NCCN Guidelines for Patients® | Stage 0 Breast Cancer - page 28

NCCN Guidelines for Patients
®
Stage 0 Breast Cancer, Version 1.2014
26
3
DCIS
Treatment | Risk reduction
Sentinel lymph node biopsy
A sentinel lymph node biopsy is a surgery that
removes lymph nodes to test for cancer cells. It is
also called a sentinel lymph node dissection. Your
doctor may suggest having this biopsy during the
mastectomy if it would be hard to remove your lymph
nodes, if needed, afterward.
For this biopsy, a radioactive tracer is injected
into your breast. A blue dye is also injected, which
the surgeon can see with his or her naked eye.
The radiotracer and dye drain into lymph vessels
within the breast and then travel to the breast’s
lymph nodes. Most of these nodes are in the armpit
(“axilla”).
The radiotracer and dye allow your surgeon to find
the first few lymph nodes to which lymph travels and
to which the cancer would spread. These first few
nodes are called the sentinel nodes. Often, there
is more than one sentinel node to which the breast
drains. After the dye marks your sentinel node(s),
your surgeon removes it and likely some other nearby
nodes. The nodes are then sent to a pathologist for
testing.
Risk reduction
After treatment for DCIS, some women take steps to
lower their chances of having another breast tumor.
This is called risk reduction. Risk reduction may help
prevent a tumor from growing in either breast. The
three methods of risk reduction are discussed next.
Lifestyle changes
Changes in your lifestyle may reduce your chances
of developing another breast tumor. Examples
are eating more healthfully, exercising more, and
achieving a healthy body weight. Your doctor can
suggest changes in lifestyle that are specific to you.
Hormone therapy
Tamoxifen is a hormone therapy drug. It works by
attaching to estrogen receptors in cancer cells, which
stops the receptors from telling the cells to grow.
Taking tamoxifen for 5 years is one way to reduce
your chances of having another breast tumor within
the breast treated with lumpectomy alone or breast-
conserving therapy. Tamoxifen has been shown to
help if you have hormone receptor–positive DCIS,
but the gain for hormone receptor–negative DCIS
is unknown. Tamoxifen and other hormone therapy
drugs can also be used to prevent tumors in your
breast that wasn’t treated for DCIS.
Although hormone therapy can lower breast cancer
risk, it can cause hot flashes, cataracts, leg cramps,
blood clots, and other cancers depending on the drug.
Talk to your doctor for more information. Your doctor
may also know about research studies of hormone
therapy or other drugs that you can join.
Surgery
The third method of risk reduction is surgery. If you
have hereditary breast cancer, you may want to have
a total mastectomy of your breast that didn’t have
DCIS. Removing all your breast tissue greatly lowers
your chances for breast cancer. Some women have
breast reconstruction afterward. See page 29 for
more information.
Your doctor may suggest that you have a bilateral
salpingo-oophorectomy. This surgery removes
both ovaries and both fallopian tubes. It is only
recommended if you likely have mutations in
BRCA1
and
BRCA2
genes.
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