Do You Need Chemo After a Lumpectomy
Chemotherapy after a lumpectomy may be needed if the tumor is larger than ¼ inch, has spread to the lymph nodes, and if there is a chance of recurrence

After a lumpectomy, you will need radiation therapy on remaining breast tissue. Chemotherapy after a lumpectomy may be needed in the following cases:

  • Tumor is larger than ¼ inch or 0.5 cm
  • Tumor has spread to the lymph nodes
  • There is a chance of recurrence
  • Tumors that are small and:
    • Fast-growing
    • Have receptors for the hormones estrogen and progesterone
    • Produce too much of the  growth-promoting protein HER2
    • Have a high score on gene panels such as Oncotype DX, EndoPredict, and MammaPrint
  • Younger people (breast cancer tends to be more aggressive in young people)

Can a lumpectomy reveal whether breast cancer has spread?

After the breast tumor has been removed during a lumpectomy, your surgeon may also check your lymph nodes to see if cancer has spread beyond the breast. 

They may perform a biopsy by removing a lymph node through a separate, small incision in the armpit area. A pathologist then checks the biopsy sample for signs of spread of cancer in the lymph nodes. This helps your cancer treatment team determine which treatments are most likely to be effective for your case.

What is the role of chemotherapy in breast cancer?

Chemotherapy is typically used to shrink breast cancer tumors before surgical removal. This is especially necessary when:

  • The tumor is so large that it cannot be removed via surgery. Once the tumor regresses with chemotherapy, it becomes easier for doctors to remove it without risking spread to adjacent organs.
  • Doctors want to check how well a particular medication works on your breast cancer. This helps them decide whether to continue the same drug after surgery or switch to another medication if the previous one does not work.

Breast cancer varies from person to person, and the type of medications your oncology team prescribes will depend on the goals of treatment and the features of your particular cancer.

How is chemotherapy administered in breast cancer?

Chemotherapy involves the use of anticancer medications that kill cancer cells in the body:

  • Can be given in the form of intravenous (IV) therapy or as oral pills
  • Given in cycles of 2-3 weeks for a period of 3-6 months. 
  • Total duration and type of medications depend on how well you tolerate the therapy. 
  • A gap is given in between 2 cycles to allow you time to recover from the treatment.

Chemotherapy for breast cancer can be given in the form of neoadjuvant therapy or adjuvant therapy:

  • Neoadjuvant therapy: Involves medications given to reduce tumor size before removal of breast cancer tissue through surgery. This typically includes chemotherapy.
  • Adjuvant therapy: May be either medications or radiation therapy given after surgery to destroy any remaining cancer cells. The medications may be the ones used in chemotherapy and targeted therapy.

Treatment of breast cancer depends on your overall health, age, and specific needs.

QUESTION

A lump in the breast is almost always cancer. See Answer

Tips to maintain your health during breast cancer chemotherapy

Take care of body before and during treatment

Taking care of your body before and during chemotherapy sessions can help lessen side effects or at least allow you to tolerate them better:

  • Get plenty of rest.
  • Stay physically active.
  • Eat a nutritious, balanced diet rich in fruits, vegetables, whole grains, and nuts.
  • Maintain good hygiene such as washing or sanitizing your hands frequently and staying up to date on your vaccinations.
  • Visit the dentist to maintain teeth and gum health.
  • Get blood tests such as liver function tests, kidney function tests, and heart function tests. This can let your doctor know if a chemotherapy drug is causing any problems so that the medication can be changed.
  • Managing stress.

Plan in advance for side effects

Chemotherapy medications come with their own set of side effects. Ask your doctor about what to expect so that you can plan ahead. For example, if one of the side effects of chemotherapy is infertility, you may decide to preserve your sperm or eggs before starting the treatment. 

You may need to take time off work or arrange for someone to help with your responsibilities at home, as you do not know how severely the chemotherapy will affect you.

Inform your doctor about current drugs or supplements

Drugs or supplements can interact with the chemotherapy medications and affect the way they work in your body. Let your doctor know about any medications you are currently taking before starting treatment.

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Medically Reviewed on 1/27/2022
References
Image Source: iStock Images

Treatment of Breast Cancer Stages I-III: https://www.cancer.org/cancer/breast-cancer/treatment/treatment-of-breast-cancer-by-stage/treatment-of-breast-cancer-stages-i-iii.html

Chemotherapy for Breast Cancer: https://www.cancer.org/cancer/breast-cancer/treatment/chemotherapy-for-breast-cancer.html