Breast Cancer

with Antonios Christou, M.D., Medical Oncologist, Advanced Healthcare

Posted: July 1, 2005

You’ve just found out that you have breast cancer. Or perhaps you’ve been diagnosed, treated and the surgeon has given you the best possible news — the cancer was removed, and there’s no evidence that it’s spread. What, if any, next steps should be taken?

In both situations, one of the persons qualified to help patients make informed decisions is a medical oncologist, who is an internist and an oncologist.

“Many patients undergo the whole process of breast cancer diagnosis and treatment, but don’t understand why they need to continue with a medical oncologist if they already had surgery, the surgeon got it out and everything looks fine,” said Dr. Antonios Christou, a medical oncologist at Advanced Healthcare who specializes in treating breast cancer patients.

Antonios Christou, M.D., Medical Oncologist, Advanced Healthcare "The major role of surgery and radiation therapy is elimination of the localized tumor and the chance of local relapse which is the first and crucial step toward a cure. The medical oncologist addresses the second component of breast cancer, which has to do with the risk of breast cancer to relapse in distant parts of the body."

Diagnosing breast cancer
A patient generally discovers she — and in some cases he — has breast cancer during a breast self-exam, an annual mammogram or doctor’s visit. An abnormal lump, area of thickening or dimple can be an indicator of the disease, but no matter what the abnormality is, the first step is a biopsy.

Most abnormalities in breast tissue should be biopsied, said Dr. Christou. A needle may be inserted into the breast to remove cells in the affected area, or a small piece of the tissue may be removed using more traditional surgical instruments or other techniques. The cells or tissue are then examined under a microscope for cancer cells and other specialized tests are done.

While many abnormalities turn out to be benign, any tissue that is cancerous requires immediate treatment by a surgeon. Most patients see the medical oncologist after surgery, when the first of two components of the disease has been addressed.

“Breast cancer has two components,” Dr. Christou said, “the localized component and the systemic component. The localized component is excellently taken care of by the surgeon and, if necessary, the radiation oncologist.”

Treatment
Depending on the extent of the tumor, the surgeon may remove a lump from the breast, the entire breast, or the breast and surrounding lymph nodes. Some patients, particularly those who have lumpectomies, also will receive radiation therapy. All these treatment modalities, said Dr. Christou, address the local care component of the cancer with which the long process for cure starts.

He enters the picture post-surgery, addressing the systemic component of the disease. As a result, he focuses on the entire body as a potential site for cancer relapse or recurrence.

“The major role of surgery and radiation therapy is elimination of the localized tumor and the chance of local relapse which is the first and crucial step toward a cure,” he said. “The role of the medical oncologist addresses the second component of breast cancer, which has to do with the risk of breast cancer to relapse in distant parts of the body.”

Some sites are the bones, lungs or liver. Different types of breast cancer carry different risks for relapse, each with their own time frame and likely location. Some can occur as far in the future as 15 or 20 years after the initial diagnosis, but most, he said, happen within two to five years.

For that reason, Dr. Christou recommended that patients see a medical oncologist as soon as possible after diagnosis.

“Even if it’s only to hear me say after surgery that you need nothing from my viewpoint, you’re almost cured based on the information I have. Your surgeon did a great job and you’re fine,” he said. “That is a great boost for a patient.”

To be able to make that determination, or recommend further treatment immediately after surgery and/or radiation, Dr. Christou said he relies on two things.

“I evaluate the findings of the pathology report, evaluate the overall health of the patient and come up with an estimate of the risk, which is different for each patient,” he said.

New analysis techniques
A range of statistical tools is used to determine the estimate for each patient. Although far from perfect, he said, they are currently the best available. That, however, is expected to change within the next one to two years.

“There’s going to be a revolution in the field,” Dr. Christou said, “because the estimate will be based on what we refer to as a genetic fingerprint of the tumor. That means the estimate will be based on changes that occurred in certain genes and participated in the cause of cancer.”

While not foolproof by any means, Dr. Christou said the new analysis techniques would be more individualized and accurate than current tools. Additionally, they would help doctors to determine which patients would benefit from specific therapies.

That’s important, he said, because currently a large number of patients fall into the “gray zone.” In other words, it’s impossible to determine conclusively whether or not they would benefit from chemotherapy, which is toxic and not always effective in every patient who has it.

“This new test will be helpful to let us know who will and who will not respond to available tools in a much better way than we can know now,” he said.

Antonios Christou, M.D.
Advanced Healthcare - East Mequon Clinic
12203 N. Corporate Pkwy
Mequon, Wis.
262-387-8200

Advanced Healthcare - Good Hope Clinic
3003 West Good Hope Rd.
Milwaukee, Wis.
414-352-3100

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