Breast cancer patients make up the highest percentage of Kellogg Cancer Center patients, and NorthShore's comprehensive, multidisciplinary breast health program is one of the largest academic multispecialty practices in the state of Illinois.
Research initiatives at NorthShore support a wide range of projects designed to improve cancer prevention, detection and treatment. Our patients benefit from a focus on translational research—bringing the latest findings from the laboratory to our clinical sites daily.
Listen as Dr. Catherine Pesce explains the exciting new technique known as Radioactive Seed Localization Lumpectomy. Helping Doctors in the community better serve you with the latest technologies.
Exciting New Technique In Breast Cancer Surgery
Featured Speaker:
Learn more about Dr. Pesce.
Dr. Catherine Pesce
Dr. Pesce is a surgical oncologist at NorthShore specializing in breast cancer.Learn more about Dr. Pesce.
Transcription:
Exciting New Technique In Breast Cancer Surgery
Melanie Cole (Host): For women diagnosed with breast cancer, the experienced collaborative team of specialists at NorthShore Kellogg Cancer Center and its Center for Breast Health combine the most advanced scientific knowledge and technology with a comprehensive and compassionate approach to breast cancer treatment. My guest today is Dr. Catherine Pesce. She’s a surgical oncologist at NorthShore University Health System specializing in breast cancer. Welcome to the show, Dr. Pesce. After a woman has gotten her diagnosis, that’s a very scary time. Tell them what is next in the line. What do you do with them once they come to see you?
Dr. Catherine Pesce (Guest): Sure. After everyone gets a diagnosis, we always have them see a breast cancer specialist. That person is usually a surgeon. What I do with every patient, as I sit down and I first go over everything that has been done up to that point, including every type of test that they had, which usually includes a mammogram, ultrasound, possibly an MRI, a biopsy, I make sure I know the rest of their medical history. Then I examine the patient, and once the physical exam is over, then I usually have a patient get dressed and we sit in a conference room, and we just go step by step with all of my recommendations from that point on, which usually include, first, surgery, by myself, and then a consultation with a medical oncologist in order to determine what types of additional treatment would be needed after a surgery.
Melanie: In this personalized breast cancer treatment that you provide, when we’re talking about surgery, people think right away, Dr. Pesce, they think mastectomy. They think lumpectomy. There are many different ways that you do breast surgery today, and some of them are less invasive than others. Speak about them.
Dr. Pesce: Correct. For every patient with a diagnosis of breast cancer, there’s essentially two options. There is a lumpectomy versus a mastectomy. Now, a mastectomy means removal of the entire breast, and that’s what we used to do a long time ago on every patient with breast cancer. Even for very small tumors, everyone had a mastectomy. But what we showed with six different clinical trials for breast cancer is that we don’t need to be removing all of the breast, especially in women with an early-stage breast cancer. We can do what’s called s lumpectomy, where we remove just a part of the breast with the tumor. However, after that, you do need to have after-surgery radiation to the breast, and that is done in order to have equal survival as well as nearly equal recurrence risk as those that have that undergo a mastectomy.
Melanie: And as lumpectomies have changed over the years, you do a radioactive seed localization lumpectomy. Speak about what that is and how it differs from what we used to get.
Dr. Pesce: Sure. For example, when a woman comes in with a very small tumor and I say they can have a lumpectomy, if I can feel the mass, then we just go right to the OR and we can remove it that way based on my ability to feel it or palpate it. Now, in a lot of women, thanks to mammogram, we catch cancers at a very early stage where we can’t even feel the mass. Now, when it is so small that I can’t see it or feel it, we need some help to help guide us through the lumpectomy to know exactly what part of the breast needs to be removed. And the standard, classic way we’ve always done that is by something called a wire localization, where truly, a patient comes in before surgery and a wire is placed into the breast and the tip of the wire is right where the tumor is. And I use that wire to help guide me down and find exactly where the tumor is that way. It is not exact. It is a little bit of a guessing game each time as a surgeon as you’re doing that procedure. We get great results. However, what we started doing at NorthShore as a surgery that I’ve implemented is something called a radioactive seed localization, where, instead of a wire, we place a small seed into the breast, right where the tumor is, and that can be placed up to five days before surgery. It doesn’t have to be the exact date of surgery, which also makes that day shorter for them. We do it when it’s convenient for them. And then, in the OR, we have a special probe. It’s a handheld device that when we scan over the breast, it makes a very loud noise right when we’re over the seed, which is in the tumor. And it’s a much more exact and accurate way of removing the tumor. We also have some evidence so far that this is decreasing what’s called our positive margin rate, which means we get all the cancer out in one surgery and to a higher extent, versus with the wire localization, sometimes we have to go back in for a second surgery even to get all of the cancer. So, really, really exciting stuff.
Melanie: That is exciting. And what are women experiencing after? Would you take the seed out then after?
Dr. Pesce: Correct. During the lumpectomy, my job is to get the tumor, which also has a clip in it, usually which was placed at the time of the biopsy, as well as the radioactive seed. Once it’s taken out, we take an x-ray of it while we’re in the OR, and we make sure that those three things are accounted for—the tumor, the clip, as well as the radioactive seed.
Melanie: Now, Dr. Pesce, we hear radioactive seed and people right away think of radiation. Is there any risk to the seed?
Dr. Pesce: Sure, that’s a great question, something I always get asked and is important to go over. The best part of this procedure is while we do say the word “radioactive,” it’s extremely low dose of radiation. You could hold an infant up to your chest and there would be no risk involved whatsoever. This is not a seed which is providing any sort of treatment for breast cancer. A lot of times, people know about radioactive seeds in prostate cancer, and that is actually treating prostate cancer. This is completely different. This is a radioactive isotope which is truly low-dose, and really, it’s only used in there so that we can find the tumor and take it out.
Melanie: And then, after the tumor is out, what is the next step for these patients and their personalized treatment? I understand it’s individual, but then what? How long does it take to recover from this radioactive seed localization? Lumpectomy, and then what’s the next step?
Dr. Pesce: Sure. With this procedure, in general, women can expect to be sore for about two to three days. I usually find about a week after surgery, most women feel great. They’re asking me if they can exercise again, which I take it they’re feeling pretty good. I always bring a patient back in order to check on their incisions, make sure everything’s looking good, as well as at that appointment, they also meet with their medical oncologist. And at that point, we go over all the results once again, and we talk about what further treatment might be necessary. There’s different types of treatments, including radiation, like we talked about. There’s something called hormonal therapy, which is a pill that a patient would take once a day for five years. And then, like most cancers, there is chemotherapy and the decision of whether or not that will be needed.
Melanie: Thank you so much, Dr. Catherine Pesce. And in the last minute or two, tell listeners why they should come to NorthShore University Health System and Kellogg Cancer Center for their breast care health.
Dr. Pesce: I just love NorthShore. It is a wonderful, wonderful, well-run system. For every patient that comes in from the moment that they get their mammogram, to the end day of treatment, they have someone walking them through every step of the process. It’s a very integrative group of physicians, nurses, nurse practitioners, therapists, counselors. It’s just a wonderful group that so many people that are there to support them throughout every step of the process, to know that they will get through this. There’s a bump in the road, but in the end, every patient, our goal is we get them through this and they move on with their life. And that’s what’s so great about NorthShore.
Melanie: Thank you so much. And for more information on the Kellogg Cancer Center and the Center for Breast Health, you can go to northshore.org. That’s northshore.org. You’re listening to NorthShore Health and Wellness. This is Melanie Cole. Thank you so much for listening.
Exciting New Technique In Breast Cancer Surgery
Melanie Cole (Host): For women diagnosed with breast cancer, the experienced collaborative team of specialists at NorthShore Kellogg Cancer Center and its Center for Breast Health combine the most advanced scientific knowledge and technology with a comprehensive and compassionate approach to breast cancer treatment. My guest today is Dr. Catherine Pesce. She’s a surgical oncologist at NorthShore University Health System specializing in breast cancer. Welcome to the show, Dr. Pesce. After a woman has gotten her diagnosis, that’s a very scary time. Tell them what is next in the line. What do you do with them once they come to see you?
Dr. Catherine Pesce (Guest): Sure. After everyone gets a diagnosis, we always have them see a breast cancer specialist. That person is usually a surgeon. What I do with every patient, as I sit down and I first go over everything that has been done up to that point, including every type of test that they had, which usually includes a mammogram, ultrasound, possibly an MRI, a biopsy, I make sure I know the rest of their medical history. Then I examine the patient, and once the physical exam is over, then I usually have a patient get dressed and we sit in a conference room, and we just go step by step with all of my recommendations from that point on, which usually include, first, surgery, by myself, and then a consultation with a medical oncologist in order to determine what types of additional treatment would be needed after a surgery.
Melanie: In this personalized breast cancer treatment that you provide, when we’re talking about surgery, people think right away, Dr. Pesce, they think mastectomy. They think lumpectomy. There are many different ways that you do breast surgery today, and some of them are less invasive than others. Speak about them.
Dr. Pesce: Correct. For every patient with a diagnosis of breast cancer, there’s essentially two options. There is a lumpectomy versus a mastectomy. Now, a mastectomy means removal of the entire breast, and that’s what we used to do a long time ago on every patient with breast cancer. Even for very small tumors, everyone had a mastectomy. But what we showed with six different clinical trials for breast cancer is that we don’t need to be removing all of the breast, especially in women with an early-stage breast cancer. We can do what’s called s lumpectomy, where we remove just a part of the breast with the tumor. However, after that, you do need to have after-surgery radiation to the breast, and that is done in order to have equal survival as well as nearly equal recurrence risk as those that have that undergo a mastectomy.
Melanie: And as lumpectomies have changed over the years, you do a radioactive seed localization lumpectomy. Speak about what that is and how it differs from what we used to get.
Dr. Pesce: Sure. For example, when a woman comes in with a very small tumor and I say they can have a lumpectomy, if I can feel the mass, then we just go right to the OR and we can remove it that way based on my ability to feel it or palpate it. Now, in a lot of women, thanks to mammogram, we catch cancers at a very early stage where we can’t even feel the mass. Now, when it is so small that I can’t see it or feel it, we need some help to help guide us through the lumpectomy to know exactly what part of the breast needs to be removed. And the standard, classic way we’ve always done that is by something called a wire localization, where truly, a patient comes in before surgery and a wire is placed into the breast and the tip of the wire is right where the tumor is. And I use that wire to help guide me down and find exactly where the tumor is that way. It is not exact. It is a little bit of a guessing game each time as a surgeon as you’re doing that procedure. We get great results. However, what we started doing at NorthShore as a surgery that I’ve implemented is something called a radioactive seed localization, where, instead of a wire, we place a small seed into the breast, right where the tumor is, and that can be placed up to five days before surgery. It doesn’t have to be the exact date of surgery, which also makes that day shorter for them. We do it when it’s convenient for them. And then, in the OR, we have a special probe. It’s a handheld device that when we scan over the breast, it makes a very loud noise right when we’re over the seed, which is in the tumor. And it’s a much more exact and accurate way of removing the tumor. We also have some evidence so far that this is decreasing what’s called our positive margin rate, which means we get all the cancer out in one surgery and to a higher extent, versus with the wire localization, sometimes we have to go back in for a second surgery even to get all of the cancer. So, really, really exciting stuff.
Melanie: That is exciting. And what are women experiencing after? Would you take the seed out then after?
Dr. Pesce: Correct. During the lumpectomy, my job is to get the tumor, which also has a clip in it, usually which was placed at the time of the biopsy, as well as the radioactive seed. Once it’s taken out, we take an x-ray of it while we’re in the OR, and we make sure that those three things are accounted for—the tumor, the clip, as well as the radioactive seed.
Melanie: Now, Dr. Pesce, we hear radioactive seed and people right away think of radiation. Is there any risk to the seed?
Dr. Pesce: Sure, that’s a great question, something I always get asked and is important to go over. The best part of this procedure is while we do say the word “radioactive,” it’s extremely low dose of radiation. You could hold an infant up to your chest and there would be no risk involved whatsoever. This is not a seed which is providing any sort of treatment for breast cancer. A lot of times, people know about radioactive seeds in prostate cancer, and that is actually treating prostate cancer. This is completely different. This is a radioactive isotope which is truly low-dose, and really, it’s only used in there so that we can find the tumor and take it out.
Melanie: And then, after the tumor is out, what is the next step for these patients and their personalized treatment? I understand it’s individual, but then what? How long does it take to recover from this radioactive seed localization? Lumpectomy, and then what’s the next step?
Dr. Pesce: Sure. With this procedure, in general, women can expect to be sore for about two to three days. I usually find about a week after surgery, most women feel great. They’re asking me if they can exercise again, which I take it they’re feeling pretty good. I always bring a patient back in order to check on their incisions, make sure everything’s looking good, as well as at that appointment, they also meet with their medical oncologist. And at that point, we go over all the results once again, and we talk about what further treatment might be necessary. There’s different types of treatments, including radiation, like we talked about. There’s something called hormonal therapy, which is a pill that a patient would take once a day for five years. And then, like most cancers, there is chemotherapy and the decision of whether or not that will be needed.
Melanie: Thank you so much, Dr. Catherine Pesce. And in the last minute or two, tell listeners why they should come to NorthShore University Health System and Kellogg Cancer Center for their breast care health.
Dr. Pesce: I just love NorthShore. It is a wonderful, wonderful, well-run system. For every patient that comes in from the moment that they get their mammogram, to the end day of treatment, they have someone walking them through every step of the process. It’s a very integrative group of physicians, nurses, nurse practitioners, therapists, counselors. It’s just a wonderful group that so many people that are there to support them throughout every step of the process, to know that they will get through this. There’s a bump in the road, but in the end, every patient, our goal is we get them through this and they move on with their life. And that’s what’s so great about NorthShore.
Melanie: Thank you so much. And for more information on the Kellogg Cancer Center and the Center for Breast Health, you can go to northshore.org. That’s northshore.org. You’re listening to NorthShore Health and Wellness. This is Melanie Cole. Thank you so much for listening.