Breast Cancer Treatment  

Breast cancer treatment varies depending on the stage or the severity of the tumor at diagnosis. In fact, not only the treatment, even the prognosis depends somehow on the BCSAD (breast cancer stage at diagnosis).  Mostly, 5 types of treatment are used to fight breast cancer: chemotherapy, radiotherapy, hormone therapy, biological therapy and surgery.  

Chemotherapy  

Chemotherapy is a systemic cancer treatment consists of using strong drugs to shrink or completely eliminate the tumor in your breast. The drugs travel your body through the bloodstream to destroy cancer cells. For some breast cancers, chemotherapy is very effective; some breast cancer victims are completely cured from the disease. However, in addition to cancer cells, normal cells are also damaged the chemotherapy, which lead to side effects:

Chemotherapy drugs can be taken by mouth, intravenously or intramuscularly. At first, chemotherapy drugs approved for the adjuvant treatment of breast cancer was a combination of cyclophosphamide (Cytoxan), methotrexate (Trexall, Rheumatrex) and 5-flurouracil (5-FU). In recent years, however, other drugs are added up in the treatment of breast cancer. Among which, there are Adriamycin (doxorubicin) and Taxol (paclitaxel); they seem to bring good results in the fight against breast cancer.  

Radiation therapy (Radioptherapy)  

Radiation therapy is a medical procedure involving the use of x-rays at high energy to kill cancer cells and shrink the tumor. Unlike chemotherapy, which is systematic, radiotherapy delivers a precised dose of radiation to the volume of the tumor, thus, sparing the maximum surrounding healthy tissue possible. Choosing the exact dose (amount of energy that radiation will deposit in the tissues) of radiotherapy is very important. According to many recent studies, under dosing beyond 5% is less effective and increases the risk of recurrence. Therefore, your oncologist will recommend the dose the most capable of fighting the cancer.  

Usually you are administered the therapy 4 or 5 days per week for a period of 5 to 6 weeks consecutively. A session of radiation can last 20 minutes or less. The therapy is painless (does not cause pain), but cause side effects, which may include: 

• fatigue 
• discoloration of the breast 
• red lips
• constipation 
• vomiting and nausea. 

A healthy and well-balanced diet and medicines can be used to remedy those effects.  

During and after the therapies (chemotherapy and radiotherapy), medical surveillance is very important. Some complications especially heart, lung and digestive problems; arm swelling may occur several years after the radiotherapy and chemotherapy. However, with invention of sophisticated and computerized machines, radiotherapy has become less dangerous, and causes less or no side effects. If your doctor thinks it will be helpful, he will recommend an internal radiotherapy (brachytherapy) along with the external radiation therapy 

Brachytherapy 

Also called internal radiotherapy, sealed source radiotherapy or curietherapy, brachytherapy is a type of radiotherapy consists of introducing the radioactive sources inside the breast next or directly in the tumor. Brachytherapy is based on the same principle as radiotherapy; the difference is that radioactive sources are introduced directly into the cancer, which makes this method less destructive to healthy surrounding cells of the treated area. In addition, brachytherapy can only be performed to treat non-metastatic cancers. Two main types of brachytherapy can be used in the treatment of breast cancer:   

Interstitial: during an interstitial brachytherapy, your oncologist will place the radioactive source directly into your breast. The radioactive material can be in the form of plastic tubes, hollow metal needles, seeds or wires.  In general, these materials are placed under the skin of your breast after receiving local, epidural or general anesthesia.  

Endocavitary: this form of radiotherapy consists of placing the radioactive source in natural cavities of the breast affected by the cancer. Endocavitary irradiation therapy allows your doctor to irradiate the tumor while protecting surrounding organs.   

Note: Endocavitary irradiation therapy is in experimental phase; it is not yet approved by the FDA.

Hormone therapy  

In some types of cancers such as breast cancer and prostate cancer, the cancer cells depend on hormones to multiply; these types of cancers are called hormone-dependent cancers. Therefore, to stop the proliferation of the cancerous cells, your doctor may recommend you take drugs capable of blocking hormonal stimulation. Along with chemotherapy or radiotherapy, hormone therapy (HT) is commonly used to fight breast cancer; results vary from one patient to another. In general, hormone therapy is less toxic, and causes fewer side effects than chemotherapy.  

However, this therapy cannot be used in all types of breast cancer. Some young and pre-menopause women sometimes have cancers that are not hormone receptors; the cancer cells are not sensitive to hormone therapy.   

In the treatment of breast cancer, hormone therapy may include two groups of drugs: selective estrogen receptor modulators (SERMs) and aromatase inhibitors. 

Selective estrogen receptor modulators (SERMs): this class of drugs acts by blocking the action of estrogen in breast tissue, thus preventing breast cancer cells to multiply. These drugs act like estrogen on some cells (by stimulating the estrogen receptors), while blocking the effects of estrogen on other cells (by inhibiting the estrogen receptor). SERM has a preventive and curative effect against breast cancer; it kills cancer cells and reverses the growth of the tumor. 

Tamoxifen is one of the SERM which has revolutionized the hormonal treatment of breast cancer. It can be used in the prevention and treatment of breast cancer. Raloxifene is another SERM drug group and has characteristics similar to tamoxifen. However, it has a half-life much shorter than tamoxifen and should be used in higher dose.  

Side effects of s elective estrogen receptor modulators may include:  

• night  sweats 
• water retention 
• weight loss 
• irregular menstrual periods 
• hot flashes 
• vaginal itching, discharge or dryness. 

Older women may experience serious complications such as: 

• bone pain  
• back pain  
• headaches 
• cough 
• high cholesterol
• blood clots  
• endometrial cancer.  

Aromatase inhibitors: aromatase inhibitors are a recent class of drugs used in hormone therapy to treat breast cancer in menopausal women. They act by reducing estrogen levels in the blood of postmenopausal women. They inhibit or inactivate aromatase, an enzyme responsible for the synthesis of estrogens from androgens of adrenal origin. Unlike tamoxifen, users of aromatase inhibitors may experience one negative effect, increased risk of osteoporosis; they generally are well tolerated by most women. The most common aromatase inhibitors are anastrozole (Arimidex), letrozole (Femara) and exemestane (Aromasin).  

Surgical treatment  

Although surgery can lead to pain and other adverse effects, if you have breast cancer, your chance of undergoing surgery to remove the cancer is very high. The type of surgery performed depends greatly on the size of the tumor. Your surgeon may, at the same time, perform an axillary lymph node dissection on the same side as the tumor to determine if the cancer has spread to the lymph nodes. In general, the surgeon will perform one of the following surgical procedures:   

• Lumpectomy : often performed in surgical treatment of breast cancer, lumpectomy is a surgical procedure consists of removing breast tumor (benign or cancerous) and tissue that surrounds it. It is usually followed by radiotherapy to kill cancerous cells remaining in the breast tissue. Your surgeon may also remove some axillary lymph nodes during the lumpectomy. However, there are tumors that cannot be eradicated by lumpectomy: 

1)    large tumor  

2)    cancer deep within the breast 

3)    cancer metastasis (in the same breast) 

4)    Inflammatory breast cancer  

5)    In addition, if you have already had radiation therapy or suffer from a connective tissue disease, lumpectomy may not be appropriate for you.   

Partial mastectomy – also called segmental mastectomy, partial mastectomy involves surgical removal of the tumor along with a large amount of breast tissue and some skin. Depending on the extension of the tumor, your surgeon may also remove a small part of your chest and some lymph nodes. As for lumpectomy, partial mastectomy is often followed by radiation therapy.  

Simple mastectomy – this surgery is more radical than both lumpectomy and partial mastectomy; it involves complete removal of the breast: nipple, areola, lobules, ducts, fatty tissue and skin. A mastectomy may be followed by radiation therapy, chemotherapy or hormone therapy. After surgery, the surgeon may recommend you breast prosthesis until a date when it is possible to consider a reconstruction.  

Modified radical mastectomy: This method is the most performed surgical intervention in the treatment of breast cancer. It involves the removal of the entire breast including the nipple and the skin tissue but without removing the pectoral muscles, which includes pectoralis major muscle and pectoralis minor muscle.  Your surgeon may remove some axillary lymph nodes to determine if the cancer has metastasized.  

Radical mastectomy: this is a total removal of the breast including underlying pectoral muscles and axillary lymph nodes. Your surgeon will perform this operation if the cancer is deep within your breast or if the cancer cells have invaded your chest wall.  

Reconstructive surgery - If you have a mastectomy, it can negatively change your appearance, and causes emotional and social impacts on you. You do need a breast reconstruction to help you overcome those problems. This could be done at the time of the mastectomy or later after the surgery. A breast reconstruction may include reconstruction of your nipple and areola, reconstruction with implants, reconstruction with a tissue flap, or deep inferior epigastric perforator (DIEP) reconstruction. However, not all women can have these operations; talk to your doctor for more details. 

Biological therapy 

Cancer and its treatment often weaken the immune system. Biological therapy, also called biotherapy or immunotherapy, is the use of natural or synthetic substances to stimulate and strengthen the immune system. This therapy can be used to fight cancer or reversing the side effects caused by the treatment. The most commonly used drugs in immunotherapy include:  

Trastuzumab (Herceptin) - This medication is sometimes very effective in fighting breast cancer. It is a monoclonal antibody that reacts against HER2 (Human Epidermal growth factor Receptor 2)-Neu, a protein of which level is aggressively higher in approximately 20% of patients treated for breast cancer. Along with chemotherapy, herceptin can shrink or eliminate the tumor. Trastuzumab is approved by the FDA (Food and Drug Administration) for the treatment of breast cancer.  

Bevacizumab (Avastin) - Avastin is a humanized monoclonal antibody that works by binding to VEGF (vascular endothelial growth factor) and inhibits its binding to its receptor Flt-1 (VEGFR-1) and KDR (VEGFR-2), two chemicals located at the surface of endothelial cells that contribute in the growth of new blood vessels. In a simple term, Avastin inhibits the formation of new blood vessels and prevents them from growing. Being unable to grow, cancer cells end up dying. Avastin is also approved by the U.S. Food and Drug Administration (FDA) in the biological therapy of breast cancer.  

Lapatinib (Tykerb) – in 2007, this drug was approved by the US Food and Drug Administration (FDA)for the treatment of patients with advanced or metastatic breast cancer whose tumors overexpress HER2, and who have received prior therapy including anthracycline, taxane, and herceptin^® .  

      Stages                                                           Prevention