Breast Cancer Treatment

The most important thing to remember about your treatment is not to delay it. After you have done your homework about the tumor type, grade and other characteristics, you will have the information you need to understand the treatment plan recommended by your doctor.

It is important to realize that breast cancer is a wide spectrum of diseases and no comparisons should be made just on the basis that someone you know has "breast cancer" and shares a different treatment approach with youYour treatment plan will likely be based on whether the cancer has traveled into the lymph nodes near your breast, the size of the primary tumor and details of pathology tests such as the tumor grade, which shows how quickly the cancer cells are dividing.

Most treatment plans will include the following options:

SURGERY

Your doctor will likely recommend some type of surgery with the goal of removing the cancer from your breast. Breast cancer surgeries fall into 3 categories: (1) mastectomy and (2) lumpectomy for tumor removal and (3) plastic surgery for reconstruction of the breast after tumor removal.  In some cases, your doctor will recommend that you receive chemotherapy, radiation or hormone therapy to reduce the tumor size prior to undergoing surgery for tumor removal. This is called neoadjuvant therapy. In other cases, your doctor will recommend that you undergo surgical removal of the tumor prior to receiving chemotherapy or radiation. This is called adjuvant therapy.


Your doctor will likely recommend a complete mastectomy (the removal of the entire breast),[1] if:

• You have multiple tumors in the breast
• The cancer is in your skin
• The tumor is in the nipple area
• You had cancer before in the same breast
• You have a large tumor (5cm or larger)
• You have calcifications (calcium deposits) or other abnormal cells over a large area in your breast

 If you have a genetic mutation called BRCA mutation, you may discuss with your doctors the option of removing both breasts.  This procedure is called a bilateral mastectomy.  Depending on where you are in your life and whether you want to have biological children, you also may consider removing your ovaries to reduce your risk of ovarian cancer. Your doctor can help you understand how these decisions impact your treatment and quality of life.

Lumpectomy is one type of breast-conserving surgery which is also referred to as a partial mastectomy. During this outpatient procedure, the surgeon removes the tumor plus a small rim of normal tissue around the tumor, called a margin. As shown below, you will keep most of your breast, and you will have a scar at the incision site.lumpectomy

This type of removal is usually recommended when:

  • You have a single breast cancer tumor less than five  than centimeters in diameter.
  • You have enough tissue so that removing surrounding tissue would not leave a misshapen breast.
  • You are medically able to undergo surgery AND follow-up radiation therapy.

A lumpectomy followed by radiation therapy is often considered the standard therapy for women with breast cancer who meet these criteria. Large studies have shown similar survival rates for both breast conservation with radiation and removal of the whole breast, but a lumpectomy gives a better cosmetic result.[2]

CHEMOTHERAPY

Chemotherapy works by killing cancer cells throughout the body. Sometimes it may be the only cancer treatment needed. Some chemotherapy drugs are given intravenously via tube in the vein. Others may be given by injection or taken by mouth as a pill or liquid. Some types are available as creams that you rub on your skin.

Depending on the type of chemotherapy your doctor suggests, you may need to go to the hospital or an outpatient clinic for chemotherapy. Or you may be able to take your medicine at home. How and when you receive chemotherapy depends on a number of factors, including the medicine, the type of cancer, and your health. Chemotherapy may be given every day, every week, or every month, depending on the situation. For example, you may receive one week of chemotherapy, followed by three weeks of rest. This four-week period is considered a "cycle" of chemotherapy. You may need several cycles of treatment, depending on your condition.

RADIATION

Radiation therapy is usually given after lumpectomy and is sometimes needed after a mastectomy.  Roughly half of all cancer patients need radiotherapy at some time during their illness.  Radiation therapy involves various kinds of radiation treatment techniques. The most common types of radiation therapy are 3-D treatment planning, external beam radiation, IMRT, stereotactic radiosurgery, prostate seed implants, brachytherapy and concurrent chemotherapy and radiation therapy. The oncologist selects the most effective radiation technique, for each particular patient, to destroy abnormal (cancer) cells while sparing the normal surrounding tissue.  Generally, these treatments are not painful as patients cannot see, smell, taste, hear or feel the radiation treatment.

For those with incurable cancers, the treatment helps patients deal with their symptoms. For example, if they have pain in their bones, radiotherapy can be a very useful treatment. Radical treatment is a method used to try and cure patients. Thus radiation oncologists use a mixture of very aggressive treatment for people who have a good chance of being cured, and very simple treatments for people who have incurable cancer but still need treatment and help.

HORMONE THERAPY AND HER2 RECEPTOR THERAPY

There are certain hormones that can attach to breast cancer cells and affect their ability to multiply. The purpose of hormone therapy -- also called hormonal therapy or hormone treatment -- is to add, block, or remove hormones.

With breast cancer, the female hormones, estrogen and progesterone, can promote the growth of some breast cancer cells. A naturally occuring cell protein, called human epidermal growth factor receptor 2 or HER2, also promotes rapid growth of cancer cells.  So in these patients, hormone therapy and/or HER2 therapy is given to block the body's naturally occurring estrogen, progesterone or HER2 and fight the cancer's growth.

There are two types of hormone therapy for breast cancer: (1) drugs that inhibit estrogen and progesterone from promoting breast cancer cell growth and (2) drugs or surgery to turn off the production of hormones from the ovaries.  Drugs targeting HER2+ cancer generally inhibits breast cancer cell growth.  The rate of survivals have increased over the last 20 years.  Much of that improvement has been attributed to the discovery of hormone therapy and HER2+

Do not confuse the term, hormone therapy, that is used for treating breast cancer patients with hormone replacement therapy that is typically used by postmenopausal women. Hormone therapy for cancer treatment stops hormones from getting to breast cancer cells. Hormone therapy for postmenopausal women without cancer -- in the past called "hormone replacement therapy" -- adds more hormones to your body to counter the effects of menopause.

Please note that treatment options are constantly changing.  For the most up-to-date information on treatment options, visit the American Cancer Society's website at www.cancer.org 

REFERENCES
[1] http://breastcancer.about.com/od/treatments/tp/lumpectomy_procedure.html
[2] http://www.webmd.com/breast-cancer/lumpectomyr/lumpectomy-partial-mastectomy
[3] http://www.webmd.com/breast-cancer/hormone-therapy-overview

Last Medical Review: August 2010