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Claire Bonneau (Surgeon)
A few weeks ago, Caroline Receveur announced the end of her chemotherapy and more recently, she informed her fans of her mastectomy. But the disease is not behind her yet, cancer cells were found within the mammary gland which was removed. What does that mean ? Explanations from Dr Claire Bonneau, lecturer at Versailles Saint-Quentin University and surgeon at the Institut Curie in Saint-Cloud.
After several cycles of chemotherapy, Caroline Receveur also underwent a mastectomy a few days ago and announces today that “Analyses showed that there were some small cancer cells remaining in the tissue that was removed.” What does that mean ?
Finding cancer cells remaining after chemotherapy at the time of surgery is common
“When a woman is treated for aggressive breast cancer, the most common case is where she receives neo-adjuvant chemotherapy treatment, that is to say before the main treatment which is surgery” begins first with Dr Claire Bonneau, lecturer at Versailles Saint-Quentin University and surgeon at the Institut Curie in Saint-Cloud.
“Depending on the type of cancer, it is possible that a more or less significant remainder – that is to say a few tumor cells – remains in the breast after chemotherapy. It is the role of surgery to remove them.”. This situation ultimately represents a majority of patients.
“It is estimated that for hormone-dependent cancers, women who will see their tumor disappear completely represent only 20 to 30% of cases.” adds the specialist. “For HER2+ or triple negative cancers, the proportion is higher – 60% of cases – but it is still not all.”
An essential tissue analysis for the future
“After chemotherapy treatment, surgery is essential to remove potential persistent tumor cells and to analyze all the tissues collected (breast and lymph nodes) in order to inform us of the sensitivity of the tumor to chemotherapy. In cases where chemotherapy works very well, and there are no longer any cancer cells in the breast, we can legitimately think that there are no longer any circulating alone in the blood.” further details Dr Bonneau.
This is why the study of the surgical piece removed, after the operation, is essential. It helps guide the rest of the treatment. The tissues are analyzed by a pathologist. It can thus provide details on the tumor and its receptors, and determine whether the entire tumor mass has disappeared or whether, on the contrary, tumor cells persist in the removed tissues. These analyzes also make it possible to know if the extent of the resection carried out is sufficient or if new surgery is necessary in the event of insufficient resection…
The objective for the surgeon is, remember, to completely remove the tumor, when possible, by reaching what we call a “healthy margin”. That is to say, a sufficient margin of healthy tissue around the tumor to consider that all of the cancer cells have been removed.
What is the continuation of the support?
However, to avoid any risk of recurrence for patients in whom cancer cells are found after the operation in the operating room, post-surgery chemotherapy will be prescribed.. “This is a treatment by tablets, to be taken once a day or by subcutaneous injections to be given once a month. Patients are treated for a year” indicates the specialist. However, it is a tolerated treatment with few side effects and is much lighter and more bearable than chemotherapy. “It is a preventive treatment, much better tolerated with few side effects and which does not cause alopecia“. With this treatment, the chances of recovery are enhanced.
In the second case, where cancer cells remain at the time of surgery due to insufficient resection of the tumor (when a lumpectomy is performed, rather than a mastectomy), a new surgery is necessary. The choice between a new partial excision of the mammary gland or a total mastectomy will be “function of the volume of remaining mammary gland and the extent of residual damage on the analyzes” concludes Dr. Bonneau.