Dr. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983. He completed his internship at St. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Patients with breast cancer have many treatment options. Most treatments are
adjusted specifically to the type of cancer and the staging group. Treatment options should be discussed with your health-care team. Below you will
find the basic treatment modalities used in the treatment of breast cancer.
Surgery
Most women with breast cancer will require surgery. Broadly, the surgical
therapies for breast cancer can be divided into breast conserving surgery and
mastectomy.
Breast-conserving surgery
This surgery will only remove part of the breast (sometimes referred to as
partial mastectomy). The extent of the surgery is determined by the size and
location of the tumor.
In a lumpectomy, only the breast lump and some surrounding tissue is removed.
The surrounding tissue (margins) are inspected for cancer cells. If no cancer
cells are found, this is called "negative" or "clear margins." Frequently,
radiation therapy is given after lumpectomies.
Mastectomy
During a mastectomy (sometimes also referred to as a simple mastectomy), all
the breast tissue is removed. If immediate reconstruction is considered, a skin-sparing mastectomy is sometimes performed. In this surgery, all the breast tissue
is removed as well but the overlying skin is preserved.
Radical mastectomy
During this surgery, the surgeon removes the axillary lymph nodes as well as
the chest wall muscle in addition to the breast. This procedure is done much
less frequently than in the past, as in most cases a modified radical mastectomy
is as effective.
Modified radical mastectomy
This surgery removes the axillary lymph nodes in addition to the breast
tissue.
Depending on the stage of the cancer , your health-care team might give you a
choice between a lumpectomy and a mastectomy. Lumpectomy allows sparing of the
breast but usually requires radiation therapy afterward. If lumpectomy is
indicated, long-term follow-up shows no advantage of a mastectomy over the
lumpectomy.
Radiation therapy
Radiation therapy destroys cancer cells with high energy rays. There are two
ways to administer radiation therapy:
External beam radiation
This is the usual way radiation therapy is given for breast cancer. A beam of
radiation is focused onto the affected area by an external machine. The extent
of the treatment is determined by your health-care team and is based on the
surgical procedure performed and whether lymph nodes were affected or not.
The local area will usually be marked after the radiation team has determined
the exact location for the treatments. Usually the treatment is given five days a
week for five to six weeks.
This form of delivering radiation uses radioactive seeds or pellets. Instead
of a beam from the outside delivering the radiation, these seeds are implanted
into the breast next to the cancer.
Chemotherapy
Chemotherapy is treatment of cancers with medications that travel through the
bloodstream to the cancer cells. These medications are given either by
intravenous injection or by mouth.
Chemotherapy can have different indications and may be performed in different
settings as follows:
Adjuvant chemotherapy: If surgery has removed all the visible cancer, there is
still the possibility that cancer cells have broken off or are left behind. If
chemotherapy is given to assure that these small amounts of cells are killed as
well, it is called adjunct chemotherapy.
Neoadjuvant chemotherapy: If chemotherapy is given before surgery it is
referred to as neoadjuvant chemotherapy. Although there seems to be no advantage
to long-term survival whether the therapy is given before or after surgery,
there are advantages to see if the cancer responds to the therapy and by
shrinking the cancer before surgical removal.
Chemotherapy for advanced cancer: If the cancer has metastasized to distant
sites in the body, chemotherapy can be used for treatment. In this case, the
health-care team will need to determine the most appropriate length of treatment.
There are many different chemotherapeutic agents that are either given alone
or in combination. Usually these drugs are given in cycles with certain
treatment intervals followed by a rest period. The cycle length and rest
intervals differ from drug to drug.
Hormone therapy
This therapy is often used to help reduce the risk of cancer reoccurrence
after surgery, but it can also be used as adjunct treatment.
Estrogen (a hormone produced by the ovaries) promotes the growth of a few
breast cancers, specifically those containing receptors for estrogen (ER
positive) or progesterone (PR positive).
Tamoxifen (Nolvadex): This drug prevents estrogen from binding to estrogen receptors on
breast cells.
Fulvestrant (Faslodex): This drug eliminates the estrogen receptor and can be used even
if tamoxifen is no longer useful.
Aromatase inhibitors: They stop estrogen production in postmenopausal women.
Examples are letrozole (Femara),
anastrozole (Arimidex), and
exemestane
(Aromasin).
Targeted therapy
As we are learning more about gene changes and their involvement in causing
cancer, drugs are being developed that specifically target the cancer cells.
They tend to have fewer side effects then chemotherapy (as they target only the
cancer cells) but usually are still used in adjunct with chemotherapy.
Targeting HER2/Neu protein
Monoclonal antibody: Trastuzumab is a engineered protein that attaches to the
HER2/Neu protein on breast cancer cells. It helps slow the growth of the cancer
cell and may also stimulate the immune system to attack the cancer cell more
effectively.
It is given IV either once a week or every three weeks.
Drugs that target new tumor blood vessels
Tumors need new blood vessels to grow. The process of blood vessel growth is
known medically as angiogenesis. New drugs are being developed to target this
growth and fight certain cancers, including breast cancer.
Bevacizumab is a monoclonal antibody directed against vascular cells. Newer
study results seem to indicate that this drug slows the cancer growth in some
patients but did not improve survival. The use of this medication should be
discussed with your health-care team.
Alternative treatments
Whenever a disease has the potential for much harm and death we search for
alternative treatments. As a patient or the loved one of a patient you want to
try everything and leave no option unexplored. The danger in this approach is
usually found in the fact that the patient might not avail themselves of
existing, proven therapies. You should discuss your interest in alternative
treatments with your health-care team and together explore the different options.
Lymph nodes help the body's immune system fight infections. Causes of swollen lymph nodes (glands) may include infection (viral, bacterial, fungal, parasites). Symptoms of swollen lymph nodes vary greatly. They can sometimes be tender, painful or disfiguring. The treatment of swollen lymph nodes depends upon the cause.
Systemic lupus erythematosus is a condition characterized by chronic inflammation of body tissues caused by autoimmune disease. Lupus can cause disease of the skin, heart, lungs, kidneys, joints, and nervous
system. When only the skin is involved, the condition is called discoid lupus.
When internal organs are involved, the condition is called systemic lupus
erythematosus (SLE).
Fibrocystic breast condition (sometimes called fibrocystic breast disease) is characterized by lumpiness and usually discomfort in one or both breasts. The condition is very common and benign (not malignant). Fibrocystic breast condition is the most common cause of "lumpy breasts" in women. A common symptom of fibrocystic breast condition is breast pain or discomfort. There are two types of fibrocystic breast condition, cysts and fibrosis, and Hyperplasia and atypical hyperplasia of breast cells.
Pleurisy, an inflammation of the lining around the lungs, is associated with sharp chest pain upon breathing in. Cough, chest tenderness, and shortness of breath are other symptoms associated with pleurisy. Pleurisy pain can be managed with pain medication and by external splinting of the chest wall.
Cancer is a disease caused by an abnormal growth of cells, also called malignancy. It is a group of 100 different diseases, and is not contagious. Cancer can be treated through chemotherapy, a treatment of drugs that destroy cancer cells.
Pleural effusion is an excess fluid between the two membranes that envelop the lungs. There are two classifications of causes of pleural effusion; transudate and exudate. The treatment of pleural effusion depends on the cause.
Breast lumps in women can have a variety of causes such as breast inflammation, infection, injuries, cancer, and non-cancerous growths. Breast lumps in women are diagnosed with physical exam, mammogram, ultrasound, MRI, and biopsy. Treatment of breast lumps in women depend on the cause.
The breast generally refers to the chest, however, more specifically, to the mammary gland. The mammary gland is a milk producing gland comprised largely of fat. Within the mammary gland is a complex network of branching ducts. The ducts exit from sac-like structures called lobules, which can produce milk in females. The darkened area around the nipple is called the areola. Common medical concerns in regard to the breast include breast lumps, breast cysts, breast cancer, and breast infections.
Male breast cancer accounts for 1% of all breast cancers, and most cases are found in men between the ages of 60 and 70. A man's risk of developing breast cancer is one in 1,000. Signs and symptoms include a firm mass located below the nipple and skin changes around the nipple, including puckering, redness or scaling, retraction and ulceration of the nipple. Treatment depends upon staging and the health of the patient.
Phlebitis is the inflammation of a vein. Thrombophlebitis is when a blood clot causes the inflammation. Phlebitis can be superficial or deeper in the veins. A blood clot deep in a vein is deep vein thrombosis (DVT). Some of the common causes of phlebitis include prolonged inactivity, varicose veins, trauma to a vein, underlying cancers, clotting disorders, etc. Symptoms of phlebitis may be mild (pain, tenderness, redness, or bulging of a vein. Treatment of phlebitis depends on the cause.
Hypercalcemia is a condition in which calcium levels in the blood are elevated. Hypercalcemia is associated with other conditions such as hyperparathyroidism, lung cancer, breast cancer, kidney failure, and elevated levels of vitamin D. Symptoms of hypercalcemia include constipation, nausea, abdominal pain, kidney stones, to name a few. Treatment depends on the cause of hypercalcemia.
Lymphedema is a condition in which one or more extremities become swollen as the result of an impaired flow of the lymphatic system. There are two types of lymphedema; primary, secondary. Filariasis is the most common cause of lymphedema worldwide; however, in the U.S. breast cancer surgery is the most common cause. Symptoms include swelling of one or more limbs, thickening, cracked, and secondary bacterial or fungal infections of the skin. There is no cure for lymphedema.
Enjoying a satisfying sex life as we age is important to both physical and mental health. As we age, diseases and conditions may pose challenges in our sexual health, and sexual experiences. Learn how to manage your conditions and still have a gratifying sex life as you age.
Inflammatory breast cancer is an accelerated form of breast cancer that is not usually detected by mammogram or ultrasound. Symptoms of inflammatory breast cancer include pain in the breast, skin change in the breast area, bruise on the breast,sudden swelling of the breast, nipple retraction or discharge, and swelling of the lymph nodes.
Lymphedema is a common chronic, debilitating condition in which excess fluid called lymph collects in tissues and causes swelling in them. It is common after a mastectomy, lumpectomy or breast cancer surgery and radiation therapy.
Women's health is an important topic area to guide a woman through the stages of her life, as well as knowing the conditions and diseases that may occur. Educating yourself so that the transitions into different phases of life is key to a healthy, happy, and productive life.
Lifestyle changes, a healthy antioxidant-rich diet, exercise, and weight reduction can help reduce a woman's risk of developing breast cancer. It's important to be aware of how risk factors such as family history, lifestyle factors, breast conditions, radiation therapy, and hormonal factors may influence your chances of developing breast cancer. Mammography and breast self-examinations are crucial steps in breast cancer prevention.
Disease prevention in women includes screening tests that are a basic part of prevention medicine. All screening tests
are commonly available through your general doctor. Some specialized tests may be available elsewhere.
As breast cancer is the most diagnosed non-skin cancer in American women, it is important to know your breast cancer risk. Risk factors include age, age at menarche, age at first live birth, history of breast abnormalities, breast biopsies, race, and history or breast cancer among first-degree relatives.
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