• Prepare For Your First Visit
• How To Get Here

• Make An Appointment
• Early Detection
• Diagnosis
• Treatment
• Remodelling
• After Surgery

• FAQ
• Wide Excision
• Mastectomy
• Axillary Dissection
• Sentinel Lymph Node Biopsy

Frequently Asked Questions of Treatment

Breast cancer treatment involves not only a breast surgeon like Dr Tan. Medical oncologists (doctors who treat cancer using medication) and radiation oncologists (doctors who treat cancer using x-ray therapy, sometimes also known as Radiotherapists) also participate in the care of breast cancer patients. To give an idea of the role of these specialists, the staff of MammoCare interviewed Dr LS, a senior consultant medical oncologist and Dr LK, a senior consultant radiation oncologist. Excerpts of the interview are reproduced here. Please note that these are not a substitute for a formal consultation, and it would be best to consult an appropriate specialist for more information regarding your unique situation.

Should you wish to be referred to these doctors, kindly apply in person at MammoCare. Thank you.

1: What is the difference between chemotherapy and radiotherapy?

Dr LS - Chemotherapy is an administration of drugs through intravenous injection or orally at times. This is done to try to kill the microscopic tumour that may be left in the body to reduce the chance of tumour recurrence. Radiotherapy is using radiation to kill any tumour cells that may be left behind in the chest wall. Chemotherapy is to reduce the risk of systemic relapse whereas radiotherapy is to reduce the risk of local relapse.

Dr LK - Chemotherapy is mainly for decreasing the risk of distant relapse such as in the liver, lung, bones and brain. Radiation may be required mainly for local control. For those who require chemotherapy, the control rate can still be improved for local metastasis where radiation is tentative.

2: If a patient had mastectomy, does it mean they will not need chemotherapy and radiotherapy?

Dr LS - Chemotherapy is dependant on the actual size of the tumor and how many lymph nodes are involved. Whether the patient has lumpectomy or mastectomy, it probably does not make a difference to their need for chemotherapy. Radiotherapy may make a difference. For example, if a patient has a small tumor less than 5cm and that it does not spread to the lymph node. If they choose mastectomy, they can omit radiotherapy. However, for patient whose tumors are larger, for example, more than 5cm or even if the tumor is small, say 2cm, but they have 5 lymph nodes involved, even though they may have had mastectomy, they would need radiation.

Radiation-Oncologist - The requirement for chemotherapy depends very much on tumor size, nodule status that is also used to address decreasing the risk of distant relapse. When we talk about radiation, it is more for local relapse. Therefore classically, if mastectomy has been offered and if the tumor is small, supposing at the end of surgery, the pathology result comes back, the lymph nodes are negative or only 1 to 3 lymph nodes are involved, the patient will not require radiation. If one elects for mastectomy, it does not guarantee the patient will not require radiation after surgery.

3: For early breast cancer tumor less than 4cm, is survival affected by surgical treatment of the breast? i.e. the difference between mastectomy and breast conservation

Dr LS - If you are talking about survival, there is no difference between mastectomy and lumpectomy. First of all, lumpectomy has to follow by radiation. If the patient chooses not to have radiotherapy after that, then they must have mastectomy. You can only do lumpectomy if the tumour is small enough relative through the breast size. So this is nothing to do with the absolute tumour but rather the size of the tumour in relation to the size of the patient's breast. So, you can even do breast conservation surgery for tumor that is 5cm if patient has a large breast. On the other hand, you could have a patient who has only 3cm tumor and the breast is very small, then it is better to do mastectomy. Secondly, the location of the tumor is very important. Even if the tumor is very small and is right underneath the nipple, then it becomes difficult to conserve. (please note that Dr Mona Tan does not agree with this comment) With all these provisions, then mastectomy and breast conservation plus radiotherapy has the same outcome in terms of survival that has been proven by randomized study.

Dr LK - For tumor less than 3cm or 4cm, despite the absolute size concern, it doesn't really matter breast conserving surgery versus mastectomy, studies has shown there is no overall survival for patient electing one way or other.

4: What in your opinion is the reason for a surgeon offering mastectomy rather than breast conservation for smaller tumors?

Radiation-Oncologist - It must be multifactor, not just the surgeon's point of view, in terms of offering mastectomy, the surgeon will look at the disease itself, patient's preference and the surgeon's skills. Each time a patient has a breast cancer small enough tumors that is possible to be operated with breast conserving in mind, I think this option should be offered and discussed with the patient.

5: Is the final cosmetic result one of these concerns? Why?

Radiation-Oncologist - I would like certainly say so in terms of electing breast conserving surgery, patient would really want to see a very good cosmetic outcome. Therefore, sometimes it can be very challenging for surgeons. Having said that, from our clinical experience, patient either gone through mastectomy or breast conserving surgery, I find that we clinicians are setting ourselves a much higher standard in terms of cosmetic outcome compared to patient's satisfaction of breast conserving surgery.

Consultant Oncologist - The final cosmetic result is of course the concern. For example, I think it would be wrong to try to do lumpectomy if the patient has very small breast and the results are very poor anyway. It's no point for me doing a lumpectomy and get a lot of scarring or the breast itself looks very lopsided. Sometimes, mastectomy does not necessarily give worst cosmetic result.

6: Is it possible to include more patients, or those with larger tumors to do breast conservation treatme1nt?

Radiation-Oncologist - The absolute indication is still 3 to 4cm. (This is another comment that Dr Tan does not agree with - she has done breast conservation successfully with tumours that are more than 4 cm) Women with small breast sizes, a lot of them still qualify for breast conserving surgery. We have seen that their cosmetic outcome can be quite remarkable. Studies have shown that if you do breast conserving surgery followed by radiation, it is as good as part of mastectomy in terms of survival.