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glossary:lumpectomy

Lumpectomy:

(1) The removal of the cancerous breast tissue plus a margin of healthy tissue. The surgical removal of a small tumor (a lump) which may or may not be benign (or malignant). Lumpectomy has come to refer specially to the removal of a lump from the breast.

The word “lumpectomy” is a hybrid term. “Lump” is of Middle English origin while ”-ectomy” comes from two Greek roots “ek” (out) + “tome” (a cutting) = a cutting of. So a lumpectomy is literally “a cutting out of a lump.” A lumpectomy is as opposed to a mastectomy in which the breast is removed. It is a more conservative approach to breast tumor surgery.

(2) A lumpectomy is a type of surgery used to treat breast cancer. It is considered “breast-conserving” surgery because in a lumpectomy, only the malignant tumor and a surrounding margin of normal breast tissue are removed. Lymph nodes in the armpit (axilla) also may be removed. This procedure is called lymph node dissection.

Purpose

Lumpectomy is a surgical treatment for newly diagnosed breast cancer. It is estimated that at least 50% of women with breast cancer are good candidates for this procedure. The location, size, and type of tumor are of primary importance when considering breast cancer surgery options. The size of the breast is another factor the surgeon considers when recommending surgery. The patient's psychological outlook, as well as her lifestyle and preferences, should also be taken into account when treatment decisions are made.

The extent and severity of a cancer is evaluated or “staged” according to a fairly complex system. Staging considers the size of the tumor and whether the cancer has spread to other areas, such as the chest wall and the lymph nodes, and/or to distant parts of the body. Women with early stage breast cancers usually are better candidates for lumpectomy. In most cases, a course of radiation therapy after surgery is part of the treatment. Chemotherapy or antiestrogens also may be prescribed.

Many studies have compared the survival rates of women who have had removal of a breast (mastectomy) with those who have undergone lumpectomy and radiation therapy. The data demonstrate that for women with comparable stages of breast cancer, survival rates are similar between the two groups, but the risk of the cancer recurring in the breast is slightly higher with lumpectomy. A 2003 study confirmed that younger women who have lumpectomies have a higher risk of tumor recurrence than those who have mastectomies.

In some instances, women with later stage breast cancer may be able to have lumpectomy. Chemotherapy may be administered before surgery to decrease tumor size and the chance of spread in selected cases.

Precautions

A number of factors may prevent or prohibit a breast cancer patient from having a lumpectomy. The tumor itself may be too large or located in an area where it would be difficult to remove with good cosmetic results. Sometimes several areas of cancer are found in one breast, so the tumor cannot be removed as a single lump. A cancer that has already attached itself to nearby structures, such as the skin or the chest wall, needs more extensive surgery.

Certain medical or physical circumstances also may eliminate lumpectomy as a treatment option. Sometimes lumpectomy may be attempted, but the surgeon is unable to remove the tumor with a sufficient amount of normal tissue surrounding it. This may be termed “persistently positive margins,” or “lack of clear margins,” referring to the margin of unaffected tissue around the tumor. Lumpectomy is not used for women who have had a previous lumpectomy and have a recurrence of the breast cancer.

The need for radiation therapy after lumpectomy makes this surgery medically unacceptable for some women. For instance, radiation therapy cannot be administered to pregnant women because it may injure the fetus. If, however, delivery would be completed prior to the need for radiation, pregnant women may undergo lumpectomy. Women with collagen vascular disease, such as lupus erythematosus or scleroderma, would experience scarring and damage to their connective tissue if exposed to radiation treatments. A woman who has already had therapeutic radiation to the chest area for other reasons cannot have additional exposure for breast cancer therapy.

Some women may choose not to have a lumpectomy for other reasons. They may strongly fear a recurrence of breast cancer, and may consider a lumpectomy too risky. Others feel uncomfortable living with a cancerous breast and experience more peace of mind with the entire breast removed.

The need for radiation therapy also may be a barrier due to non-medical concerns. Some women simply fear this type of treatment and choose more extensive surgery so that radiation will not be required. The commitment of time, usually five days a week for six weeks, may not be acceptable for others. This may be due to financial, personal, or job-related constraints. Finally, in geographically isolated areas, a course of radiation therapy may require lengthy travel, and perhaps unacceptable amounts of time away from family and other responsibilities.

Description

Lumpectomy is an imprecise term. Any amount of tissue, from 1% to 50% of the breast, may be removed and called a lumpectomy. Breast conservation surgery is a frequently-used synonym for lumpectomy. Partial mastectomy, quadrantectomy, segmental excision, wide excision, and tylectomy are other names for this procedure.

A lumpectomy is frequently done in a hospital setting (especially if lymph nodes are to be removed at the same time), but specialized outpatient facilities sometimes are preferred. The surgery is usually done while the patient is under general anesthesia. Local anesthetic with additional sedation may be used for some patients. The tumor and surrounding margin of tissue is removed and sent to the pathologist. The surgical site is closed.

If axillary nodes were not removed in a prior biopsy, a second incision is made in the armpit. The fat pad that contains lymph nodes is removed from this area and also is sent to the pathologist for analysis. This portion of the procedure is called an axillary lymph node dissection; it is critical for determining the stage of the cancer. Typically, 10 to 15 nodes are removed, but the number may vary. Surgical drains may be left in place in either location to prevent fluid accumulation. The surgery may last from one to three hours.

The patient may stay in the hospital one or two days, or return home the same day. This generally depends on the extent of the surgery and the medical condition of the patient, as well as physician and patient preferences. A woman usually goes home with a small bandage. The inner part of the surgical site usually has dissolvable stitches. The skin may be sutured or stitched; or the skin edges may be held together with steristrips, which are special thin, clear pieces of tape.

Preparation

Routine preoperative preparations, such as having nothing to eat or drink the night before surgery, are typically ordered for a lumpectomy. Information about expected outcomes and potential complications also is part of preparation for lumpectomy, as it is for any surgical procedure. It is especially important that women know about sensations they might experience after the operation, so the sensations are not misinterpreted as signs of further cancer or poor healing.

If the tumor cannot be felt (not palpable), a preoperative localization procedure is needed. A fine wire, or other device is placed at the tumor site, using x-ray or ultrasound for guidance. This is usually done in the radiology department of a hospital. The woman is most often sitting up and awake, although some sedation may be administered.

Aftercare

After a lumpectomy, patients are usually cautioned against lifting anything that weighs more than five pounds for several days. Other activities may be restricted (especially if the axillary lymph nodes were removed) according to individual needs. Pain is often enough to limit inappropriate motion. Women often are instructed to wear a well-fitting support bra both day and night for approximately one week after surgery.

Pain is usually well controlled with prescribed medication. If it is not, the patient should contact the surgeon, as severe pain may be a sign of a complication that needs medical attention. A return visit to the surgeon normally is scheduled approximately 10 days to two weeks after the operation. Studies have shown that women improve their survival rates after lumpectomy if they stop smoking.

Radiation therapy is usually started as soon as feasible after lumpectomy. Other additional treatments, such as chemotherapy or hormone therapy, may also be prescribed. The timing of these is specific to each individual patient.

Risks

The risks are similar to those associated with any surgical procedure. Risks include bleeding, infection, asymmetry, anesthesia reaction, or unexpected scarring. A lumpectomy also may cause loss of sensation in the breast. The size and shape of the breast will be affected by the operation. Fluid can accumulate in the area where tissue was removed, requiring drainage.

If lymph node dissection is performed, there are several potential complications. A woman may experience decreased feeling in the back of her armpit. She also may experience other sensations, including numbness, tingling, or increased skin sensitivity. An inflammation of the arm vein, called phlebitis, can occur. There may be injury to the nerves controlling arm motion.

Approximately 2% to 10% of patients develop lymphedema (swelling of the arm - see arm lymphedema) after axillary lymph node dissection. This swelling of the arm can range from mild to severe. It can be treated with elastic bandages and specialized physical therapy, (see - Treatment) but it is a chronic condition, requiring continuing care. Lymphedema can arise at any time, even years after surgery. See - Secondary Lymphedema in the cancer patient, Arm or Leg Swelling After Cancer, Prevalence of Lymphedema in Breast Cancer, and Lymphedema After Cancer - How Serious Is It

A new technique often eliminates the need to remove many axillary lymph nodes. Sentinel node biopsy (mapping) and biopsy is based on the idea that the condition of the first lymph node in the network, which drains the affected area, can predict whether the cancer may have spread to the rest of the nodes. It is thought that if this first, or sentinel, node is cancer-free, there is no need to look further. Many patients with early-stage breast cancers may be spared the risks and complications of axillary lymph node dissection as the use of this approach continues to increase.

Normal results

When lumpectomy is performed, it is anticipated that it will be the definitive surgical treatment for breast cancer. Other forms of therapy, especially radiation, are often prescribed as part of the total treatment plan. A 2003 study reported that radiation of the entire breast produces better results than radiation of part of the breast. The expected outcome after lumpectomy and radiation is no recurrence of the breast cancer, however, women who have had lumpectomies, particularly those who were young at the time of treatment, should continue to see their physicians for regular breast cancer check-ups, since the cancer can recur.

Key terms

Lymph node — A small mass of tissue in the form of a knot or protuberance. Lymph nodes are the primary sources of lymph fluid, which serve in the body's defense by removing toxic fluids and bacteria.

Abnormal results

An unforeseen outcome of lumpectomy may be recurrence of the breast cancer, either locally or distally (in a part of the body far from the original site). Recurrence may be discovered soon after lumpectomy or years after the procedure. For this reason, it is important for patients to be regularly and closely monitored by their physicians. A 2003 report showed that magnetic resonance imaging (MRI) is accurate in detecting any cancer left in the breast after lumpectomy. Women should continue to have regular mammograms. While the scar tissue from lumpectomy and radiation therapy can make mammograms less comfortable, a special cushion was approved by the U.

glossary/lumpectomy.txt · Last modified: 2012/10/16 14:40 (external edit)