(5 of 7)
Eventually, women may be able to forgo surgery entirely. Doctors at the M.D. Anderson Cancer Center at the University of Texas in Houston and the Weill Cornell Center in New York City are experimenting with high-frequency radio waves that can literally cook tumors from the inside. Using ultrasound to guide them, doctors insert a multipronged probe into a tumor. The prongs open up like the spokes of an umbrella and melt malignant cells without burning surrounding breast tissue. So far, the procedure has been performed only on women who were planning to get a mastectomy or lumpectomy anyway. But early results have been encouraging enough that physicians hope to test it as a stand-alone procedure this spring.
One of the drawbacks to minimally invasive surgery, in the eyes of many women, is that it is usually followed by radiation. Currently, doctors shoot high-powered beams across the affected breast five days a week for six or seven weeks. But it has become increasingly clear, particularly with smaller tumors, that if the cancer recurs, it usually does so in the original spot from which the tumor had been removed. By focusing radiation more precisely on the place where the original tumor occurred, says Dr. Silvia Formenti, chairwoman of radiation oncology at New York University School of Medicine, "we think we can make radiation better and easier for the patient."
Taking a page from treatment manuals for prostate cancer, a few doctors have implanted tiny radioactive "seeds" in the breast to ensure that the maximum amount of radiation is delivered near the tumor site. They leave a small, balloon-tipped catheter in the breast after a lumpectomy. The balloon is filled from the outside with the radioactive material for five to 10 minutes twice a day. After five days, both catheter and contents are removed.
Don't have five days to spare? Doctors in the U.S. and Europe think they may be able to deliver all the radiation that's needed while a woman is still on the operating table. In an experiment conducted on 15 women in England, physicians inserted a tiny coil into the cavity created by the removal of a tumor. The bottom of the coil was shielded in lead to protect the heart and lungs, while the breast tissue was stretched around the coil. As the surgical team left the room to avoid exposure, the device delivered a full course of radiation treatment at once. After 25 minutes, the coil was removed. In 18 months of follow-up, none of the breast cancers have recurred.
Unfortunately, some cancers do reappear, sometimes far from their original site. This is where chemotherapy can make a difference. Once again, it's not always clear who will benefit most. A concrete example helps explain:
Many doctors would recommend chemotherapy to a woman whose tumor measures 2 cm across, even if it has shown no sign of spreading to the lymph nodes. Why? There is always the possibility that some cancer cells have already escaped to the rest of the body through the bloodstream.