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Local treatment options for breast cancer

Local treatment options for breast cancer include surgery and radiation therapy. Their purpose is to treat a tumour without affecting the rest of the body.

Local treatment option: Surgery

Most women with breast cancer will have some type of surgery to treat the main breast tumour. The purpose of surgery is to remove as much of the cancer as possible.

Surgery is also used to find out whether the cancer has spread to the lymph nodes under the arm (sentinel lymph node biopsy).

Plastic and Reconstructive or cosmetic surgery can be done to improve the breasts appearance after the surgery.

Breast-conserving surgery 

Lumpectomy (Wide Local Excision) and Partial mastectomy are examples of breast-conserving surgery.

In these types of surgery, only part of the breast is removed. It needs to be followed by radiation therapy:

Lumpectomy or Wide Local Excision

This surgery involves removing only the breast lump and a margin of normal tissue around it. Radiation treatment is usually given after this type of surgery.

If chemotherapy is also going to be used, the radiation may be delayed until the chemo is finished.

Partial mastectomy

This surgery involves removing more of the breast tissue than in a wide local excision. It is usually followed by radiation therapy.

Mastectomy

Mastectomy involves removal of the whole breast.

Mastectomy scar

Reconstructive surgery 

These operations do not treat the cancer, but can be done to restore the way the breast looks after the cancer has been surgically removed.

There are several choices available:

  • the type of reconstruction can be done
  • whether it is done at the time of the cancer surgery, or delayed until after all treatment.

This should be discussed with your surgeon and a plastic surgeon BEFORE the cancer surgery is performed.

Cancer.org has an excellent resource: Talking to your doctor about breast surgery options.

Complications of surgery

Possible surgical complications can include  bleeding, pain, infection, temporary swelling, seroma  (pocket of clear or bloodstained fluid collecting at incision site).

You may also experience shoulder stiffness, numbness, thickened tissue due to scar tissue that forms at the surgical site.

Complications are more common in smokers, diabetics, older patients and those who have had previous radiotherapy.

The simpler the surgery, the less likely the complications.

Lymphoedema is an important complication:
If lymph nodes are removed from under the arm, lymphoedema may occur. Lymphoedema is swelling (usually of the arm in the case of breast surgery and/or radiation) caused by disruption to the lymphatic drainage system leading to lymphatic fluid build-up.

It can occur any time after treatment for breast cancer – right after surgery, months or even years later.

Lymphoedema is treatable but not curable, so is best prevented or at least diagnosed as early as possible and kept under control.

Injury or infection of the arm on the affected side can cause lymphoedema or make it worse. Tell your doctor right away about any swelling, tightness or injury to the hand or arm.

Lymphoedema should ideally be treated by a trained lymphoedema therapist (usually a physiotherapist, occupational therapist or nurse), working together with the patient and the family. Most of the time, there is some improvement.

If the lymphoedema has been there for a long time, there are changes to the soft tissues in the arm which may not be reversible. As a result, the arm may be permanently swollen.

Therefore, it is important to start management for lymphoedema early to try and prevent a chronic problem.

Preventative strategies include using gloves when gardening and avoiding having intravenous drips, blood drawn from or blood pressure taken on the arm on the side of the lymph node surgery or radiation.

Contact CANSA for information about lymphoedema clinics near you. They have great information about lymphoedema support here.

Find a lymphoedema therapist near you.

Another great resource from breastcancer.org

Find our list of trusted treatment, management and support associates here.

Local treatment option: Radiotherapy

(Also called radiation therapy, or radiation oncology). This is the medical use of ionising radiation or high-energy rays to damage cancer cells and stop them growing and dividing. Like surgery, it is a highly targeted  local  treatment which affects cancer cells only in the treated area.

Radiotherapy for breast cancer can be used:

  • after lumpectomy or mastectomy, either alone or in combination with chemotherapy and/or hormone therapy.
  • as the main treatment if the tumour cannot be safely surgically removed, or the person’s health does not allow for surgery.
  • to treat the bones or the brain if the cancer has spread there.
  • to relieve pain, or assist in reducing the leaking or bleeding of open wounds of locally advanced cancer.

Side effects or complications of radiotherapy

These depends on the treatment dose and the part of the body that is treated:

The most common side effects are  tiredness, loss of appetite, breast swelling/tenderness, skin rash/redness or hair loss in the treated area.  Some patients may find the breast skin more sensitive after radiation, while others may find it less sensitive.

Some skin changes can look similar to the changes seen in breast cancer.

Most radiotherapy side effects are not critical. And because the treatment team usually sees the patient every day, they can be managed effectively.

Lymphoedema:  as with surgery, radiotherapy may increase a patient’s risk of developing lymphoedema (swelling) of the arm. The risk is higher for patients who have had radiotherapy as well as having had axillary lymph nodes removed.

Find a lymphoedema therapist near you.

Breastcancer.org has excellent, comprehensive information about radiotherapy and side-effects here.

More info

Find out more about systemic breast cancer treatments (chemotherapy, hormone therapy, immunotherapy and biological therapy)  here.

For information on TARGETED systemic breast-cancer treatment options, read  here.

For  useful information from reputable websites, please refer to our support list here.

For a list of trusted treatment associates, please click  here.

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