Lumpectomy (also known as breast conserving surgery or wide excision) is a common treatment for breast cancer [2]. The procedure removes only part of the breast (the tumor and some of the normal tissue around it). This leaves the breast looking as close as possible to how it looked before surgery. Usually, the shape of the breast is preserved, as is the nipple area. Radiation therapy is given after the surgery to get rid of any cancer cells that may remain. This lowers the chances of the cancer coming back.
Eligibility for Lumpectomy Plus Radiation
Lumpectomy plus radiation is an option for many women, including those who have ductal carcinoma in situ or early breast cancer that has not spread throughout the breast. In some cases, it is also an option for women with locally advanced breast cancer. However, women with certain medical conditions cannot have radiation therapy and may need to have a mastectomy instead. Some of these conditions are listed below.
- History of scleroderma or systemic lupus. These disorders can keep tissue from healing correctly after lumpectomy and radiation therapy.
- Pregnancy. Radiation can harm a fetus. If a woman is in her third trimester, she can often have lumpectomy and put off radiation therapy until after delivery.
- Previous radiation therapy to the same breast. In general, radiation therapy to the breast can only be given once.
In some cases, when a large amount of the breast has to be removed in order to get rid of the tumor(s), a mastectomy may be the better option. These situations may include:
- Multiple tumors in different areas of the breast (multi-centric tumors).
- A large tumor, relative to breast size.
- One tumor spread throughout the breast (diffuse tumor).
- A tumor located directly beneath the nipple.
- Attempts at lumpectomy are unable to obtain negative margins.
Treatment Guidelines
Although the exact treatment for breast cancer varies from person to person, several organizations have treatment guidelines to help ensure quality care. These guidelines are based on the latest research, and some are available online. The American Society of Clinical Oncology (ASCO) and National Comprehensive Care Network (NCCN) are two respected organizations that regularly update and post their guidelines online. The National Cancer Institute (NCI) also has overviews of treatment options.
Cosmetic Issues
Women choose lumpectomy over mastectomy mainly for cosmetic reasons. They not only want to keep their breast, but they also want to keep it looking as much as it did before surgery. Lumpectomy, however, may change the look of the breast. Because some tissue is removed, the breast may be smaller, and there will be a scar. Sometimes, factors like the location and size of the tumor can make it unlikely that a woman will be happy with the look of the breast after lumpectomy. In these cases, mastectomy may be the better option.
Updated 01/22/10
