cope with some side effects, and lost hair does
grow back, although sometimes in a different color or texture.
The most common side effects of chemotherapy include:
• Temporary hair loss
• Fatigue
• Nausea
• Pain
• Increased risk of infection
• Depression
• Increased sun sensitivity
• Numbness or weakness in the hands and feet
Cancer Treatment Options
CLINICAL TRIALS
Clinical trials are research studies in which patients help doctors find ways to improve health and
cancer care. Each study tries to answer scientific questions and to find better ways to prevent,
diagnose or treat cancer. It is designed to show how a particular anticancer strategy - a promising
drug, a gene therapy treatment, a new diagnostic test or a possible way to prevent cancer - affects
the people who receive it.
The doctors at Florida Breast Health Specialists, in collaboration with doctors at the Florida
Hospital Cancer Institute, use clinical trials to answer scientific questions and find better ways to
prevent, screen for, diagnose and treat cancer. Clinical trials are the best way for our doctors to
learn what cancer treatment works best.
Each trial offers its own opportunities and risks, but many people find that all clinical trials
offer these benefits in common:
• Health care provided by leading physicians in the field of cancer research
• Access to new drugs and interventions before they are widely available
• Close monitoring of your health care and any side effects
• A more active role in your own health care
• If the approach being studied is found to be helpful, you may be among the first to benefit
• An opportunity to make a valuable contribution to cancer research
The Florida Hospital Cancer Institute is one of the most active clinical trial sites in the state and has
received multiple honors for improving care through their clinical trials.
If you're thinking of participating in a clinical trial, knowing all you can about clinical trials can help
you make a more informed decision. You can view a list of the current, open clinical trials on the
Florida Hospital Cancer Institute website.
Cancer Treatment Options
GENETIC TESTING
At Florida Breast Health Specialists, our leading breast surgeon, along with sub-specialist
oncologists and hematologists, can perform many genetic tests that help identify a patient’s risk for
developing certain cancers.
Genetic testing (also called DNA-based tests) is among the newest and most sophisticated
techniques used to test for genetic diseases and disorders which involve direct examination of the
DNA molecule itself.
Analyzing DNA to look for a genetic alteration that may indicate an increased risk of developing a
specific cancer related disease or disorder is being used as a proactive approach against fighting
cancer.
Genetic testing allows the genetic diagnosis of vulnerabilities to inherited diseases. In addition to
studying chromosomes to the level of individual genes, genetic testing in a broader sense includes
biochemical tests for the possible presence of genetic diseases, or mutant forms of genes associated
with increased risk of developing genetic disorders.
Genetic testing identifies changes in chromosomes, genes or proteins. Most of the time, testing is
used to find changes that are associated with inherited disorders. The results of a genetic test can
confirm or rule out a suspected genetic condition or help determine a person's chance of developing
or passing on a genetic disorder.
Who should consider genetic testing?
Predictive genetic testing is done only if you choose to do it. If you are concerned about your
family's pattern of disease, cancer you've had in the past or other cancer risk factors, you may want
to talk to your doctor about whether to have genetic testing.
Doctors will sometimes suggest patients have genetic testing if others in their family have had a
certain disease.
If you have any of the following, you might consider genetic testing for yourself:
• Several first-degree relatives (mother, father, sister, brother) with cancer, especially the
same type of cancer
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A family history of cancers that are known to be linked to a single gene mutation (for
instance, breast, ovarian and pancreatic cancer)
Family members who developed cancer at a young age
Close relatives with rare cancers that are linked to hereditary cancer syndromes
A physical finding that is linked to hereditary cancer (such as many colon polyps)
A known genetic mutation in the family (from one or more family members who had genetic
testing)
It's important to know what tests may be available. For some types of cancer, there are no
mutations known at this time to be linked to increased risk. Some other cancer types may have
known mutations, but genetic tests are not yet available for them.
What to Expect from Genetic Testing
You will want to think about what the results of testing may tell you before you decide to be tested.
It's important to find out how useful testing may be for you before you do it. Before the actual
testing, a session with a genetic counselor—someone who is trained to interpret and explain the
results of testing—can help you know what to expect. Testing does not always give you clear blackand-white answers. Before having the testing done, you may want to think about how the results
might affect you and your family members.
Example of Genetic Tests
BRCA1 and BRCA2 are human genes that belong to a class of genes known as tumor suppressors.
Mutation of these genes has been linked to hereditary breast and ovarian cancer.
BRCA1
A gene on chromosome 17 that normally helps to suppress cell growth. A person who inherits
certain mutations (changes) in a BRCA1 gene has a higher risk of getting breast, ovarian, prostate
and other types of cancer.
BRCA2
A gene on chromosome 13 that normally helps to suppress cell growth. A person who inherits
certain mutations (changes) in a BRCA2 gene has a higher risk of getting breast, ovarian, prostate
and other types of cancer.
Cancer Treatment Options
HORMONAL THERAPY
Hormonal therapy is one of the major modalities of medical treatment for cancer, others being
cytotoxic chemotherapy and targeted therapy (biotherapeutics). It involves the manipulation of the
endocrine system through exogenous administration of specific hormones, particularly steroid
hormones or drugs which inhibit the production or activity of such hormones (hormone
antagonists).
Because steroid hormones are powerful drivers of gene expression in certain cancer cells, changing
the levels or activity of certain hormones can cause certain cancers to cease growing, or even
undergo cell death. Surgical removal of endocrine organs, such as orchiectomy and oophorectomy
can also be employed as a form of hormonal therapy.
Hormonal therapy is used for several types of cancers derived from hormonally responsive tissues,
including the breast, prostate, endometrium and adrenal cortex. Hormonal therapy may also be
used in the treatment of paraneoplastic syndromes or to ameliorate certain cancer- and
chemotherapy-associated symptoms, such as anorexia. Perhaps the most familiar example of
hormonal therapy in oncology is the use of the selective estrogen-response modulator tamoxifen for
the treatment of breast cancer, although another class of hormonal agents, aromatase inhibitors,
now have an expanding role in that disease.
Cancer Treatment Options
RADIATION
Our comprehensive array of radiation therapy treatment technology includes:
Intraoperative Radiation Therapy (IORT): ORT, Intraoperative Radiation Therapy, is a type of
radiation therapy in which radiation is delivered at the time of surgery. In breast IORT, the entire
dose of radiation may be delivered during a single, intraoperative fraction. A typical IORT treatment
can be delivered in as little as 8 minutes, compared to the seven-week course of external beam
therapy.
Accelerated Partial Breast Radiation (APBI):
MammoSite
5-Day Targeted Radiation Therapy works from inside the breast, directly targeting the area where
cancer is most likely to recur.3
Spares healthy tissue and organs from the effects of radiation
Allows treatment to be completed in just 5 days instead of 5-7 weeks
Over 50,000 women have been successfully treated with MammoSite Targeted Radiation Therapy4
MammoSite Multi-Lumen
Advanced technology from the makers of the most widely utilized and accepted method of APBI.
A single insertion 4 lumen balloon brachytherapy applicator
Will allow you to easily satisfy the current clinical recommendation that the dose to the skin and
ribs be maintained to less than 125% of the prescription dose23
Expanding the horizon of accelerated partial breast irradiation for early stage breast cancer
patients
Three-dimensional Simulation and Treatment Planning: utilizes three-dimensional imaging
information to visualize the target and critical structures so that an optimal treatment plan can be
designed.
Radiation:
Traditional radiation therapy, that is administered daily for 5 to 7 weeks, uses a special kind of
high-energy beam to damage cancer cells. (Other types of energy beams include light and x-rays.)
These high-energy beams, which are invisible to the human eye, damage a cell’s DNA, the material
that cells use to divide.
Cancer Treatment Options
Over time, the radiation damages cells that are in the path of its beam — normal cells as well as
cancer cells. But radiation affects cancer cells more than normal cells. Cancer cells are very busy
growing and multiplying — 2 activities that can be slowed or stopped by radiation damage. And
because cancer cells are less organized than healthy cells, it's harder for them to repair the damage
done by radiation. So cancer cells are more easily destroyed by radiation, while healthy, normal
cells are better able to repair themselves and survive the treatment.
There are two different ways to deliver radiation to the tissues to be treated:
a machine called a linear accelerator that delivers radiation from outside the body
pellets, or seeds, of material that give off radiation beams from inside the body
Cancer Treatment Options
TARGETED THERAPY
Targeted cancer therapies are drugs or other substances that block the growth and spread of cancer
by interfering with specific molecules involved in tumor growth and progression. Because scientists
often call these molecules “molecular targets,” targeted cancer therapies are sometimes called
“molecularly targeted drugs,” “molecularly targeted therapies” or other similar names. By focusing
on molecular and cellular changes that are specific to cancer, targeted cancer therapies may be
more effective than other types of treatment, including chemotherapy and radiotherapy and less
harmful to normal cells.
Many targeted cancer therapies have been approved by the U.S. Food and Drug Administration
(FDA) for the treatment of specific types of cancer. Others are being studied in clinical trials and
many more are in preclinical testing.
Targeted cancer therapies are being studied for use alone, in combination with other targeted
therapies and in combination with other cancer treatments, such as chemotherapy.