Breast Cancer Program

Breast Cancer

Members of Our Team

Lee B. Riley, MD 
St. Luke's Cancer Care Associates

Tricia Kelly, MD 
St. Luke's Cancer Care Associates

Hikaru Nakajima, MD 
St. Luke's Hematology Oncology Specialists

Subhash Proothi, MD 
St. Luke's Hematology Oncology Specialists

Nimisha Deb, MD 
Advanced Radiation Oncology Associates

David Andolino, MD 
Advanced Radiation Oncology Associates

 

Types

Not all breast tumors are the same. There are more than 15 types or subtypes. The earliest form or breast cancer is labeled In Situ. In these cases, the abnormal cells or tumor is contained within the duct or lobes and has not spread, or invaded, other tissue. However, women with In Situ breast conditions are considered at higher risk for invasive breast cancer.

Ductal Carcinoma In Situ

  • In this condition, the cancer is contained and growing only inside the ducts of the breast. At this stage, the cancer has not spread to other tissue.

Lobular Carcinoma In Situ

  • Lobules are hollow glands, which, at appropriate times, make milk. Sometimes, these glands develop abnormal cells.

Invasive Breast Cancer

  • This condition occurs when cancer cells that originated in the milk ducts or lobes spread to other healthy surrounding tissue. Sometimes, invasive or infiltrating breast cancer can travel to other parts of the body through the blood stream and lymph system.

Inflammatory Breast Cancer

  • This rare and aggressive form of breast cancer gives the appearance of inflammation. There also may also be a sudden increase in breast size; itchy breast skin; breast pain; swollen lymph nodes under the arm or above the collar bone; nipple retraction; and a change in breast skin color. This form of breast cancer usually affects younger women and is more common among young African American women. This breast cancer tends to spread early throughout the body.

Causes, Symptoms & Risk Factors

Sometimes changes in the breast are not breast cancer at all; lumps or swelling in the breast tissue may come about from hormonal changes. Many lumps are the result of benign growths or cysts. However, women with these conditions have a higher risk of developing breast cancer.

Early stage breast cancer may not cause pain or discomfort. The best way to detect a potential problem early is to become familiar with your breasts so that changes can be readily identified. Routine self-breast exams done at home; clinical breast exams conducted in the doctor's office; and regular mammograms can help detect changes in breast tissue and identify areas of concern earlier when treatment is most effective and the chance for a cure the greatest. Having a baseline mammogram, beginning at age 40, can help keep track of changes that occur in the breast over time.

The American Cancer Society recommends annual screening using mammography and clinical breast examination for all women beginning at age 40. Mammograms can help detect 85 to 90 percent of all breast cancers, even before a lump can be felt.

Symptoms of breast cancer may include:

  • Swelling in the armpit - This could be a sign of swollen lymph nodes, an indication that the body is fighting something off and indicate the need for further screening and evaluation
  • A change in the size and shape of the breast
  • Fluid leaking from only one nipple
  • Change in the size of shape of the nipple
  • Changes in color, shape or texture of the nipple or areola
  • Unusual pain in only one breast or armpit that do not appear to be caused by regular cyclical changes

Tests

Joseph Russo, MD 
Progressive Physician Associates

Laurie Sebastiano, MD 
Progressive Physician Associates

A doctor may perform a clinical breast exam, review symptoms and refer you for additional testing that may include:

  • Ultrasound-guided core biopsy
  • Stereotactic core biopsy
  • Galactography
  • Ultrasound-guided cyst aspirations

Treatments

Treatment options for breast cancer can include:

  • Surgery
  • Sentinel lymph node biopsy
  • External beam radiation therapy (whole breast irradiation)
  • Partial breast irradiation
  • Chemotherapy

Decisions about Breast Cancer Surgery

There are two components of breast cancer surgery.

  • The first deals with removing the breast tumor; this can be done either by removing the entire breast (mastectomy) or removing just the tumor and a small amount of surrounding normal breast tissue (breast-conserving surgery or lumpectomy). Some women with early stage breast cancer who are candidates for lumpectomy may also benefit from Intraoperative Radiation Therapy (IORT). IORT can spare some women weeks of radiation therapy.
  • The second part involves removing the lymph nodes. This is necessary to find out whether the tumor has spread to the lymph nodes. Ideally, these two components (breast and lymph node surgery) are performed at the same time.

Types of Breast Cancer Surgery

Mastectomy

A mastectomy is the surgical removal of the entire breast. There are several different types of mastectomies.

  • Simple Mastectomy: A “simple mastectomy” removes the breast, nipple, and areola (the tan or brown-colored area surrounding the nipple) but it does not remove the axillary (armpit) lymph nodes.
  • Modified Radical Mastectomy: A modified radical mastectomy is the removal of the entire breast, the lining over the chest muscle, and some axillary lymph nodes. When the axillary lymph nodes are removed the surgeon may place a soft, plastic drain in the wound to drain the fluid that typically collects there. The drain remains in place when the patient goes home from the hospital. Prior to leaving the hospital, the patient is taught how to empty and take care of the drains. These drains typically are removed at the first post-operative check-up.
  • Skin-Sparing Mastectomy: Skin-sparing mastectomy is a technique that preserves as much skin as possible when performing a mastectomy. This is done to help the plastic, or reconstructive, surgeon provide the best cosmetic result during breast reconstruction. However, if the surgeon believes there is an area of skin that is involved with the tumor, this portion of the skin will be removed along with the tumor.
  • Total Skin-Sparing Mastectomy: Total skin-sparing mastectomy is similar to the skin-sparing mastectomy, but the nipple and areola tissue are left along with the skin. Because the ducts, which can contain tumor cells, drain to the nipple, there are some restrictions/limitations for this approach.

Breast-Conserving Surgery (BCS)

Breast-conserving surgery (BCS) involves a lumpectomy (the surgical removal of a tumor and a margin of normal tissue) followed by radiation therapy to the remaining breast tissue. The goal of this treatment is to excise the tumor, while maintaining a cosmetically-acceptable breast. Sometimes this is not feasible; if the breast is very small and the tumor is large, BCS may not be an option because the surgery could create a cosmetically unacceptable breast. Additionally, patients who are pregnant may not be amenable to this technique because the radiation therapy might be harmful to the developing fetus.

Other terms that describe the removal of the tumor and a margin of normal breast include, “partial mastectomy”, “segmental mastectomy” and “quadrantectomy.” Because all of these techniques leave some breast tissue behind, they are considered breast conserving.

An important aspect of BCS is assuring the margin of normal tissue surrounding the tumor is free of cancer cells. Once the tumor is removed, the pathologist will evaluate the margins. If the margins are positive (there are cancer cells extending to the edge of the resected tissue), the patient will need to have a re-excision (more normal tissue removed from the tumor bed area) of the area to assure that all cancer cells have been removed.

INTRABEAM Intraoperative Radiation Therapy (IORT) for Breast Cancer

INTRABEAM® IORT technology now available at St. Luke's Anderson Campus spares some women with early stage breast cancer weeks of radiation therapy. Fewer than 50 sites nationwide offer this advanced radiation therapy.

Who Needs Lymph Node Surgery and Why?

There are two main goals of breast cancer surgery – the first is to remove the cancer via a mastectomy or lumpectomy. The second is to determine if any cancer cells have spread to the lymph nodes. This is recommended for patients with invasive breast cancers. Breast cancers like DCIS that are not invasive, cannot spread beyond the ducts and lobules; therefore, these patients do not need their lymph nodes evaluated. One exception to this concept is if the surgeon suspects that invasive cancer will be found when the entire tumor is removed.

There are two operations used to evaluate the lymph nodes.

When too many lymph nodes are removed, many patients develop lymphedema (swelling of the arm). To minimize the risk of lymphedema and still provide an accurate assessment of the lymph nodes, sentinel lymph node biopsy can be done.

The sentinel lymph node (SLN) is the first lymph node that receives drainage from around tumor. These nodes are typically the first to be invaded by cancer cells. The SLN is tested for cancer at the time of surgery. If there is no cancer in the SLN, it is unlikely that it has spread to other lymph nodes and, so, they are left alone. If cancer is in the SLN, the standard operation (axillary dissection) is performed. Sentinel lymph node surgery has fewer complications than axillary node dissection, but the physicians performing the procedure must have special training.

Decisions about Gene Expression Profile Testing

Technology is available to evaluate the genetic profile of individual tumors. St. Luke's uses these genetic profiles of an individual's breast cancer to help determine if chemotherapy should be given as an adjuvant therapy. There are two main tests used today—OncotypeDX® and MammaPrint®. OncotypeDX® uses 21 genes to estimate the risk of a tumor recurrence. MammaPrint®, an FDA-cleared gene expression profile test, provides information based on 70 genes about tumor biology and actively identifies a woman's risk for recurrence.

The 70-gene genomic profile can provide prognostic information in both ER-positive and ER-negative early-stage, node-negative breast cancer. However, this test requires that the tissue be appropriately preserved at the biopsy procedure or at the time of surgery. Therefore, having this test done should be discussed with the surgeon prior to surgery.

Advanced Margin Analysis

St. Luke's Hospital is one of 10 hospitals in Pennsylvania and was one of the first in the state to use MarginMarker® to color-code cancerous breast tissue immediately after surgical removal to see if the entire cancer was removed during the procedure. Using six different inks, the operating surgeon color-codes the entire excised breast tissue specimen to show exactly how the tissue was positioned, or oriented, in the body.

St. Luke's fellowship-trained surgical oncologists and most general surgeons performing breast cancer surgery at St. Luke's Hospital have been using this innovative device since 2008. It allows for a higher level of precision and greater accuracy for surgeons, radiologists and pathologists involved in the patient's care, and helps improve outcomes following breast cancer surgery.

Breast Reconstruction Surgery

This is a procedure to restore the natural appearance of the breast, and is frequently performed after partial or total mastectomy. Patients treated with a lumpectomy procedure frequently do not require reconstruction. Some patients may choose not to have immediate reconstruction of the breast, but prefer to have reconstruction at a later date. Consultation with a board-certified plastic surgeon, experienced in breast reconstruction is warranted in all of these instances.

Why Choose St. Luke's

At St. Luke's, we have developed a personalized team approach to breast cancer care to successfully diagnose and treat the disease, and provide essential support every step of the way. From the very start of a breast cancer journey, St. Luke's multidisciplinary network of exceptional breast cancer specialists including doctors, nurses, breast health specialists, cancer counselors and support staff are there every step of the way to offer support, foster hope and provide the best treatment options available. This team works together to help ensure breast cancer patients have the best chance of becoming breast cancer survivors - and thrivers.

Specialization Makes a Difference

In every field of medicine, specialization makes a difference – cancer surgery is no exception. Studies have shown that finding the best-trained, educated and experienced surgeon to perform breast cancer surgery can significantly improve care and survival. Surgical oncologists have completed specialized fellowships and participate in societies dedicated to cancer and breast surgery.

Breast Health Specialists

Breast Health Specialists serve as a resource for the patient/family through diagnosis and treatment of breast disease. This patient advocate provides individualized information and support, coordinates appointments for consultations, physician visits, biopsy procedures and other needs.

St. Luke's Personalized Breast & Ovarian Health Program is free assessment to help individuals evaluate the risks of developing breast and ovarian cancer and provide certain options that are available to reduce these risks.

Women who are diagnosed with breast cancer or are at any stage of breast cancer are invited to attend the St. Luke's Breast Cancer Support Group. New members are welcome to bring a female family member or friend to the meetings. The support group promotes the physical and emotional well-being of women living with breast cancer by providing support, friendship and understanding of mutual issues and concerns. Members of the group share ways they may have dealt with the side effects of breast cancer treatments or other concerns that arise after breast cancer. The group experience can be therapeutic to women at any stage of breast cancer.