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| Scrutinizing the evidence for breast cancer procedures and treatments |
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there's a lot more information I should know. I definitely want to "look before I leap" after hearing from breast patients who say they would do their surgery differently. Can I safely postpone?
as you can to make the choice you must live with the rest of your life. Putting off surgery a month or so on a tumor that has most likely been there 6-8 years in order to get your thoughts straight is most always acceptable to your doctor. I am going to have surgery. How can I reduce the spread of cancer cells before and during my procedure? According to Robert Rosser, MD., writing in The Breast (2000), choosing minimally invasive procedures may help to reduce the spread of cancer cells around the time of surgery. Most surgeons want to get a wide margin, that is, cut as far out from the tumor as they can and still achieve a good cosmetic effect. But Rosser and others suggest further steps be taken. 1. Avoiding trauma to the breast may prevent the spread of cancer: No compression of the breasts, no squeezing of the breasts, no massaging of the breasts during medical procedures. The longer an injury-induced traumet exists, the longer this occult micrometastasis has time to grow larger, divide, and become a full-sustaining malignancy if not removed. See Dr. Rosser's article. 2. "Full surgical procedures should be done as soon as possible, taking great care in handling the tumor and to excise wide margins around the neoplastic mass." See Carroll RG, Lancet Oncology, [2004]. 3. "Tumor cells may be inadvertently spread by several mechanisms during surgical procedures. These include the grasping of lymph nodes with forceps, the local injections of analgesic agents, and the insertion of the arterial clip into the tumor to protect bleeding." See also Coffey, et al., Lancet Oncology, [2003]
trauma to your breast in order to forestall possible spread of cancer cells?
originally published in Life Extension Magazine in 2009.
general anesthesia? Some patients request a mild sedation with local anesthesia. Some prefer to be awake and alert. Still others want to be out cold. Discuss your preferences with your doctor and if you prefer local anesthesia get complete assurance from your surgeon in advance. Otherwise, you may arrive at the hospital and you may be pressured to have a general anesthesia. When you sign the surgical consent form, it is necessary to read it carefully. Be sure to indicate on the form that you are not consenting to general anesthesia for your lumpectomy unless complications ensue and your life is at stake. I have heard that timing my surgery with my menstrual cycle may improve my outcome. Is this assertion true? This subject has been studied several times with conflicting results, depending upon how the researchers got their information. However, timing surgery after ovulation appears to improve outcomes. Timing Surgery In The Lancet article, "Excisional Surgery for Cancer Cure: Therapy at a Cost," (Dec. 2003), Coffey, et al. suggest that the activity of NK (natural killer) cells are already impaired in patients with underlying malignancies. Add to this insight the fact that NK cell activity changes during the menstrual cycle such that the numbers of these immune cells are lower in the follicular phase prior to ovulation and higher in the luteal phase after ovulation. This difference in immunity may help explain why there is an earlier pattern of recurrence in premenopausal women operated on during their follicular cycle. Veronesi, et al. (see below) found that premenopausal women who were operated on during the luteal phase had a "signficantly better prognosis" than women operated on during the follicular phase due to the reduced NK cells and/or the high concentration of unopposed estrogens during the follicular phase. Similarly, other researchers agree that the luteal phase is when the protective benefit of progesterone helps to balance what had been estrogen dominance. Dr. Susan Love has endorsed the notion of timing surgery. (See her website,www. susanlovemd.com, for more specific details.) Your doctor, however, may feel that timing surgery is hogwash. If so, you can only ask if there is any evidence that waiting this small amount of time will have a negative impact on your survival. The medical journal, The Lancet (1994), published clinical trial information on breast cancer surgery timing that is excerpted below with emphasis for clarity. Effect of menstrual phase on surgical treatment of breast cancer. Veronesi U, Luini A, Mariani L, Del Vecchio M, Alvez D, Andreoli C, Giacobone A, Merson M, Pacetti G, Raselli R. Istituto Nazionale per lo Studio e la Cura del Tumori, Milano, Italy. 1175 premenopausal women whose date of last menstrual period was known were followed up for up to 20 years (average 8 years) after surgery for breast cancer. 525 patients were in the follicular phase and 650 in the luteal phase. We observed 192 unfavourable events among patients operated on during the follicular phase (36.6%) and 192 among patients operated on during the luteal phase (29.6%). The effect of phase was restricted to patients with positive axillary nodes. The 5-year relapse-free survival was 75.5% in 246 node-positive patients operated on during the luteal phase and 63.3% in 190 node-positive patients who had surgery during the follicular phase. The hazard ratio at Cox multivariate analysis was 1.329 for all patients (p = 0.006) and 1.431 for node-positive patients (p = 0.03). In our study, premenopausal patients with breast cancer and positive axillary nodes operated on during the luteal phase had a significantly better prognosis than patients operated on during the follicular phase. It may be that the processes of cell metastases, such as loss of adhesiveness, may be enhanced by high concentrations of unopposed oestrogens or by reduced activity of natural killer cells during the first half of the menstrual cycle.
The consent form for general anesthesia speaks for itself. Be sure to get a copy of your hospital's consent form as far in advance of your surgery as possible. In reading it you will see reasons to avoid general anesthesia unless absolutely necessary. Some women report more side effects (some lasting months) from the anesthesia than the surgery. Bear in mind that general anesthesia can affect the immune system: "Depression of lymphocyte (a type of white blood cell) transformation is detectable two hours after induction of anesthesia and is generally restored to normal after one week." (See Coffey, et al. above.) How much pain will I feel after a lumpectomy if I do not have a node procedure? Most patients report they have not had very much pain following a lumpectomy. Some may require mild pain medications for a day or two. Still others may require pain medication for a longer period of time I have chosen to have a mastectomy without a nodal procedure. Immediately after surgery I expect to be given morphine for pain. I've heard that morphine may promote tumor growth. Is there any evidence for this assertion? We are currently reviewing evidence that morphine may not be the wisest pain reliever choice for cancer patients. See Gupta, et al., Morphine Promotes Angiogenesis and Breast Tumor Growth In Vivo," Cancer Research (2002). What about breast reconstruction? Reconstruction carries a complication rate of up to 24% (Nahabedian [2003]). There are Internet groups dedicated to women contemplating these procedures. These groups will be able to give you a comprehensive look at the risks. Still, a recent article in Breast Cancer Research, by Gem (2005) showed longer survival rates among those who had reconstruction than among those who did not. The researchers looked at analyzed data from the Surveillance, Epidemiology and End Results (SEER) Breast Implant Surveillance Study conducted in San Francisco- Oakland, in Seattle-Puget Sound, and in Iowa. Given the infections that often accompany reconstruction procedures, this result seems paradoxical and is not fully understood. How long will I be hospitalized after a simple mastectomy? As long as you have not had nodes removed you will probably only need to stay one or two nights. Discuss this question with your doctor. Do I have to have general anesthesia during a mastectomy? No. Mastectomies can be done under local anesthesia if your doctor is experienced with this approach. Local anesthesia has been used on elderly patients, for whom general anesthesia would present a higher risk. There is no reason that younger patients would not also benefit. See Grant Carlson, MD., Total Mastectomy Local Anesthesia: The Tumescent Technique," The Breast Journal, [2005] I'm thinking about what to do after I get out of the hospital. Is there anything I need to do immediately, or can I wait a few weeks to think about a protocol? Research studies, such as the work by Coffey mentioned above, suggest that the immune system is most vulnerable in the days immediately following surgery. A lowered immune system may provide an environment favorable to growth of a new tumor. Before your surgery, it is a good idea to begin researching therapeutic procedures to bolster your immune system, so that you will be prepared in the event you experience postoperative immunosuppression. This website is intended as information only. The editors of this site are not medically-trained. Please consult your licensed health care practitioner before implementing any health strategy. The information provided on this site is designed to support, not replace, the relationship that exists between a patient/site visitor and his/her existing physician. This site accepts no advertising. The contents of this site are copyrighted 2004-2010 by Breast Cancer Choices, Inc. Contact us with comments or for reprint permission at admin@breastcancerchoices.org Web page updated January 17, 2010 |
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Take home question to ask yourself: Can you plan your surgery with your doctor in order to avoid trauma to your breast in order to forestall possible spread of cancer cells? |
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