The first step in a breast cancer treatment plan is usually surgery. Depending on the tumor location, size, grade, and lymph node status, surgical options may include:
Lumpectomy: The removal of the cancerous lump along with a margin of surrounding tissue. This surgery is usually done as an outpatient procedure, and typically the patient is placed under general anesthesia. A lumpectomy may be immediately preceded by Breast Needle Localization, a procedure used to identify the precise location of abnormal breast tissue for the purpose of removing it in the operating room.
Mastectomy: The removal of all of the breast tissue. This procedure is done under general anesthesia. Depending on a variety of factors, the doctor will determine whether inpatient or outpatient surgery will best meet your needs.
Sentinel Node Biopsy: This procedure, which usually takes place during a lumpectomy or mastectomy, is a standard technique for determining whether cancer has spread beyond the original tumor site. Since lymph nodes filter and trap cancer cells, they act as “sentries” to warn doctors and help them assess the stage of the disease. The “sentinel node” is the lymph node closest to the tumor location, and can be identified by the injection of a radioactive tracer substance or blue dye to the tumor site. The surgeon will make a small incision about 0.5” long to remove the sentinel node for laboratory analysis.
Axillary Dissection: If the sentinel node biopsy comes back positive, indicating that the cancer has spread to the lymph nodes, the surgeon may perform an axillary dissection. Axillary lymph nodes are the nodes in the underarm or "axilla" area. The number of nodes removed by the surgeon depends upon the extent to which the cancer has spread.
Chemotherapy Infusion Port Placement: Patients undergoing chemotherapy infusions may opt to use an infusion port in order to reduce the discomfort of repeated needle sticks into their veins. A port is a small disc, (the size of a quarter) that is made of plastic or metal and is surgically inserted just under the skin. The port has a catheter (a thin flexible tube) that the surgeon inserts into a vein. A port minimizes the discomfort of repeated blood draws and chemotherapy drug infusions by allowing both procedures to be done through this single port device. The oncology nurse uses a special type of needle to access the port. Talk to your oncology nurse or doctor to find out if a port is right for you.
Breast Reconstruction: While the surgeons at CVMC do not perform reconstructive surgery, they can refer to you to doctors at the University of Vermont Medical Center or at Dartmouth-Hitchcock Medical Center for this procedure. On occasion, University of Vermont Medical Center doctors can perform your breast reconstruction immediately following your breast surgery at CVMC.