The tumor is tested for the presence of estrogen and progesterone receptors (ER/PR). These sites on the cell surface determine how sensitive the tumor is to stimulation by native estrogen and how effective blocking these sites with hormonal therapy would be.
With the development of the concept of treating breast cancer as a systemic disease from early in its course, chemotherapy and hormonal therapy have been increasingly added to the treatment plan. The indications for chemotherapy have increased so that now even some small tumors without axillary node involvement are felt to benefit. The administration of hormone blockers like tamoxifen and raloxifene in ER/PR positive patients may reduce recurrence. There is also evidence of a protective effect for older women who do not have cancer but are at higher risk. Addition of chemo- or hormonal therapy in the absence of evidence of spread (metastasis) is called adjuvant therapy.
If any axillary nodes contain tumor, adjuvant therapy is routinely used. If breast conservation therapy is chosen and axillary nodes are positive, the radiation field may be extended to include the highest level of the axilla not normally encompassed in the breast field.
Patients with various stages of disease may be eligible for clinical trials at academic medical centers and at the National Institutes of Health. The physician will inform the patient of the potential benefits and risks of entering one of these trials.
Many mastectomy patients with early disease are choosing one of several alternative methods of breast reconstruction in lieu of wearing a prosthetic breast in the bra. The most common procedure places a salt-water (saline) implant beneath the large pectoralis major chest muscle. If there is no evidence of extensive disease, this is often done at the time of the mastectomy. If the amount of skin left is not adequate to accommodate the prosthesis immediately, an inflatable tissue expander is placed initially, followed later by the implant.
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