Patients with breast cancer have many treatment options. Most
treatments are
adjusted specifically to the type of cancer and the staging group.
Treatment options should be discussed with your health care team. Below
you will
find the basic treatment modalities used in the treatment of breast
cancer. Treatment modalities are always changing and developing. It is
important that you discuss the different options with your health care
team.
Surgery
Most women with breast cancer will require surgery. Broadly, the surgical
therapies for breast cancer can be divided into breast conserving surgery and
mastectomy.
Breast-conserving surgery
This surgery will only remove part of the breast (sometimes referred to as
partial mastectomy). The extent of the surgery is determined by the size and
location of the tumor.
In a lumpectomy, only the breast lump and some surrounding tissue are
removed. The surrounding tissue (margins) is inspected for cancer cells. If no cancer
cells are found, this is called "negative" or "clear margins." Frequently,
radiation therapy is given after lumpectomies.
Mastectomy
During a mastectomy (sometimes also referred to as a simple
mastectomy), all
the breast tissue is removed. If immediate reconstruction is considered,
a skin-sparing mastectomy is sometimes performed. In this surgery, all
the breast tissue
is removed as well but the overlying skin is preserved.
Radical mastectomy
During this surgery, the surgeon removes the axillary lymph nodes as well as
the chest wall muscle in addition to the breast. This procedure is done much
less frequently than in the past, as in most cases a modified radical mastectomy
is as effective.
Modified radical mastectomy
This surgery removes the axillary lymph nodes in addition to the breast
tissue.
Depending on the stage of the cancer, your health care team might give you a
choice between a lumpectomy and a mastectomy. Lumpectomy allows sparing of the
breast but usually requires radiation therapy afterward. If lumpectomy is
indicated, long-term follow-up shows no advantage of a mastectomy over the
lumpectomy.
Radiation therapy
Radiation therapy destroys cancer cells with high energy rays. There are two
ways to administer radiation therapy:
External beam radiation
This is the usual way radiation therapy is given for breast cancer. A beam of
radiation is focused onto the affected area by an external machine. The extent
of the treatment is determined by your health care team and is based on the
surgical procedure performed and whether lymph nodes were affected or not.
The local area will usually be marked after the radiation team has determined
the exact location for the treatments. Usually the treatment is given 5 days a
week for 5 to 6 weeks.
Brachytherapy
This form of delivering radiation uses radioactive seeds or pellets. Instead
of a beam from the outside delivering the radiation, these seeds are implanted
into the breast next to the cancer.
Chemotherapy
Chemotherapy
is treatment of cancers with medications that travel through the
bloodstream to the cancer cells. These medications are given either by
intravenous injection or by mouth.
Chemotherapy can have different indications and may be performed in different
settings as follows:
Adjuvant chemotherapy: If surgery has removed all the visible cancer, there is
still the possibility that cancer cells have broken off or are left behind. If
chemotherapy is given to assure that these small amounts of cells are killed as
well, it is called adjunct chemotherapy.
Neoadjuvant chemotherapy: If chemotherapy is given before surgery it is
referred to as neoadjuvant chemotherapy. Although there seems to be no advantage
to long-term survival whether the therapy is given before or after surgery,
there are advantages to see if the cancer responds to the therapy and by
shrinking the cancer before surgical removal.
Chemotherapy for advanced cancer: If the cancer has metastasized to distant
sites in the body, chemotherapy can be used for treatment. In this case, the
health care team will need to determine the most appropriate length of treatment.
There are many different chemotherapeutic agents that are either given alone
or in combination. Usually these drugs are given in cycles with certain
treatment intervals followed by a rest period. The cycle length and rest
intervals differ from drug to drug.
Hormone therapy
This therapy is often used to help reduce the risk of cancer reoccurrence
after surgery, but it can also be used as adjunct treatment.
Estrogen (a hormone produced by the ovaries) promotes the growth of a few
breast cancers, specifically those containing receptors for estrogen (ER
positive) or progesterone (PR positive).
The following drugs are used in
hormone therapy:
Tamoxifen
(Nolvadex): This drug prevents estrogen from binding to estrogen receptors on
breast cells.
Fulvestrant
(Faslodex): This drug eliminates the estrogen receptor and can be used even
if tamoxifen is no longer useful.
Aromatase inhibitors: They stop estrogen production in postmenopausal women.
Examples are
letrozole (Femara),
anastrozole (Arimidex), and
exemestane
(Aromasin).
Targeted therapy
As we are learning more about gene changes and their involvement in causing
cancer, drugs are being developed that specifically target the cancer cells.
They tend to have fewer side effects then chemotherapy (as they target only the
cancer cells) but usually are still used in adjunct with chemotherapy.
Targeting HER2/Neu protein
Monoclonal antibody:
Trastuzumab is an engineered protein that attaches to the
HER2/Neu protein on breast cancer cells. It helps slow the growth of the cancer
cell and may also stimulate the immune system to attack the cancer cell more
effectively.
It is given IV either once a week or every 3 weeks.
Drugs that target new tumor blood vessels
Tumors need new blood vessels to grow. The process of blood vessel growth is
known medically as angiogenesis. New drugs are being developed to target this
growth and fight certain cancers, including breast cancer.
Bevacizumab is a monoclonal antibody directed against blood vessel cells. Newer
study results seem to indicate that this drug slows the cancer growth in some
patients but did not improve survival. The use of this medication should be
discussed with your health care team.
Alternative treatments
Whenever a disease has the potential for much harm and death we search for
alternative treatments. As a patient or the loved one of a patient you want to
try everything and leave no option unexplored. The danger in this approach is
usually found in the fact that the patient might not avail themselves of
existing, proven therapies. You should discuss your interest in alternative
treatments with your health care team and together explore the different options.
