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SYNTHESIS- Logo
A publication  of the UC Davis Cancer Center
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  D E P A R T M E N T S
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"" Breast surgery without the scalpel
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  Past issues
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Current Issue: Fall/Winter 2003
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  DEPARTMENTS
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NONSURGICAL LUMPECTOMY: BREAST SURGERY WITHOUT THE SCALPEL

An investigational technique uses radio waves to treat early breast cancer

 "" PHOTO -- Judy Burke
 
Judy Burke
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When Judy Burke, 51, was offered the chance to participate in a clinical trial that might one day lead to less invasive breast cancer surgery, she didn't hesitate to volunteer. "That's how doctors learn," she says matter-of-factly.

Burke was the first patient at UC Davis Cancer Center to volunteer for a study that is evaluating what may be the next breakthrough in breast cancer surgery — radiofrequency ablation. Sometimes referred to as "nonsurgical lumpectomy," the procedure uses radio wave energy, delivered via a small wand inserted into a tumor, to literally cook cancer cells to death. The procedure offers two potential advantages over current surgical options: A better cosmetic outcome and less destruction of normal breast tissue, allowing for an easier surgical recovery.

"One potential benefit would be a small incision," says Vijay Khatri, the cancer surgeon pioneering the technique at UC Davis Cancer Center. "And you would have to kill only the tumor and a very thin layer of tissue surrounding it. In a lumpectomy, you take out much more tissue. There is also the potential for significantly better cosmetic results."

PHOTO -- Surgeon Vijay Khatri, far right, leads the nonsurgical lumpectomy trial at UC Davis Cancer Center  ""

Surgeon Vijay Khatri, far right, leads the nonsurgical lumpectomy trial at UC Davis Cancer Center.
 
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Thanks to early detection by mammography, breast cancer is increasingly diagnosed when tumors are very small. These cranberry-sized and smaller lumps tend to be good candidates for tissue-conserving surgery — and are also the ones being considered for radiofrequency ablation.

In the operating room, Khatri locates the tumor either by feel or ultrasound. A small incision is made in the skin, just large enough to insert the thin probe. When activated, tiny wires at the probe's tip vibrate rapidly, generating heat by friction. The heat kills all the cells the probe touches, as the surgeon monitors the procedure's progress on an ultrasound screen.

As part of his study, Khatri then removes the burned tumor surgically, sending the tissue to the lab for confirmation that all cancer cells have been killed. So far, results are promising.

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History of breast cancer treatment at a glance

Early 1600s: A special forceps was designed to constrict the base of the breast, allowing the surgeon to more easily amputate it. Enlarged lymph nodes were also removed.

1880: The radical mastectomy was developed, which removed the entire breast, underlying chest muscles and lymph glands in the armpit.

1920s: Radiation was first used to shrink tumors.

1940s: Some doctors favored the modified radical mastectomy, in which the entire breast and lymph nodes were removed but the chest muscles were spared. Others favored a simple mastectomy, involving removal of the breast but not the nodes, followed by radiation to destroy cancer cells in the lymph glands.

1950s: Chemotherapy was used to kill cancer cells that may have spread anywhere in the body.

1965: Surgeons performed partial mastectomies — excising only the tumor, along with a wide margin of healthy tissue.

1985: Publication of a landmark study showed that lumpectomy and radiation resulted in long-term cure rates comparable to those after mastectomy. In a lumpectomy, the surgeon removes the tumor alone along with a narrow margin of surrounding healthy tissue.

Mid-1990s: Sentinel node biopsy allowed surgeons to determine the likelihood of cancer spread and optimal therapy without removing all of the lymph nodes in the armpit.

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After completing the initial study, Khatri and his co-investigator, John McGahan, hope to launch a larger clinical trial that will compare radiofrequency ablation with standard surgical treatments. Patients who volunteer for the study will be randomly selected to undergo either standard surgery or the new procedure. Both groups will be followed over many years, allowing researchers to compare recurrence rates.

Khatri hopes the research will pave the way for nonsurgical lumpectomy to become a stanard surgical option for women with small breast tumors.

For many years, total breast removal was the only choice for women diagnosed with breast cancer. Surgeons thought that taking out as much of the tissue surrounding a tumor as possible gave patients the best chance for a cure.

But breast cancer surgery has become kinder and less invasive over the years — without any sacrifice in survival — thanks to women like Burke, who were willing to take a chance on promising new techniques. The radical mastectomy gave way to the simple mastectomy and lumpectomy, as surgeons demonstrated that less tissue could be removed with equivalent results, especially when surgery is combined with radiation, chemotherapy or both. Today most of the more than 200,000 women diagnosed with breast cancer each year undergo lumpectomy, in which just the tumor and a thin margin of surrounding tissue are removed.

Radiofrequency ablation is the latest technique in this trend. But while the approach is new in breast cancer, surgeons have used it to destroy liver tumors for more than a decade. McGahan was one of the first physicians in the country to use radiofrequency ablation in liver disease. The technique is also finding a place in bone cancer treatment, and is being investigated as a therapy for lung and prostate cancers.

As a patient in Khatri's study, Burke underwent a lumpectomy following the radiofrequency ablation procedure. The resulting disfigurement is mild compared to what breast cancer patients experienced in previous generations. Still, Burke feels some selfconsciousness. To avoid questions and curious stares, she turns her back when she slips in or out of her bathing suit in the swimming pool locker room.

All in all, though, she counts herself lucky. Because of women who took part in clinical trials before her, most of her breast is intact today. And she had an opportunity to play a role in current research that may allow the next generation of breast cancer patients to emerge from their treatment with only a tiny scar.

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  "Breast cancer surgery has become kinder and less invasive over the years, thanks to women like Judy Burke."  
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UC DAVIS CANCER CENTER
4501 X Street
Sacramento, CA 95817

cancer.center@ucdmc.ucdavis.edu

© 2003 UC Regents. All rights reserved.

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