Breast Cancer Treatments
Surgery, Radiation, Chemo Therapy

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Breast Cancer Treatments

Contents

Breast Cancer Treatments Explained
What Are The Surgical Options For Breast Cancer?
When is Radiation Recommended?
When Is Chemotherapy Recommended?
What About Hormonal Therapies?
What Are Targeted Therapies?
How Is Stage 4 Breast Cancer Treated?


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Breast Cancer Guide

Breast Cancer Treatments Explained

Once a woman has had a breast biopsy and received a diagnosis of breast cancer, she will work with her doctor to put a treatment plan together which is specific to her condition and pathology report. The treatment plan will consist of one or more types of treatment to target the cancer in different ways and to reduce the risks of future recurrence. All therapies will be based on a woman's unique situation and she should be prepared to take an active role with her physician in deciding which course of action to take. Periodically those decisions may need to be re-evaluated, and the medical team will be the guide.

Treatment plans may combine any of the following options:

Cancer surgery.
Radiation.
Chemotherapy treatment.
Hormonal therapy (anti-estrogen therapy).
• Targeted therapies (such as Avastin, Herceptin & Tykerb).

A breast cancer diagnosis is rarely ever a medical emergency. Breast cancer is a relatively slow growing disease as cancers go, so there is usually no problem in taking a few weeks to consider your options. There are many informative books and websites to learn about therapies, talk to other women either online or locally who have had breast cancer. Get two or more opinions from breast cancer surgeons before making any final decisions. As women are emotionally vulnerable when they are diagnosed with cancer, many breast cancer centers are now offering several multidisciplinary consultations with a number of different specialists. Staying involved with the process can help make you feel empowered.

Ultimately most women with breast cancer will be faced with two basic decisions:

1. Surgery: How much tissue should be removed? Just the cancerous lump itself (lumpectomy) and a little extra, or a partial section of the breast (partial mastectomy) or the whole breast (total mastectomy)? If the woman chooses to have the lump alone removed then radiation therapy to kill any potential remaining cancer cells will also be required. Women who chose a total mastectomy are usually offered a breast reconstruction.

2. Systemic Therapy: What kind of systemic therapy, if any, will you have? Systemic therapies are used to eradicate cancer cells which may have spread to distant parts of the body. The options here include chemotherapy and hormonal therapy. Some patients may even receive these treatments before surgery with the goal that they will shrink the tumor so that a less extensive operation will be needed. This is known as neoadjuvant therapy.

What Are The Surgical Options For Breast Cancer?

Surgery is usually the first option for breast cancer. The goal of surgery is to remove the original tumor so that it can not send cancerous cells out to invade other parts of the body. It is common for a surgeon to remove some of the surrounding lymph nodes as well. This is usually to done to check the breast cancer staging as evidence of cancer in the lymph nodes means that metastasis has already occurred. The idea that removing lymph nodes may halt the progress of cancer has been discarded. In fact removing too many lymph nodes can cause a condition known as lymphedema, where lymphatic fluid pools under the skin causing inflammation and swelling. To avoid removing nodes unnecessarily many surgeons use a process called sentinel lymph node mapping. This involves injecting a dye before surgery and the first lymph node to take up the dye (known as the sentinel node) is removed for analysis. If cancer is detected further nodes are removed for analysis as well. If no cancer is detected, no other nodes are usually removed. Read also about cancer surgery recovery, to read about the recovery period.

See also, Alternative treatments for cancer: How to aid recovery naturally. Or check out our list of books on breast cancer, including survivor guides.

Lumpectomy & Mastectomy

For most women with stage 1 or 2 cancer the survival rates are similar no matter which type of procedure they chose, a lumpectomy or a mastectomy. Before a woman chooses which procedure she will have, she will need to consider the degree of disfigurement resulting from each operation, side effects, necessary follow up systemic therapy and the peace of mind that comes with removing as much of the cancer stricken breast as possible. The traditional treatment for lobular carcinoma in situ (LCIS) and ductal carcinoma in situ (DCIS) was mastectomy. In the case of lobular carcinoma it was a double mastectomy because if it was found in one breast the risk of developing cancer in the other breast was high. Today however, many surgeons prefer to adopt a watch and wait approach, carefully monitoring the situation with a regular mammogram test. In the case of DCIS a lumpectomy plus radiation, particularly if the tumors are small may be advocated. Nevertheless women with either LCIS or DCIS should realize that anything short of a mastectomy will involve some risk of recurrence. Ultimately the decision is a personal one.

Lumpectomy Pros & Cons

1. The main advantage is that much of the breast can be saved in both appearance and sensation.
2. The procedure is less invasive and recovery time is shorter than with a mastectomy.
3. After surgery, the woman still usually requires 5 to 7 weeks of radiation therapy, 5 days per week to ensure the cancer is gone.
4. Radiation may affect the timing of breast reconstruction and may also affect later options of surgery to lift or balance the breast.
5. There is still some risk of developing a local breast cancer recurrence. If you have a recurrence a mastectomy is usually performed.

Mastectomy Pros & Cons

1. Peace of mind knowing that the entire cancerous breast is removed.
2. The procedure takes much longer than a lumpectomy and recovery time is longer.
3. It does mean the permanent loss of a breast and possible breast reconstruction surgery.

Check: Breast cancer symptoms - Know the signs.

When Is Radiation Used?

Any woman who chooses to remove only the cancerous lump (lumpectomy) will require radiation therapy after surgery. The radiation will be applied locally to the surrounding tissue to ensure that any remaining cancerous cells will be destroyed. Five year recurrence rates for lumpectomy without radiation are around 40 percent, whereas with radiation are only 10 percent. Radiation is also sometimes given after a mastectomy where cancer cells may have spread to nearby tissue. In the case of Stage 4 cancers (incurable) radiation may be given to reduce the size of tumors in the hope of alleviating some pressure, pain and bleeding. Sometimes traditional radiation is supplemented with newer radiation techniques in which slender radioactive tubes are implanted in the breast. These deliver radiation directly to the affected area without damaging surrounding tissues.

If you are interested in experimental options, see:
cancer clinical trials.

When Is Chemotherapy Recommended?

If cancer has spread beyond the breast to lymph nodes or other parts of the body then various options are available to help eradicate those cancer cells. The main ones are chemotherapy (chemo) and hormonal therapy. The trend is to start giving these therapies to women in earlier stages of breast cancer in the hope of preventing the disease spreading. Chemo involves the use of drugs which interfere with the growth of cancer cells. Drugs may be administered for up to 6 months. Generally however chemo is only started after surgery has been completed. The classic form of chemo is known as CMF, to represent the 3 drugs involved (cyclophosphamide, methotrexate and 5-fluorouracil). Side effects can include some hair loss, nausea, weight gain and conjunctivitis. Another combination of drugs used is CA (cyclophosphamide and adriamycin) which is more toxic than CMF. It is better at killing cancerous cells than CMF, but it can also attack the good cells. CA is given in 4 treatments over a period of 3 months but appears as effective as CMF given in 12 treatments over 6 months.

What About Hormonal Therapies?

As female hormones play such an important role in breast cancer, the idea behind hormone therapy for breast cancer is to shift the balance of hormones in such a way as to discourage cancer growth. The most commonly prescribed hormone treatment is the anti-estrogen drug tamoxifen. Tamoxifen (Nolvadex) is prescribed to women who are considered high risk of developing breast cancer (see genetic testing for breast cancer), or those women considered high risk of recurrence after surgery. It belongs to a class of drugs called SERMS (selective estrogen receptor modulators) which work by preventing estrogen from promoting cancer. Taking 1 tamoxifen pill a day seems to give postmenopause women with breast cancer better survival chances. Statistically it seems to prolong life longer in this age group than chemo, although an individual woman may be better opting for chemo. Tamoxifen seems to reduce local recurrences and secondary unrelated cancers developing in the remaining breast tissue. Most women are prescribed the drug for 5 years although studies are still being carried out to determine optimum time. Side effects include increased risk of womb cancer and the occurrence of menopause symptoms such as hot flashes and night sweats. Tamoxifen does not appear to be as successful in treating perimenopause women. Recent studies suggest premenopausal women would be better to consider complete ovary removal, as this is the chief source of estrogen in the body. Another SERM, raloxifene (evista), has fewer years of testing but works in a similar way to tamoxifen. However it seems to pose fewer risks (namely fewer incidences of uterine cancer recorded).

What Are Targeted Therapies?

Targeted cancer therapies (also known as biological therapies) involve treatments which target specific characteristics of cancer cells to prevent them growing. Targeted therapies are less likely to harm normal healthy cells than chemo. Therapies which involve artificial antibodies working like natural ones are known as immune targeted therapies. Currently there are 3 targeted therapies doctors use in treating breast cancer:

Herceptin (trastuzumab): Targets the HER2/neu receptor protein in cancer cells so that they no longer receive the chemical signal to grow.
Tykerb (lapatinib): Also targets the HER2/neu receptor proteins in cancer cells.
Avastin (bevacizumab): Blocks the growth of new blood vessels feeding the cancer cells.

How Is Stage 4 Breast Cancer Treated?

If cancer has progressed beyond the breast and is classified as Stage 4, surgery is often pointless and unnecessary. Removing the original tumor will do little to affect cancer which has spread to other organs. As a result the goal of any treatment at this stage is to reduce symptoms and make the patient as comfortable as possible. In some cases chemo or hormonal therapy may be used to slow down the growth of cancer, particularly in postmenopausal patients. Traditionally stage 4 premenopausal women have been treated by having their ovaries removed but recent studies show that administering tamoxifen may be just as effective. Any treatments will only offer remission for a certain time. On average, a woman with stage 4 cancer responds to chemo for 6 to 8 months and her breast cancer survival rates are very low. She may only live 18 months to 2 years.

Related Questions
What is the best treatment for cancer?
Effects of estrogen: How this hormone works with your body.

  Related Articles on Breast Cancer

For more information see the following:

Breast Self-Examination - How to exam, and how often.
Cancer Treatments - Overview of options.
Breast Cancer Risk Factors - Genetics, smoking & obesity.
Breast Cancer Prevention - Lifestyle adjustments

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