May 05--PEORIA -- "Less is more" is a dominant theme in modern breast cancer
treatment, said breast cancer surgeon Lynne Jalovec during an interview at her
Peoria offices recently.
"We're finding that previously we did all this radical surgery, and now we're
seeing that maybe our thoughts about cancer need to change," said Jalovec.
Three treatments Jalovec highlighted as part of that theme include a study that
showed certain early-stage cancer patients do as well when a few sentinel lymph
nodes are removed versus similar patients who have all the nodes removed in the
affected area; new technologies being used in breast reconstruction, which allow
it to be done immediately following mastectomy, eliminating a second surgery;
and non-surgical common-sense health advice that can reduce the risk of
recurrence by up to 50 percent.
Cancer is being detected earlier now than it was 20 years ago, a fact that is
allowing surgeons to take a less invasive approach during most surgeries,
"The average size of a tumor is much smaller than it was 20 years ago," she
said. At that time tumors were typically found when they were an inch or larger.
"Under a half an inch is typical now."
Breast cancer surgeons were glad when the Z0011 trial confirmed what they
already suspected -- lumpectomy patients with minimal lymph node disease did
just as well when only a few lymph nodes were removed as compared to similar
patients who had all the nodes in the affected area removed.
Two years ago, if cancer was found in a single lymph node, all the nodes in the
affected area were removed. Now patients who fit the criteria are allowed to
keep the axillary lymph nodes if only two of the three sentinel nodes -- those
closest in lymphatic flow to the cancer -- are cancer positive. If three or more
sentinel nodes are positive, the axillary lymph nodes are still removed.
Eligible for this option are lumpectomy patients planning whole breast radiation
after surgery. They must have early stage cancer and be clinically node
negative, meaning the nodes are not noticeably enlarged when examined before
"This option leads us even further from unnecessary surgery on lumpectomy
patients who have minimal lymph node disease," said Jalovec.
Leaving as many lymph nodes as possible lowers the chance the patient will
develop lymphedema, a permanent condition that can range from minor to severe.
"When you take out lymph nodes you interrupt the lymphatic drainage in the arm,"
explained Jalovec. A healthy lymphatic system removes excess fluid and waste,
destroys pathogens, and delivers nutrients and oxygen. But if the lymphatic
system is damaged, fluids can pool and cause swelling.
Not everyone who has their axillary lymph nodes removed gets lymphedema, said
Jalovec. An estimated 30 percent to 45 percent will have some degree of
lymphedema, and 10 percent to 15 percent will have noticeable problems. Being
overweight and having radiation after surgery are factors that make the
condition more likely.
"The chance of having severe lymphedema has been improved by doing less lymph
node surgery," said Jalovec. "We have clearly seen a reduction in lymphedema
Breast reconstruction with silicone or saline implant used to mean two
surgeries, but with new technologies plastic surgeons are now sometimes able to
build a new breast using an implant immediately following breast removal.
The key to this procedure is The SPY Intraoperative Imaging System, which helps
surgeons check the blood supply in the skin flaps that once covered the natural
breast, said Jalovec.
"The skin has to have a good blood supply," she said. "Without the little SPY
imaging camera you could not go direct to implant. This way we can pick which
patients are appropriate for this procedure."
If the blood supply is deemed sufficient, the surgeon uses a product called
AlloDerm Tissue Matrix to create a hammock to hold the implant. Derived from the
skin of cadavers, AlloDerm has been processed to remove cells that can lead to
tissue rejection. It is accepted by the body and allows the patient's own cells
to grow through it, ultimately becoming part of the patient's body.
A portion of the pectoralis muscle is used to create the top of the implant
pouch and is stitched to the AlloDerm hammock. Implant surgery for mastectomy
patients used to require the insertion of an expander behind the pectoralis
muscle of the chest wall. It could take weeks to stretch the muscle enough to
accommodate the implant, and then required a second surgery for implant
insertion, Jalovec said.
"The procedure saves the patient from a second surgery and the pain the tissue
expanding process often caused," she said.
The surgeon later tattoos the reconstructed breast with an areola and carefully
puckers the skin to form a nipple, Jalovec said. "Reconstructions look pretty
darn good nowadays," she said.
Good health, good results
The least invasive procedure is no procedure -- breast cancer survivors are
given a set of health guidelines to help them keep cancer from recurring.
"Achieving and maintaining your ideal body weight can lower breast cancer
recurrence by half," said Jalovec.
Patients should eat healthy, stop smoking, and stop or limit alcohol consumption
to a single drink a day, Jalovec said.
"We all know what we should be doing," said Jalovec. "Instead of waiting until
we have cancer, we should do it before."
Jalovec also stressed the importance of early detection.
"Patients where the cancer is found earlier have more choices and are less
likely to have the axillary lymph nodes removed," she said.
In spite of recent controversial government recommendations that women should
wait until 50 to get their first mammogram, Jalovec stresses that yearly
mammogram screening should begin at 40.
"If you are due and you have no insurance, there's a program in Peoria County
that is administered through the Heartland Community Clinic," she said. The
Illinois Breast and Cervical Cancer Program is administered for uninsured women
in other counties through the various health departments.
Leslie Renken can be reached at 686-3250 or firstname.lastname@example.org. Follow her on
Twitter, @LeslieRenken, and Pinterest, larenken.
(c)2013 Journal Star (Peoria, Ill.)
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