Cancer Articles (Dr. S.N White)

The surgery of curable breast cancer is controversial principally in regard to whether the breast alone should be removed (a simple mastectomy) or whether the breast should be removed together with the underlying chest wall muscles and the contents of the armpit (a radical mastectomy). The latter has been the procedure advised in most medical centers in this country. In cases of old age or poor general condition, the simpler procedure is always chosen. Sometimes only the tumor is removed, leaving the remainder of the breast intact. This has been termed a lumpectomy. Some surgeons also do more extensive operations that entail removing part of the chest wall (a super radical mastectomy). Others do only a simple breast removal and later give radiation treatments. Each has its place. Just as one size dress does not fit everybody, so the operative procedure is tailored to fit the needs of the individual patient, insofar as we know how to do this.

As a general policy surgeons try to avoid cutting into a suspected cancer for biopsy without having the opportunity immediately to deal with the results of the biopsy. Each time a breast operation for a tumor is to be done, the surgeon discusses with the patient in advance the possibility that, if the biopsy indicates a cancer, the breast may have to be removed. Actually the patient usually gives written consent, in advance, for a breast amputation. Under very special circumstances, where the surgeon can be almost 100 percent certain that the mass is a benign tumor, he will remove it without discussing the possibility of the more radical procedure. This pertains, for example, to breast tumors in teen-age girls. These are so rarely cancerous that it is safe to go with this statistical experience. What you're telling me then is that I will not know in advance, not until I wake up, whether or not my breast has been removed. That's true.

It is usually a very short stay, a day or two or overnight. The sutures can then be removed in the surgeon's office. You can resume full activities almost immediately. Why don't you do the biopsy in your office by removing the tissue under local anesthesia that is, the way a dentist removes a tooth? This is an operative procedure because the tumor may be deep and there may be many blood vessels around it. Is is much safer and technically more appropriate to do it with all the hospital nursing and instrument facilities. In this way one can minimize bleeding and infection. From a practical point of view and in some cases, there is no reason why your suggestion cannot be carried out in a facility specially equipped for that purpose. It would certainly save hospital beds. There is a method of drill biopsy for breast masses that is done on an ambulatory basis, but this approach has not yet found broad acceptance in this country.

This is a general term for poorly understood changes in the ducts of the breast. It is not an infection, although the terminology suggests that it is. Cystic mastitis may occur in both breasts or be dominant in one. The duct leading to the nipple may give out a greenish yellow discharge. The breast lumps may be quite tender, and they usually vary in size and tenderness in relation to the menstrual cycle. It is a completely innocent process. Mastitis: Recognition and Treatment This is also referred to as cystic disease, although in fact it is less a disease than a physiological dysfunction. If the diagnosis can be accurately made in advance, then there is no reason to do anything about it. The injection of hormones is of no help. Surgery is done often for this disease because it can be difficult to differentiate it from a tumor.

One can never be 100 percent positive about what it is until it is examined under the microscope. The removal of a benign tumor is such a safe and simple procedure that it is better to have it removed and know what it is rather than to worry about it, watch it, and still be uncertain. My friend has an ugly scar across the center of the breast. I want to avoid that. This is what makes me hesitant about being operated on. For the removal of a breast cyst or the biopsy or excision of an innocent tumor, the surgeon rarely needs to make an obvious and unsightly incision. The incision can be concealed in the pigmented skin about the nipple or in the lower or outer curve of the breast. These incisions heal so well and fall so well into the natural skin tissues that they are virtually imperceptible after several months. The scar is red at first because it contains blood vessels; as the scar matures, the blood vessels are no longer obvious and the well made scar blends with the normal skin co...

What is a biopsy? The term "biopsy," of course, does not apply only to the breast. It is a surgical procedure in which a part (incisional biopsy) or all (excisional biopsy) of any tumor, growth, cyst, flesh, or organ anywhere in the body is removed so that its nature may be determined by microscopic examination. The results of this examination, called the pathology report, indicate the exact diagnosis and help select the proper method of treatment, which may be further surgery, X-ray treatment, drug administration or no treatment at all. How is the biopsy treatment done?  This is a regular operation performed in the hospital on at least an overnight stay. It is usually done under general anesthesia so that the patient is asleep. The excised tissue is rapidly frozen like dry ice and cut into thin slices that can be viewed under the microscope. This procedure takes 15-30 minutes. It is employed only when this information is required during surgery as a guide to determini...

What is the first sign of breast cancer? Many women have no signs at all and are first diagnosed by the alert physician during his breast examination. The patient may first note a lump in the breast or a bloody discharge from the nipple, a change in the appearance of the breast, or a lump in the armpit.  When are breast lumps treated by needling to remove the fluid?  The method of treatment is termed aspiration. It is employed only when the physician is certain that the lump is a cyst. A cyst can be compared to a balloon filled with water. When the fluid is removed, it is hoped that the cyst wall will collapse and be obliterated. If the cyst recurs after aspiration, it then requires surgical removal. Some women are fortunate in that the cyst never reappears. This procedure must be used cautiously and selectively; it is never employed when the nature of the lump is in doubt. Aspiration is particularly suited to the woman who keeps reforming cysts after a biopsy has show...

How doctors detect breast cancer? It is possible to feel 90 to 95 percent of breast tumors.Deciding about the nature of the tumor can be another matter. In about two-thirds of patients it is possible, by feel alone, to make a fairly accurate diagnosis of an innocent breast cyst on the one hand or of a definite cancer on the other. In all instances the nature of the lump can be exactly determined only by taking it out in an operation and having it examined under a microscope. This is not to say that all breast lumps have to be removed. The examiner may be so certain that it is a breast cyst that he may recommend initial observation and removal only if it persists. Breast cancer test at home Do you approve of women examining their own breasts? Yes, indeed. It is an excellent form of self-evaluation. The woman who does this regularly, say, seven days before and seven days after her period, will be able to feel the difference when something new appears. Do not get hysterical and ...

What is a mammogram? This is a special X-ray method of examining the breasts. Skill and special experience are required for the performance of the examination and for the interpretation of the X ray. This is done either in the hospital's department of diagnostic radiology or in the specialist's office. A specially trained technician, usually female, will X-ray the breasts in various positions. Each breast will be radiographed, even though the lump is only in one, so that the two sides may be compared. The presence and type and arrangement of certain calcium granules suggest the nature of the growth. In recent years this has become a great aid to the diagnosis of early breast conditions and to the follow-up examination of women who have already had some form of breast surgery. It is completely painless and involves no risk. The examination may take thirty to sixty minutes. How accurate is the mammogram, and why haven't I had this preventive cancer test suggested to me...

WE DON'T know the cause of breast tumors or of breast cancer. There is no way of preventing the disease. Early breast cancer can be cured in 80 percent of the individuals. The problem is with a woman who feels a lump in her breast or who has already been treated for a breast "tumor." At the time of consultation the patient wants to know if this is "really a tumor." Can it be cancer? The questions all filter down to this consideration and to whether the breast may have to be removed. In these times information about these problems is widely disseminated, and women are appearing for early diagnosis and treatment. Often the lump is not a cancer. More than 50 percent of the lumps in mature women are not cancer. For the patient who has already had a breast tumor removed, the consultation concerns whether another operation is required for the new lump. The patient who has already had a breast amputation seeks advice regarding ways to arrest the growth or reappea...

How are X rays obtained? Most X-ray diagnostic studies of the stomach, intestine, gall-bladder, chest, kidney, bones, and skull can be obtained on an ambulatory basis. They are performed by an X-ray specialist (radiologist) in conjunction with a trained technician, who actually develops the film. The techniques of the examination and the interpretation of the findings are the province of the radiologist. The X rays are taken in the radiologist's office or on a comeand- go basis in the radiology department of a hospital or a group clinic. These films are loaned to the surgical consultant for his evaluation. However, certain elaborate X-ray examinations, such as those that follow injections for visualizing the blood vessels, should be done only with the facilities and precautions that are available to a patient within the hospital. The disadvantage of hospitalization is that, incongruously, it may actually take longer to get the studies completed. Furthermore, some hospital ins...

The majority of patients have already been seen by their own physician or a previous nonsurgical consultant. They are referred to a specific surgeon for any number of reasons, the most important being that he is regarded as especially capable in the area of a particular problem. Physicians tend to refer patients to surgeons in their own hospital so that they may also participate in the subsequent handling of the case. Other patients may prefer to choose the surgeon themselves because of his reputation or because he has already treated a member of the family or an acquaintance. A surgeon may also be selected by a referral from a specific agency, a medical group or union panel, or a hospital administration office. Another patient may choose to go to a particular hospital or clinic and leave the choice of a surgeon to that organization's administrative policy. What makes one a surgeon? A surgeon is, first of all, a physician. He is a M(edical) D(octor). After receiving his degree...