According to the American Cancer Society, this year 182,460 women and 1,990 men in the United States will hear those words. Breast cancer is the most common cancer among women and it is the second leading cause of cancer death for women aside from lung cancer. Receiving a breast cancer diagnosis can be devastating but you are not alone. The cancer team at North Florida Regional Medical Center (NFRMC) is here to walk with you every step of the way from diagnosis, to treatment, to life after breast cancer.

The Breast Health Program at the Women’s Center at NFRMC assists in the diagnosis of breast cancer by offering patients mammograms, breast ultrasounds and the choice of several types of minimally invasive breast biopsies. Digital mammograms, breast ultrasounds and breast MRIs can help identify a lump in the breast. If a lump is found, a biopsy (when a piece of tissue is removed from a suspicious lump in the breast and viewed under a microscope) is done to determine whether the lump is cancerous or not. If a diagnosis of breast cancer is made, you will discuss treatment options with cancer specialists.

There are three treatment modalities for breast cancer which are often used in conjunction with each other: surgery, radiation and chemotherapy. Surgery options include removing part of or the entire breast. Radiation therapy directs radiation specifically at the site of cancer in the breast. Chemotherapy, hormonal therapy and biological therapy attack cancer cells that may be present throughout your entire body on a microscopic level. Patients may also participate in clinical trials and exercise therapy to combat their cancer. You should talk with your doctor about the best treatment options for the stage of your disease.

Surgery
There are several different types of surgery for breast cancer patients. Lumpectomy is a breast-sparing operation that is used to remove the cancer but not the breast. This method is best for patients with small amenable lumps. The surgeon will remove the cancerous tumor and some of the tissue surrounding it.

Another type of surgery for breast cancer patients is a mastectomy. This is an operation for women with a large lump, multifocal lumps, or small breasted women where removing the lump would disfigure them. In this procedure the surgeon removes the entire breast. Surgeons often remove the lymph node under the arm as well to see if the cancer cells have entered the lymphatic system.

“Surgically we always try to do minimally invasive procedures,” said surgeon Peter Sarantos, M.D.

Breast reconstruction is an option for patients undergoing breast surgery. It is plastic surgery to rebuild the shape of the breast and can be done at the same time of your breast surgery. Several different reconstruction options are available such as those using the patients own tissue, implants or a combination. “Treatment of cancer is our number one priority,” said Jason Rosenberg, MD, FACS, breast cancer reconstruction specialist. His office will work with the patient’s oncologists and surgeons to determine which type of reconstruction will work best for them.

The Deep Inferior Epigastric Perforator (DIEP) flap procedure is Dr. Rosenberg’s preferred method. In this microsurgical procedure the patient is able to use her own abdominal tissue for breast reconstruction without the sacrifice of the abdominal musculature. Small blood vessels from the muscle and skin of the abdomen are transferred to the chest to recreate the breast. In using your own tissue there is less chance of developing an infection, the breasts will gain and loss weight with you and they will appear more natural. Once the reconstruction is complete there are no required procedures for maintenance.

“Only 8-12 percent of women with mastectomies will get reconstructions. A lot of women didn’t do it because they didn’t know about it or didn’t think their insurance companies would cover it,” said Dr. Rosenberg.

According to the Women’s Health and Cancer Rights Act of 1998 health plans and individual health policies that provide coverage for mastectomies are required to also provide coverage for breast reconstruction in connection with the mastectomy. Women receiving mastectomy related services are entitled to reconstruction of the breast on which the mastectomy has been performed and on the other breast to produce a symmetrical appearance.

Radiation Therapy
The radiation oncology department at NFRMC specializes in radiation therapy treatments of breast cancer and is headed by Dr. Cherylle Hayes, radiation oncologist. Dr. Hayes along with Dr. Mark Perman, radiation oncologist, determine the best type of radiation treatment for your specific case of breast cancer. They work closely with your other physicians to develop a coordinated treatment plan including chemotherapy and/or surgery if needed. Dr. Hayes and Dr. Perman will monitor your progress throughout your treatment and make decisions on your care based on your needs.

The radiation oncology department provides you with the latest in cutting edge treatment options. Radiation uses high-energy rays to kill cancer cells. One form of treatment is external beam radiation where a machine is used to create and aim high-energy radiation at the cancer or area where the cancer used to be. NFRMC offers two methods of external beam radiation for breast cancer patients: Conformal 3D Radiation Therapy and Intensity Modulated Radiation Therapy.

Conformal 3-Dimensional Radiation Therapy (3DCRT) identifies the different sizes, shapes and locations of a tumor. Once the specifics of the tumor are identified, doctors target the radiation beams to the exact size and shape of the tumor. Intensity Modulated Radiation Therapy (IMRT) shapes and adjusts the radiation beam so higher doses of radiation can be given to some parts of the tumor while lower doses are given to sensitive tissues nearby.

The radiation oncology department also offers brachytherapy. An example of this treatment is the Mammosite® balloon brachytherapy, a high-dose radiation therapy which uses a catheter (needle) to inject a temporary radiation pellet or seed directly into the area where cancer is or was located. Once therapy is complete the seed is removed and patients can return to their normal activities.

During radiation therapy at NFRMC, Dr. Hayes and Dr. Perman will see you at least once per week to follow your progress and address any concerns that you may have. After treatment is completed, a followup appointment will be scheduled to monitor your recovery progress and health status. The radiation oncology department is always there to answer any questions that you may have about your breast cancer treatment.

Chemotherapy
Chemotherapy is a type of cancer treatment that uses drugs to kill cancer cells. It works by slowing the growth of cancer cells, which grow and divide quickly. For breast cancer patients it is usually a combination of medications given as a pill or injection into a vein (IV). It is often used along with surgery and radiation. Depending on the stage of cancer chemotherapy can cure cancer (when doctors can no longer detect cancer cells in your body and they will not grow back), control cancer (when chemotherapy keeps cancer from spreading, slows its growth or destroys cancer cells that have have spread to other parts of your body) or erase cancer symptoms (when the therapy shrinks tumors that are causing pain or pressure).

Dr. Robert Carroll is one of the world’s leading experts on breast cancer oncology and specializes in breast cancer treatments and clinical trials at NFRMC. Dr. Carroll said the field is moving fast thanks to new findings in breast cancer research. “We are now able to look at the expression of various genes in an individual patient’s breast cancer to assess the likelihood of its responding to hormonal therapy or chemotherapy. Years ago, chemotherapy treatments were more difficult, drugs weren’t as effective and the outcomes were not as beneficial. Now treatments are easier and more effective. Patients can now live normal lives while going through treatment. “From our particular vantage point, it is obvious that the changes in breast cancer medicine are real, they are important, and they’ve made a change in people’s lives,” said Carroll.

NFRMC Cancer Program
Gwen Carriere, ARNP, is the Cancer Program Coordinator for NFRMC and a volunteer for the American Cancer Society (ACS). Everyday she visits with cancer patients who have been admitted to the hospital answering any questions patients and their families might have. Carriere also runs a comprehensive resource center that includes materials such as books and pamphlets containing information about different types of cancer. The resource center helps to further educate patients and their families and acts as a reference tool. Carriere notes, “It is not just the patients that get continuing education but also all the medical staff who attend regular meetings and seminars to keep up to date on new procedures.”

For the newly diagnosed patient, Carriere brings along a fuzzy ACS bear with her on a first visit to the patient’s room. The bear reminds a patient that not only is North Florida Regional Medical Center there to help them, but the American Cancer Society is there as well. Carriere makes it a priority to register every newly diagnosed cancer patient with the ACS, an organization that provides assistance to cancer patients and survivors. The ACS provides support groups, transportation to and from treatment and other services.

Not only does Carriere assist cancer patients at NFRMC, she also reaches out to the community explaining what cancer is and discussing the various treatment options. She believes it is important to inform the community about early detection and prevention.

Carriere feels rewarded when patients thank her for the loving kindness and consideration they received from NFRMC from the beginning of their treatment all the way through to recovery. “I know at the end of the day that I’ve helped navigate someone through the journey of cancer,” said Carriere.

NFRMC Cancer Center
In the summer of 2009, the first phase of the new NFRMC Cancer Center will be complete. The facility will house a 16,000 square foot Radiation Oncology and CyberKnife® Center. A grand lobby will feature a cancer resource center with Internet access; a meditation area to meet the spiritual needs of patients and their families; Bella Caffé coffee shop; and retail sales.

For more information contact (352) 333-4970