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Breast Cancer Surgery

Breast cancer is one of the most common cancers affecting women in Australia, though it can also occur in men. Surgery is a primary treatment for breast cancer, aimed at removing the tumour and preventing its spread.

Breast cancer can be classified into several types, each with its characteristics and treatment approaches. The most common types include:

  • Ductal Carcinoma In Situ (DCIS): A non-invasive cancer where abnormal cells are found in the lining of a breast duct but have not spread outside the duct.
  • Invasive Ductal Carcinoma (IDC): The most common type of breast cancer, where abnormal cells in the breast ducts invade surrounding breast tissue.
  • Invasive Lobular Carcinoma (ILC): Cancer that starts in the milk-producing lobules and invades nearby tissues.
  • Triple-Negative Breast Cancer: A type of cancer that lacks the three most common types of receptors known to fuel most breast cancer growth: estrogen, progesterone, and HER-2/neu.
  • Inflammatory Breast Cancer: A rare and aggressive form of breast cancer that causes the breast to become red, swollen, and warm.
  • HER2-Positive Breast Cancer: Cancer that tests positive for a protein called human epidermal growth factor receptor 2, which promotes cancer cell growth.

The exact cause of breast cancer is not fully understood, but it is believed to result from genetic mutations in breast cells. Several factors can increase the risk of developing breast cancer:

  • Genetic Factors: Inherited mutations in genes such as BRCA1 and BRCA2 significantly increase the risk.
  • Hormonal Factors: Long-term exposure to oestrogen and progesterone, such as from early menstruation, late menopause, or hormone replacement therapy, can increase the risk.
  • Environmental and Lifestyle Factors: Factors such as alcohol consumption, obesity, lack of physical activity, and exposure to radiation can contribute to the risk.

Symptoms of breast cancer can vary widely, and some individuals may not experience any symptoms. Common signs and symptoms include:

  • A Lump in the Breast or Underarm: Often the first noticeable symptom, a lump may be painless or tender.
  • Changes in Breast Shape or Size: Swelling, dimpling, or changes in the shape or size of the breast.
  • Nipple Changes: Inversion, discharge (especially bloody), or changes in the appearance of the nipple.
  • Skin Changes: Redness, scaling, or thickening of the breast skin or nipple.
  • Pain: Persistent pain in the breast or nipple area.

Several risk factors increase the likelihood of developing breast cancer. While some factors cannot be changed, such as age and genetics, others can be managed through lifestyle choices:

  • Age: The risk of breast cancer increases with age, with most cases diagnosed in women over 50.
  • Family History: A family history of breast cancer, especially in a mother, sister, or daughter, increases the risk.
  • Genetic Mutations: Inherited mutations in BRCA1, BRCA2, and other genes.
  • Hormonal Factors: Early menstruation (before age 12), late menopause (after age 55), and hormone replacement therapy.
  • Reproductive History: Having no children or having the first child after age 30.
  • Lifestyle Factors: Alcohol consumption, obesity, physical inactivity, and a diet high in saturated fats.

Treatment Options

Treatment for breast cancer often involves a combination of therapies tailored to the individual’s specific type and stage of cancer. The primary treatment options include surgery, radiation therapy, chemotherapy, hormone therapy, and targeted therapy.

Surgery is often the first line of treatment for breast cancer and aims to remove the tumour and affected tissue. The main types of breast cancer surgery include:

  • Lumpectomy: Also known as breast-conserving surgery, this procedure involves removing the tumour and a small margin of surrounding tissue while preserving most of the breast.
  • Mastectomy: The removal of one or both breasts, partially or completely. Types of mastectomy include:
    • Total (Simple) Mastectomy: Removal of the entire breast.
    • Modified Radical Mastectomy: Removal of the entire breast and some of the lymph nodes under the arm.
    • Radical Mastectomy: Removal of the entire breast, lymph nodes, and chest wall muscles under the breast (rarely performed today).
  • Sentinel Lymph Node Biopsy: Removal of a few lymph nodes to check for cancer spread.
  • Axillary Lymph Node Dissection: Removal of many lymph nodes from the armpit area if cancer is found in the sentinel nodes.

Radiation therapy uses high-energy rays to target and destroy cancer cells. It is often used after surgery to eliminate any remaining cancer cells in the breast, chest wall, or axilla (underarm area). Radiation therapy can be delivered externally or internally (brachytherapy).

Chemotherapy involves using drugs to destroy cancer cells or stop them from growing. It can be administered before surgery (neoadjuvant chemotherapy) to shrink the tumour or after surgery (adjuvant chemotherapy) to reduce the risk of cancer recurrence. Chemotherapy is also used for advanced-stage breast cancer.
Hormone therapy is used to treat breast cancers that are hormone receptor-positive (estrogen or progesterone receptors). It works by blocking the body’s natural hormones from fuelling cancer growth. Common hormone therapies include tamoxifen and aromatase inhibitors.
Targeted therapy drugs specifically target cancer cells with certain characteristics, such as the HER2 protein. These therapies are less likely to harm normal, healthy cells. Common targeted therapies include trastuzumab (Herceptin) and pertuzumab (Perjeta).

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