Mills Breast Cancer Institute

Multidisciplinary Care Team Approach

Receiving care at an NAPBC-accredited center ensures that a patient will have access to specialists who meet regularly to create individualized treatment plans for each patient.

Patients will also have access to:

• Comprehensive care, including a full range of state-of-the-art services
• A multidisciplinary team approach to coordinate the best treatment options
• Information about ongoing leading edge clinical trials and new treatment options
• And, most importantly, quality breast cancer care close to home

The Mills Breast Cancer Institute team includes Carle physicians from the following specialties:

• Radiology/breast imaging
• Diagnostics
• Fellowship trained surgical oncologist
• Radiation oncology
• Reconstructive surgery
• Genetics
• Medical oncology

Our Breast Cancer nurse navigator is a registered nurse and a certified oncology nurse. After breast cancer diagnosis, she assists with:

• Coordinating appointments with your team of physicians
• Communicating your needs with your team of physicians
• Answering questions about test results, side effects and treatment options
• Providing individualized education
• Guiding you to medical and community resources, such as breast cancer support groups
• Educating patients and the community about complete breast care

Multidisciplinary Care Teams:

• Breast Cancer
• Gastrointestinal Cancers
• Gynecologic Cancers
• Head and Neck Cancers
• Lymphoma/Leukemia
• Skin Cancer
• Urologic Cancers

Treatment Options

At Mills Breast Cancer Institute, the latest state-of-the-art treatments and technologies are available to our patients. Different cancers require different treatments based on many factors. Each treatment plan will be designed to meet the needs of your specific form of breast cancer. There are many different types of breast cancer based on the hormonal status of each cancer as well as the genetic makeup.

Physicians will create an individualized treatment plan for each patient. Treatment plans depend on:

• Exact location of tumor
• Stage of cancer
• Patient's age
• General health

Patients and physicians will meet to carefully consider treatment options. Treatment options may be used together or alone based on the type of breast cancer. Each step of a treatment plan will be carefully analyzed in the best interest of the patient. Treatment options may include:

Surgery
Lumpectomy, or sometimes called breast conserving surgery or partial mastectomy. This surgery is where only the lump or area of malignancy is removed. It can be done by localizing the area with either a seed or a wire which tells the surgeon where the malignancy is. It is important to achieve clear margins with this type of surgery so that there is no cancer at the very edge of the removed area. If the margins are found to be positive the surgeon may need to go back or "re-excise" to remove more of the area to get margins that are clear of the cancer. Lumpectomy is most often followed by radiation therapy to "mop-up" any remaining cancer cells that may remain and decrease recurrence of the cancer.

Seeds and wire localizations are a method where the radiologist places either a tiny minimally radioactive seed or a small wire at the site of the cancer using mammography or sonography. This is done to help the surgeon in removing the cancer. Seeds can be done up to 5 days prior to a surgery and wires are done the day of surgery.

Mastectomy is the surgery that removes the entire breast. The most common type of mastectomy is a "simple" or "total" mastectomy where the surgeon removes the entire breast but none of the musculature under the breast. "Modified radical" mastectomy is the procedure where the entire breast is removed as well as the lymph nodes in the underarm.

Reconstruction after mastectomy is also a choice a patient may elect. There are numerous types of reconstruction, the best choice for a patient is determined with a discussion with one of our plastic surgeons.

Removal of lymph nodes is sometimes part of breast surgery. A Sentinel Lymph Node Biopsy is a procedure where only 1-3 nodes are removed to see if there is any cancer spread. It is done with an injection of a radioactive substance the nodes take up then the surgeon can identify them during the surgery, so they c. or an axillary lymph node dissection where the surgeon takes 10-20 nodes from the underarm area if there is cancer in those nodes.

Chemotherapy
Chemotherapy for breast cancer can be given orally or intravenously. Tables given for breast cancer can be medicines to block hormones in the body that may cause the cancer to grow or targeted therapy. Targeted therapy for breast cancer is often considered chemotherapy since it is given intravenously or orally as with chemotherapy. Traditional chemotherapy generally kills both cancer cells but also some normal cells. Targeted therapy interferes with the growth, progression and spread of the cancer cells while limiting damage on the normal cells. Often breast cancer chemotherapy is given directly into the bloodstream. The drugs travel through the blood stream to reach all parts of the body. Chemotherapy as well as targeted therapy are usually given in cycles. Periods of chemotherapy treatments are alternated with rest periods when no chemotherapy is given. Chemotherapy may be administered once a week, every other week or every three weeks. The frequency of chemotherapy depends largely on the type of cancer and type of drug or drugs being given. The length of time for chemotherapy is based on research evidence guidelines, response to treatment and side effects encountered. Depending on the cell type and stage of breast cancer, most individuals receive chemotherapy for four to six cycles. Occasionally chemotherapy is given before surgery to help decrease the size of the cancer and improve the outcome after surgery. This type of chemotherapy is called neoadjuvant.

Very few chemotherapy treatments require hospital admission. Some chemotherapy drugs come in an oral form and can be taken at home. By far the most common setting for chemotherapy administration is in a specialized chemotherapy infusion center which is staffed by specially-trained infusion nurses.

Common chemotherapy drugs given for breast cancer include: Adriamycin, Cytoxan. Taxol, Taxotere, and Carboplatin. Targeted therapy for breast cancer include: Heceptin, Perjeta, Afinitor, and Kadcyla.

Side effects from chemotherapy can be well controlled or may not occur for some patients. Common side effects may include: hair loss, constipation, diarrhea, heart damage, mouth sores, nail changes, fatigue, appetite changes, nausea or vomiting, numbness or tingling of the hands and feet.

Radiation Therapy
Radiation treatments are given five days per week, over several weeks. You will likely have the same treatment time for all of your appointments.

Carle Cancer Center offers several options for radiation treatment to the breast. These include:

• High dose, low fraction radiation treatments - Some patients may benefit from higher daily doses of radiation, which results in less number of treatment fractions.
• Deep inspiration breath hold technique (DIBH) - A radiation treatment technique that can be used to decrease radiation dose to the heart for patients needing radiation to their left breast. This technique requires the patient to hold their breath for 20 to 30 seconds, throughout the entire procedure. The images demonstrate the different in the amount of heart in or near the treatment area. Not all patients are candidates for this procedure, and it may not work for all patients.

We offer other positioning options as well, including the prone technique. With this technique, the patient will lie on her stomach, rather than her back for treatment. Your physician will discuss the treatment options with you and decide which technique is best for you.