Breast Cancer

Compassionate and Multidisciplinary Care
Range of Treatment Options
Participation in Clinical Trials
New Treatments for Metastatic Cancers
State-of-the-Art Reconstructive Surgery
Facility Dedicated to Breast Care

Compassionate and Multidisciplinary Care
When patients come to the Siteman Cancer Center for treatment of breast cancer, they are seen by a team of experts – medical oncologists, radiation oncologists, surgeons and a health psychologist – all of whom come to the examining room. They receive a follow-up letter from these specialists summarizing treatment recommendations.

Experienced nurses then spend time with patients, answering their questions and putting them in touch with resources that may help during this stressful time. These nurses offer patients literature and videotapes on benign breast diseases, breast cancer, surgery, chemotherapy, radiation therapy and other related issues. In addition, Internet access is available. As a unique feature of our care, we also offer the services of a psychologist or psychiatrist if needed.

Range of Treatment Options
Our team of specialists treats breast cancer with surgery, radiation therapy, chemotherapy and hormone therapy. These approaches may be used individually or in combination.

Surgery – the removal of all or part of the breast tissue – is the most common procedure used to treat breast cancer. Radiation therapy, either from beams outside the body (external radiation) or through thin plastic tubes filled with radioactive materials that are placed temporarily in the breast (internal radiation), also is used to kill cancer cells and shrink tumors. Another form of treatment is chemotherapy, drugs given by mouth or intravenously to kill cancer cells. Finally, hormone therapy may be used if the cancer cells are sensitive to the hormones estrogen or progesterone.

Participation in Clinical Trials
Our breast cancer physicians are actively involved in clinical trials that investigate new surgical procedures, chemotherapy regimens and vaccines. Women who wish to pursue therapies that are as good as – or potentially better than – current standard therapies should consider participating in these trials.

For instance, our breast cancer surgeons completed a trial of sentinel lymph node mapping. In some women, this technique has replaced a routine part of breast cancer surgery known as axillary dissection, in which a surgeon removes a cluster of lymph nodes from under the arm near the cancerous breast to see whether the cancer has spread there. Using this new lymphatic mapping technique, our physicians instead identify a signaling or “sentinel” lymph node in the cluster of nodes from under the arm. Only the sentinel lymph node is then removed for cancer evaluation.

Biological therapy, sometimes called immunotherapy, is a treatment that uses materials made by the patient’s own body or in a laboratory to stimulate the immune system to fight disease. Siteman researchers are now participating in clinical trials to test this form of therapy.

New Treatments for Metastatic Cancers
Several new drugs that have emerged from clinical trials offer promise in treating metastatic breast cancer, or cancer that has spread to other parts of the body. Siteman physicians were at the heart of this research, conducting studies on some of these new treatment options. One of them is an antibody called Herceptin, which recognizes and attacks the HER2 protein found in a third of all breast cancers. While it cannot cure metastatic disease, it does overcome drug resistance and has few, if any, side effects.

A novel vaccine study under way at Siteman and two other centers is aimed at slowing the progress of metastatic breast cancer. Researchers at these three institutions are looking at MUC-1, a protein that is overexpressed on breast cancer cells and in many other cancers. By producing a double antibody and containing it in a vaccine, they hope to stimulate the patient's immune system to respond strongly and produce both antibodies and T-cells, which would cause a regression of the cancer.

State-of-the-Art Reconstructive Surgery
Plastic and reconstructive surgeons are an important part of the breast cancer team at Siteman. These surgeons work closely with oncologic surgeons, surgeons who remove breast cancer, to provide the best reconstructive outcome for patients.

Patients who undergo mastectomy to remove cancerous breast tissue have four reconstruction options. First is to forgo reconstruction. Second is to choose tissue-expansion surgery, followed later by placement of a permanent breast implant. Third is breast reconstruction using muscle, skin and fat from the back.

The fourth option, often the best, is total reconstruction with a TRAM flap, using muscle, skin and fat from the lower abdomen. During the cancer surgery, the oncologic surgeon performs a skin-sparing mastectomy, preserving the breast’s skin envelope. Then the plastic and reconstructive surgeon fills the envelope with the TRAM flap, which assumes the shape of the breast envelope and produces an excellent, natural-looking result.

Facility Dedicated to Breast Care
The Joanne Knight Breast Health Center, located on the fifth floor of the Center for Advanced Medicine on Siteman’s main campus, is a facility in which a team of physicians and support personnel provide comprehensive diagnosis and treatment for all diseases of the breast, including breast cancer. The center includes screening and diagnostic mammography services, exam rooms, and educational and support services. This approach to care ensures that all patients receive coordinated, convenient services that address their medical and emotional needs.

In addition, breast cancer care is available at Siteman's west county location near the campus of Barnes-Jewish West County Hospital in Creve Coeur.