In the past, a positive biopsy was followed immediately by surgical treatment. This was called a one-step process. Currently, when a biopsy confirms that a tumor is malignant, the decision about treatment is deferred for a week or more to allow the patient and family to explore treatment options with the patient's doctor.
Separating the diagnostic test from the surgery is called a two-step process. Although it requires another visit to a hospital and a second procedure, a two-step process allows a woman and her doctor to discuss and contemplate treatment options. Moreover, there is time to seek a second opinion. More definitive laboratory analysis of the biopsied tissue can be done during this time. In some cases, when the tumor is very small, it may be completely removed by the biopsy and additional surgery may not be necessary.
When planning therapy, an oncologist and/or surgeon considers the following factors: the stage of the cancer (that is, the size of the tumor, whether or not the lymph nodes are involved, and the presence of metastases); the tumor's hormone status; the woman's age and menopausal status; and her general health, including whether she has any serious and/or chronic illness or conditions, such as heart disease, that might be complicated by treatment. In some cases, doctors will want to consider other prognostic factors that indicate the tumor's aggressiveness and likelihood of recurrence. Treatment choices may be affected by ominous pathological features such as necrosis or comedeocarincoma or high grade.
Lumpectomy and partial mastectomy are breast conserving surgeries. In lumpectomy, the cancerous lump and a margin of normal tissue around it are removed. Depending on the size and location of the cancer, partial (or segmental) mastectomy can conserve much of the breast. The surgeon removes the cancer, some of the breast tissue, the lining over the chest muscles below the tumor, and usually some of the lymph nodes under the arm. In most cases, radiation therapy follows.
The entire breast is removed in total mastectomy. Some lymph nodes under the arm may be removed, also.
Modified radical mastectomy refers to the procedure in which the breast, some of the lymph nodes under the arm, the lining over the chest muscles, and, sometimes, part of the chest wall muscles are removed.
Finally, the surgeon, in radical mastectomy, removes the breast, chest muscles, and all the lymph nodes under the arm. This was the standard operation for many years, but it is now typically only used when a tumor has spread to the chest muscles.
To learn more about surgery, see the Cancer Treatment module.