Breast Cancer Treatments
The best chance for successful treatment is to find breast cancer early. Treatment
options include surgery, chemotherapy and radiation. Breast cancer is treated in two ways,
locally to eliminate tumor cells from the breast
by surgery and radiation, and to systemically destroy cancer cells that have traveled to
other parts of the body. Systemic therapy includes the use of drugs in chemotherapy and
hormonal treatments to reduce the amount of estrogen circulating in the blood.
Summery of breast cancer treatments
- Surgery may consist only of breast lump removal (lumpectomy), or partial, total, or
radical mastectomy, usually with the removal of one or more lymph nodes from the axilla
(armpit). Special procedures to find the most likely lymph nodes to which cancer may have
spread (sentinel nodes) are often used.
- Radiation therapy can be directed at the tumor, the breast, the chest wall, or other
tissues known or suspected to have remaining cancer cells.
- Chemotherapy is used to help eliminate cancer cells that may still remain in the breast
or that may have already spread to other parts of the body.
- Hormonal therapy with tamoxifen is used to block the effects of estrogen that may
otherwise help breast cancer cells to survive and grow. Most women with breast cancers
which express estrogen or progesterone on their surface benefit from treatment with
tamoxifen. A new class of medicines called aromatase inhibitors, such as Aromasin, have
been shown to be as good or possibly even better than tamoxifen in women with stage IV
breast cancer.
Breast Cancer Treatments: Surgery
The extent of surgery depends on the type of breast cancer, whether the disease has
spread, and the patient's age and health. If the tumor is less than about 1.6 inches or
there isn't much chance it will return, the patient and doctor may opt for removal of the
tumor alone (lumpectomy) followed by radiation therapy.
Studies have shown that conservative treatment (a lumpectomy or partial mastectomy)
offers the same odds of survival as does removal of the entire breast (total mastectomy)
in someone with a small breast tumor that has not spread into the nearby lymph nodes. New
studies suggest that after lumpectomy, a combination of chemotherapy and radiation offers
the best chance of long-term survival.
If the tumor is larger, a total (or simple) mastectomy may be needed. If the cancer has
spread to the chest muscles, most doctors believe a radical mastectomy is the best
solution. This operation is now used only when the cancer has spread to the chest muscle.
In a lumpectomy, the doctor removes:
- The lump
- Some of the tissue around it
- Some of the lymph nodes under the arm may be removed (auxillary dissection) and tested
to see if the cancer has spread there.
Even if no cancer is found in the nodes, radiation always follows lumpectomy and
treatment may include chemotherapy.
In a modified radical mastectomy, the doctor removes:
- The entire breast
- The underarm lymph nodes
- The lining over the chest muscle (but not the muscles themselves).
A radical mastectomy is almost never done, but if necessary the doctor removes:
- The breast
- The chest muscles
- All of the lymph nodes under the arm.
Surgery can be combined with breast reconstruction (creating a new breast-shaped
mound), either right away or later on. Patients who want breast reconstruction should tell
the doctor before surgery, since this could change the way the surgeon operates.
Removing the tumor and a border of normal tissue around it will remove the cancer while
saving most of the breast tissue. However, the longer a tumor has been growing in the
breast, the more likely it will be that the cancer cells have spread to the lymph nodes.
These nodes under the arm or in the chest are a common place for breast cancer cells to
spread. During surgery, some of the nodes are removed to check for cancer cells.
The presence of cancer cells in the lymph nodes may require more extensive surgery. If
the cancer has spread to the nodes, the patient will need either radiation, chemotherapy,
hormone therapy, or a combination of all three after surgery. This is called
"adjuvant therapy."
Breast Cancer Treatments: Radiation
Once the cancer has been removed, the doctor may recommend radiation to destroy or
shrink any remaining breast cancer cells. Radiation stops the cancer cells from dividing.
It works especially well on fast-growing tumors. Unfortunately, it also stops some types
of healthy cells from dividing. Healthy cells that divide quickly, like those of the skin
and hair, are affected the most. This is why radiation can cause fatigue, skin problems,
and hair loss.
Breast Cancer Treatments: Chemotherapy
Breast cancer surgery may be followed by chemotherapy in even the earliest stages.
Chemotherapy is administered either orally or by injection into a blood vessel. It is
usually given in cycles, followed by a period of time for recovery, followed by another
course of drugs. Treatment time may range between four to nine months.
There may be significant side effects with some types of chemotherapy, including nausea
and vomiting, temporarily hair loss, mouth or vaginal sores, fatigue, weakened immune
system, and infertility. However, chemotherapy for early breast cancer uses medications
that cause few side effects.
Breast Cancer Treatments: Hormone therapy
The growth of some breast cancer cells may be slowed by the drug tamoxifen. Given each
day as a pill, tamoxifen travels throughout the bloodstream, affecting all cells in the
body. Tamoxifen treatment lasts at least two years, and often as long as five. Research
suggests that tamoxifen may lower the chance that a breast cancer can return by between
25% and 35%.
Side effects of tamoxifen may include a slightly higher risk of cancer of the lining of
the uterus (endometrial cancer). The risk increases if the drug is taken for more than
five years. Other side effects include menopause-like symptoms like weight gain, hot
flashes, and mood swings.
Other possible hormone treatments include the use of progestins, estrogens, and
androgens. In rare cases, the surgeon may suggest removal of the ovaries (oophorectomy) in
pre-menopausal women as a way of eliminating the main source of estrogen, which can boost
the growth of some breast tumors.
Breast Cancer Treatments: Stem cell treatment
Stem cell treatment is used to treat advanced breast cancer. By first removing a
woman's stem cells from her bone marrow or blood, the doctor can use very high doses of
chemotherapy or radiation to kill cancer cells. Because this also kills healthy white
blood cells, leaving the woman vulnerable to infection, the stem cells are then replaced,
where they restore the body's ability to fight infection.
Expectations of breast cancer treatments
The clinical stage of breast cancer is the best indicator for
prognosis (probable outcome), in addition to some other factors. Five-year survival rates
for individuals with breast cancer who receive appropriate treatment are approximately:
- 95% for stage 0
- 88% for stage I
- 66% for stage II
- 36% for stage III
- 7% for stage IV
The axillary (armpit) lymph nodes are the main passageway that breast cancer cells must
use to reach the rest of the body. Their involvement at any time strongly affects the
prognosis.
Chemotherapy and hormone therapy can improve prognosis in all patients and increase the
likelihood of cure in patients with stage I, II, and III disease.
Complications of breast cancer treatments
Even with aggressive and appropriate treatments, breast cancer
often spreads (metastasizes) to other parts of the body such as the lungs, liver and
bones. The recurrence rate is about 5% after total mastectomy and
removing armpit lymph nodes when the nodes are found not to have cancer. The recurrence
rate is 25% in those with similar treatment when the nodes have cancer.
Other complications can be the result of surgery, altered drainage of the lymph from the
arm, radiation changes and treatment with chemotherapy and tamoxifen. But the results of
delaying or avoiding early detection and treatment of breast cancer are far more
distressing and often deadly. |