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Diagnosis & Treatment 

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The physicians of the Sentara Cancer Network use state-of-the-art technology to diagnose and treat patients with breast cancer.

Diagnosis 

Stereotactic Guided Breast Biopsy
This alternative to surgical biopsy uses an image-guided needle to quickly extract tissue that can be examined and evaluated under a microscope by a pathologist. 



Ultrasound Guided Breast Biopsy 
Another alternative to surgical biopsy using an ultrasound image-guided needle to quickly extract tissue that can be examined and evaluated under a microscope by a pathologist.

 
MRI Guided Breast Biopsy
An alternative to surgical biopsy using an MRI image-guided needle to quickly extract tissue that can be examined and evaluated under a microscope by a pathologist. 

There are a wide variety of treatment options available for treating breast cancer. Treatments vary depending on the nature of each patients cancer and will be developed individually. Some of the most common treatment options include:

Surgery
For some types of cancer, the most effective treatment is surgically removing the tumor. Your surgeon may recommend one of the following breast cancer surgical procedures:

 Lumpectomy
With this breast conserving surgery, the surgeon spares as much healthy breast tissue as possible during surgery. A  lumpectomy is an inpatient procedure involving the surgical removal of the tumor and some healthy tissue surrounding the tumor site. The surgeon also removes some axillary lymph nodes to test for evidence of cancer. If a patient is a candidate for a lumpectomy it can be an alternative to mastectomy.

 Simple Mastectomy
A simple mastectomy is an inpatient procedure consisting of the complete surgical removal of the affected breast and some axillary lymph nodes.

 Modified Radical Mastectomy
 A modified radical mastectomy is an inpatient procedure requiring the complete surgical removal of the affected breast, as well as the removal of a number of axillary lymph nodes and the lining of the chest wall muscles.

 Radical Mastectomy
A radical mastectomy is an inpatient procedure involving the complete surgical removal of the affected breast, the chest wall muscles, the underarm lymph nodes and the fat and skin surrounding the chest muscles. Rarely used, radical mastectomy represents the most extensive mastectomy procedure, required only when cancer invades the chest wall muscle. 

Sentinel Node Mapping
After a patient undergoes a primary cancer surgery such as a lumpectomy or mastectomy, a sentinel node mapping procedure may be recommended. With this procedure, the first lymph node that receives drainage from the affected breast can be removed and examined for cancer. Correctly identifying the draining nodes can significantly increase the accuracy of which nodes to surgically remove and evaluate for spread of cancer. It also helps prevent unnecessary removal of nodes that may not be in the lymphatic drainage field of the tumor. Reducing the number of nodes can reduce the chances of  developing lymphedema.

Axillary Node Dissection
 Another standard inpatient procedure conducted after a woman undergoes a primary cancer surgery such as a lumpectomy or mastectomy is an axillary node dissection. The axillary lymph nodes consist of three bundles of lymph nodes. Level I nodes are located beneath the armpit. Level II nodes located inside the armpit, and Level III nodes located in the shoulder. Depending upon disease progression, the surgeon removes as few as four and as many as thirty total  lymph nodes from the body to test for evidence of cancer.

Chemotherapy

Chemotherapy is a systematic treatment using drugs that can destroy breast cancer cells. Given intravenously, by injection or taken orally, chemotherapy drugs may be used alone or combined with other treatments. Learn more.

Radiation Oncology
Radiation therapy is used to treat cancer as well as offer relief from some of the symptoms of cancer. It may be used alone or in combination with surgery or chemotherapy. Sentara's advanced radiation therapies include:  

Intraoperative Accelerated Partial Breast Irradiation (Intra Beam) 
It is a complete system to deliver Intra-operative, or post-operative radiation therapy directly into tumors or tumor cavities. Sentara is participating in a national clinical trial.

 External Beam Radiation Therapy or IORT for breast cancer 
This is a method for delivering a beam of high-energy x-rays to the location of the patient's tumor. These x-rays can destroy the cancer cells and careful treatment planning allows the surrounding normal tissues to be spared.

 Brachytherapy/Radioactive Seed Implant Therapy 
Brachytherapy is a form of radiotherapy where a radioactive source is placed inside or next to the area requiring treatment. MammoSite® is a type of brachytherapy.

Integrative Therapies
For some patients, it can be beneficial to combine conventional treatment modalities with holistic approaches related to diet, lifestyle, exercise, stress care and nutrition. Some complementary therapies may help relieve certain symptoms of cancer, relieve side effects of cancer therapy, or improve a patient's sense of well-being.

Examples might include: drinking peppermint tea for nausea or engaging in massage therapy, yoga or meditation to reduce stress. If you’re interested in trying a complementary approach, contact your physician or health care team to see what is available and what may be appropriate for you.

Breast Reconstruction
When a woman with breast cancer decides, with the input from her general surgeon, to have a partial or complete mastectomy she doesn't have to face the specter of remaining deformed for life.

Women now facing removal of the breast, and women who have had previous mastectomies, have a right, protected by federal law, to coverage by their insurance carrier for breast reconstruction, including procedures needed to enhance, reduce or lift the opposite side for symmetry.

Reconstruction can be done at the
same time as the mastectomy or afterward, depending on treatment needs.  Surgeons can reconstruct breasts using implants or a patient’s own tissue. Sentara Obici Hospital offers, state-of-the-art, microsurgical Deep Inferior Epigastric Perforator (DIEP) flap breast reconstruction using a patient’s tissue. This technique, available in only a few of places within the United States, creates a natural breast without sacrificing other body functions.
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