Breast Cancer : In Depth - Deciding on T...
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The good news is that breast cancer can be treated successfully. Treatments include surgery, radiation therapy, chemotherapy, hormonal therapy, or any combination of these. Here's a closer look at each.
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It helps to learn all you can about your disease and treatment choices so that you can take an active part in decisions about your medical care. Discuss these choices with your doctors, nurses, and loved ones. Your doctor is the best person to answer your questions about treatment. Make sure you ask how the treatment will change your daily life and how you will look and feel after treatment.
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Surgery is the most common treatment for breast cancer. Its goal is to remove the cancer from the breast and from any areas where it may have spread.
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Several surgical procedures are used to treat breast cancer. The goal of each is to remove the cancer. Based on medical factors and your own feelings, you and your surgeon will decide which approach may be best for you.
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Sentinel lymph node biopsy is still being studied. Your doctor may suggest it if you have any of these stages of breast cancer.
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Breast-conserving surgery may be right for you if you have any of these stages of cancer.
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If you don't meet the requirements for breast-conserving surgery, you may want to think about a mastectomy. There are 3 main types of mastectomies.
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The decision to have reconstructive breast surgery is a very personal one. It depends a lot on how you think you will feel after a mastectomy. If you think you would feel uncomfortable with a flat chest or wearing a false breast, called a prosthesis, you may want to consider reconstructive surgery. If you don't mind how you'll look or don't want to have any extra surgery, you may not want to do it. Reconstructive surgery can be done at the time of your mastectomy. Or you can schedule it for a later date. You may need more than one operation to complete the reconstruction.
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You may have more than one surgeon depending upon the procedures you're having. You'll meet before surgery to discuss your procedures. At this time, you can talk about any questions or concerns you may have. You may also want to review the risks and possible side effects of surgery. Ask your doctor when you can expect to return to your normal activities and whether the surgery will leave scars. If you haven't scheduled reconstructive surgery, ask about your options.
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If breast cancer spreads, it usually spreads first to the lymph nodes under your arms. The sentinel lymph node is the node it reaches first.
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Before you have breast-conserving surgery, your doctor may want to see if cancer has spread. A sentinel lymph node biopsy removes a specific lymph node from under your arm. If it doesn't have cancer, you may not need surgery. If it does have cancer, you may still need another kind of treatment before surgery.
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Lumpectomy is surgery to remove cancer. It's a breast-conserving surgery, which means your breast remains intact. If you're having a lumpectomy, you'll probably also have radiation therapy.
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What happens during a mastectomy depends on the type you have. Total mastectomy. Your surgeon removes your entire breast. Your underarm lymph nodes and the muscles underneath your breast are left alone.
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How long you stay in the hospital will depend mostly upon your overall health and the type of surgery you had. Your doctors and nurses will explain the side effects you can expect with each form of treatment. They can also suggest ways to help prevent or manage these side effects. It is important that you let the doctor or nurse know if you have side effects. Below is a description of general side effects resulting from breast cancer surgery. They're listed in order of the most common to the least common.
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Mastectomy is surgery to remove the breast. The most commonly done mastectomies are called simple and modified radical. During these procedures, the chest muscle is not removed. As a result, arm strength remains. Keeping the chest muscle also makes reconstruction easier.
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Radiation treatment is also called radiotherapy. It's one way to treat breast cancer. It uses strong X-rays or another source to kill cancer cells. Radiation is a local treatment. That means it affects the cancer cells only in the treated area.
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Your doctor may suggest radiation if you fall into one of the following categories.
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What happens during radiation therapy depends on whether you get EBRT or brachytherapy. EBRT is the more common way to have radiation therapy for breast cancer. This is how it works.
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If you get EBRT, you don't need to worry about being radioactive after your treatments. It's perfectly safe to be around other people. However, if you have brachytherapy, you may be told to avoid certain people who could be sensitive to radiation, such as small children.
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Chemotherapy uses drugs to kill cancer cells. It's a systemic treatment. That means it affects your whole body. The drugs travel all through your body in your bloodstream, killing rapidly dividing cancer cells. Here are some ways chemotherapy works.
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Your doctor may suggest chemotherapy to treat breast cancer for any of the following situations.
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What happens during chemotherapy depends on the type of drug or drugs you take.
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Chemotherapy kills cancer cells, and it also harms healthy cells. That means it often causes unwanted, and sometimes serious, side effects. Ask your oncologist and chemotherapy nurse about each drug's side effects. Everyone doesn't have the same side effects. They depend on the chemotherapy drugs you take and on the drug combinations that are used. Many of these side effects can be controlled and most end during the recovery part of the chemotherapy cycle or after the treatment is done.
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Hormones control the growth and activity of normal, healthy cells. Certain hormones, such as estrogen, can also fuel the growth of some tumors, including breast cancer. About two-thirds of breast cancers are sensitive to estrogen. This means that estrogen's presence causes the tumor to grow.
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Hormone therapy is usually given in addition to another treatment. It's given only if tests show that your cancer depends on hormones to grow. When you get it depends on the stage of your cancer. Here's a list of the stages of cancer that can be treated with hormones and when it would be given.
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Hormones are chemicals your body makes to control the growth and activity of normal cells. Hormones can also speed the growth of some types of cancer. For example, the hormones estrogen and progesterone can stimulate the growth of some breast tumors.
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There are 3 classes of drugs used for hormone therapy. Selective estrogen receptor modulators (SERMs)
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If you have not gone through menopause, you ovaries are your main source of estrogen. They may be taken out by surgery. This surgery is called oophorectomy or ovariectomy. You will get general anesthesia before the surgery so that you'll go to sleep and don't feel anything. The surgeon may do open surgery, which means you'll have a large incision. Or you may be able to have laparoscopic surgery, which means you have smaller incisions. The side effects of surgery and your recovery time depend on which procedure you have done.
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Hormone therapy with drug treatment can cause many side effects. These side effects depend on what kind of drug you're given.
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If tests show that your breast cancer grows in response to estrogen, your doctor may suggest ovarian ablation. Its goal is to reduce the amount of estrogen in your body by stopping your ovaries from making it. You may have your ovaries surgically removed. Or you may have radiation to damage your ovaries. Both procedures cause premature menopause. This means you'll stop having periods. You may have these side effects.
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1. What is tamoxifen? Tamoxifen (Nolvadex®) is a medication in pill form that interferes with the activity of estrogen (a hormone). Tamoxifen has been used for more than 20 years to treat patients with advanced breast cancer. It is used as adjuvant, or additional, therapy following primary treatment for early stage breast cancer. In women at high risk of developing breast cancer, tamoxifen reduces the chance of developing the disease. Tamoxifen continues to be studied for the prevention of breast cancer. It is also being studied in the treatment of several other types of cancer. It is important to note that tamoxifen is also used to treat men with breast cancer.
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Key Points Why was this study done? This trial was done to determine if letrozole (also called Femara®) would reduce the risk of cancer recurrence among women who have completed 4.5 to six years of tamoxifen therapy. (Question 1)
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Aromatase inhibitors are a new type of hormone therapy used to treat breast cancer. These agents are effective in treating breast tumors that are stimulated to grow by the hormone estrogen. They are recommended for women who have gone through menopause.
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A new type of treatment may be used for breast cancer. It's called targeted therapy. It uses molecularly targeted drugs. That means the drugs zone in on the exact change in the cell that lets cancer cells grow and spread. There's a specific kind of targeted drug for breast cancer. These drugs are called monoclonal antibodies. They work by stopping or slowing the growth of a certain protein in cancer cells. For breast cancer, the drug is Herceptin (trastuzumab). Herceptin aims for a protein called HER-2 or erb B2. That stands for human epidermal growth factor receptor-2. About 20 to 30% of breast cancer tumors make too much of this protein. This is called over expression. These tumors tend to grow faster than tumors that don't make too much HER-2. And these tumors are more likely to recur. Treatment with Herceptin can stop or slow the growth of cancer cells.
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Your doctor may suggest targeted therapy if these statements apply to you. You have stage IV breast cancer, and your cancer cells have high levels of the protein HER-2.
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You get Herceptin through an intravenous (IV) injection into your vein. It will take 30 to 90 minutes to get your full dose. You can usually have this done as an outpatient.
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Because Herceptin targets particular cells, it is less damaging to healthy cells than other types of treatment. Compared with chemotherapy, the side effects are mild. This list of side effects is listed alphabetically. Ask your doctor which ones are most likely for you.
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All anticancer drugs target tumors in some way. Most conventional treatments, however, attack healthy cells as well as cancer cells. As a result, there can be serious side effects from the treatment. A new approach to cancer treatment may help reduce side effects. The new treatment is called molecularly targeted therapy. It takes a more direct aim at cancer cells. And that means less damage to healthy cells.
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Herceptin is a monoclonal antibody that attaches to proteins on some cancer cells and slows or stops the growth of the cells (see Question 1).
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For more information, talk to your healthcare team or support network. You and your healthcare provider will discuss your treatment options. Weigh all of your options before deciding which is best for you. Your plan may call for one or more types of adjuvant therapy. These are treatments used in addition to surgery.
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Before you have surgery for breast cancer, your doctor is likely to schedule a bone scan for you. This test can show if the cancer has spread to the bones, called bone metastis.
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