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Treatments for breast cancerA multidisciplinary team will be involved in a breast cancer patient's treatment. The team may consists of an oncologist, radiologist, specialist cancer surgeon, specialist nurse, pathologist, radiologist, radiographer, and reconstructive surgeon. Sometimes the team may also include an occupational therapist, psychologist, dietitian, and physical therapist.
The team will take into account several factors when deciding on the best treatment for the patient, including:
- The type of breast cancer
- The stage and grade of the breast cancer - how large the tumor is, whether or not it has spread, and if so how far
- Whether or not the cancer cells are sensitive to hormones
- The patient's overall health
- The age of the patient (has she been through the menopause?)
- The patient's own preferences.
- Radiation therapy (radiotherapy)
- Biological therapy (targeted drug therapy)
- Hormone therapy
- Lumpectomy - surgically removing the tumor and a small margin of healthy tissue around it. In breast cancer, this is often called breast-sparing surgery. This type of surgery may be recommended if the tumor is small and the surgeon believes it will be easy to separate from the tissue around it.
- Mastectomy - surgically removing the breast. Simple mastectomy involves removing the lobules, ducts, fatty tissue, nipple, areola, and some skin. Radical mastectomy means also removing muscle of the chest wall and the lymph nodes in the armpit.
- Sentinel node biopsy - one lymph node is surgically removed. If the breast cancer has reached a lymph node it can spread further through the lymphatic system into other parts of the body.
- Axillary lymph node dissection - if the sentinel node was found to have cancer cells, the surgeon may recommend removing several nymph nodes in the armpit.
- Breast reconstruction surgery - a series of surgical procedures aimed at recreating a breast so that it looks as much as possible like the other breast. This procedure may be carried out at the same time as a mastectomy. The surgeon may use a breast implant, or tissue from another part of the patient's body.
Radiation therapy (radiotherapy)
Controlled doses of radiation are targeted at the tumor to destroy the cancer cells. Usually, radiotherapy is used after surgery, as well as chemotherapy to kill off any cancer cells that may still be around. Typically, radiation therapy occurs about one month after surgery or chemotherapy. Each session lasts a few minutes; the patient may require three to five sessions per week for three to six weeks.
The type of breast cancer the woman has will decide what type of radiation therapy she may have to undergo. In some cases, radiotherapy is not needed.
Radiation therapy types include:
- Breast radiation therapy - after a lumpectomy, radiation is administered to the remaining breast tissue
- Chest wall radiation therapy - this is applied after a mastectomy
- Breast boost - a high-dose of radiation therapy is applied to where the tumor was surgically removed. The appearance of the breast may be altered, especially if the patient's breasts are large.
- Lymph nodes radiation therapy - the radiation is aimed at the axilla (armpit) and surrounding area to destroy cancer cells that have reached the lymph nodes
- Breast brachytherapy - scientists at UC San Diego Moores Cancer Center revealed that patients with early-stage breast cancer in the milk ducts which has not spread, seem to benefit from undergoing breast brachytherapy with a strut-based applicator. This 5-day treatment is given to patients after they have undergone lumpectomy surgery. The researchers found that women who received strut-based breast brachytherapy had lower recurrence rates, as well as fewer and less severe side effects.
Medications are used to kill the cancer cells - these are called cytotoxic drugs. The oncologist may recommend chemotherapy if there is a high risk of cancer recurrence, or the cancer spreading elsewhere in the body. This is called adjuvant chemotherapy.
If the tumors are large, chemotherapy may be administered before surgery. The aim is to shrink the tumor, making its removal easier. This is called neo-adjuvant chemotherapy.
Chemotherapy may also be administered if the cancer has metastasized - spread to other parts of the body. Chemotherapy is also useful in reducing some of the symptoms caused by cancer.
Chemotherapy may help stop estrogen production. Estrogen can encourage the growth of some breast cancers.
Side effects of chemotherapy may include nausea, vomiting, loss of appetite, fatigue, sore mouth, hair loss, and a slightly higher susceptibility to infections. Many of these side effects can be controlled with medications the doctor can prescribe. Women over 40 may enter early menopause.
Protecting female fertility - Scientists have designed a way of aggressively attacking cancer with an arsenic-based chemo medication, which is much gentler on the ovaries. The researchers, from Northwestern University Feinberg School of Medicine in Chicago, believe their novel method will help protect the fertility of female patients undergoing cancer treatment.
Hormone therapy (hormone blocking therapy)
Hormone therapy is used for breast cancers that are sensitive to hormones. These types of cancer are often referred to as ER positive (estrogen receptor positive) and PR positive (progesterone receptor positive) cancers. The aim is to prevent cancer recurrence. Hormone blocking therapy is usually used after surgery, but may sometimes be used beforehand to shrink the tumor.
If for health reasons, the patient cannot undergo surgery, chemotherapy or radiotherapy, hormone therapy may be the only treatment she receives.
Hormone therapy will have no effect on cancers that are not sensitive to hormones.
Hormone therapy usually lasts up to five years after surgery.
The following hormone therapy medications may be used:
- Tamoxifen - prevents estrogen from binding to ER-positive cancer cells. Side effects may include changes in periods, hot flashes, weight gain, headaches, nausea, vomiting, fatigue, and aching joints.
- Aromatase inhibitors - this type of medication may be offered to women who have been through the menopause. It blocks aromatase. Aromatase helps estrogen production after the menopause. Before the menopause, a woman's ovaries produce estrogen. Examples of aromatase inhibitors include letrozole, exemestane, and anastrozole. Side effects may include nausea, vomiting, fatigue, skin rashes, headaches, bone pain, aching joints, loss of libido, sweats, and hot flashes. Ovarian ablation or suppression - pre-menopausal women produce estrogen in their ovaries. Ovarian ablation or suppression stop the ovaries from producing estrogen. Ablation is done either through surgery or radiation therapy - the woman's ovaries will never work again, and she will enter the menopause early.
A luteinising hormone-releasing hormone agonist (LHRHa) drug called Goserelin will suppress the ovaries. The patient's periods will stop during treatment, but will start again when she stops taking Goserelin. Women of menopausal age (about 50 years) will probably never start having periods again. Side effects may include mood changes, sleeping problems, sweats, and hot flashes.
Biological treatment (targeted drugs)
- Trastuzumab (Herceptin) - this monoclonal antibody targets and destroys cancer cells that are HER2-positive. Some breast cancer cells produce large amounts of HER2 (growth factor receptor 2); Herceptin targets this protein. Possible side effects may include skin rashes, headaches, and/or heart damage.
- Lapatinib (Tykerb) - this drug targets the HER2 protein. It is also used for the treatment of advanced metastatic breast cancer. Tykerb is used on patients who did not respond well to Herceptin. Side effects include painful hands, painful feet, skin rashes, mouth sores, extreme tiredness, diarrhea, vomiting, and nausea.
- Bevacizumab (Avastin) - stops the cancer cells from attracting new blood vessels, effectively causing the tumor to be starved of nutrients and oxygen. Side effects may include congestive heart failure, hypertension (high blood pressure), kidney damage, heart damage, blood clots, headaches, mouth sores. Although not approved by the FDA for this use, doctors may prescribe it "off-label". Using this drug for breast cancer is controversial. In 2011, the FDA said that Avastin is neither effective nor safe for breast cancer.
- Low dose aspirin - research carried out on laboratory mice and test tubes has suggested that regular low-dose aspirin may halt the growth and spread of breast cancer. Cancer campaigners cautioned that although the current results show great promise, this research is at a very early stage and has yet to be shown to be effective on humans.
Recent developments on breast cancer treatment from MNT news
Triple-negative breast cancer is one of the most aggressive types of breast cancer. It has few treatment options, making the prognosis poor for affected women. But these women may now have a "glimmer of hope," after researchers reveal they have identified a potential drug target for the disease.
A new study published in The New England Journal of Medicine reveals how a genetic test was successful in predicting which patients with early-stage breast cancer are unlikely to benefit from chemotherapy.
A cancer drug duo could one day eliminate the need for chemotherapy for women with HER2-positive breast cancer; in a new study, a combination of two drugs was found to completely eradicate or significantly shrink breast cancer tumors within 11 days of diagnosis.
Personalized treatment for breast cancer could be in sight, after researchers uncovered what they say is the most detailed picture to date of which genetic variations contribute to development of the disease.
Preventing breast cancer
Some lifestyle changes can help significantly reduce a woman's risk of developing breast cancer.
- Alcohol consumption - women who drink in moderation, or do not drink alcohol at all, are less likely to develop breast cancer compared to those who drink large amounts regularly. Moderation means no more than one alcoholic drink per day.
- Physical exercise - exercising five days a week has been shown to reduce a woman's risk of developing breast cancer. Researchers from the University of North Carolina Gillings School of Global Public Health in Chapel Hill reported that physical activity can lower breast cancer risk, whether it be either mild or intense, or before/after menopause. However, considerable weight gain may negate these benefits.
- Diet - some experts say that women who follow a healthy, well-balanced diet may reduce their risk of developing breast cancer. A study published in BMJ (June 2013 issue) found that women who regularly consumed fish and marine n-3 polyunsaturated fatty acids had a 14% lower risk of developing breast cancer, compared to other women. The authors, from Zhejiang University, China, explained that a "regular consumer" should be eating at least 1 or 2 portions of oily fish per week (tuna, salmon, sardines, etc).
- Postmenopausal hormone therapy - limiting hormone therapy may help reduce the risk of developing breast cancer. It is important for the patient to discuss the pros and cons thoroughly with her doctor.
- Bodyweight - women who have a healthy bodyweight have a considerably lower chance of developing breast cancer compared to obese and overweight females.
- Women at high risk of breast cancer - the doctor may recommend estrogen-blocking drugs, including tamoxifen and raloxifene. Tamoxifen may raise the risk of uterine cancer. Preventive surgery is a possible option for women at very high risk.
- Breast cancer screening - patients should discuss with their doctor when to start breast cancer screening exams and tests.
- Breastfeeding - women who breastfeed run a lower risk of developing breast cancer compared to other women. A team of researchers from the University of Granada in Spain reported in the Journal of Clinical Nursing that breastfeeding for at least six months reduces the risk of early breast cancer. This only applies to non-smoking women, the team added. They found that mothers who breastfed for six months or more, if they developed breast cancer, did so on average ten years later than other women.
Recent developments on breast cancer prevention from MNT news
Millions of women worldwide receive combined estrogen and progestin hormone replacement therapy to counter the unwanted effects of menopause. Yet studies are increasingly suggesting the use of such treatment may increase the risk of breast cancer. A new study shows that luteolin, present in vegetables such as celery, could counter this risk.
A study carried out in Spain and published in JAMA supports the theory that the Mediterranean diet, rich in plant foods, fish and olive oil, may reduce the risk of breast cancer.
High intake of fiber-rich foods in adolescence and early adulthood could reduce women's risk for breast cancer. This is the conclusion of a new study published in the journal Pediatrics.
A new study has suggested that obese women could experience a reduction in the risk of breast cancer through the administration of omega-3 fatty acids.
Latest research into breast cancer
Medical News Today is a leading publisher of medical research. All of our latest news about breast cancer can be found in our breast cancer news section.