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Breast Cancer Treatment


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Breast cancer is a serious medical condition by which no woman would like to be affected. But it occurs women are diagnosed with the disease every single day all over the world. But numerous researches have been conducted for years; better breast cancer treatment options are constantly available. Patients benefit from these treatments which are progressively more effective and customized. 

 

Breast cancer treatment depends on many factors such as the type of tumor and its stage of progression. Women receive treatments which are determined according to the stage of the disease and the nature of their cancer. But five therapeutic techniques are mainly used in breast cancer treatment: surgery, radiation therapy, chemotherapy, hormonal therapy and targeted therapy.


Breast Cancer Surgery

Surgery is often the first and ideal treatment undertaken to treat malignant breast tumors. The surgical therapy is important in order to remove the cancerous tumor, thus stop its progression. Different types of surgeries can be performed to treat cancer patients, but in breast cancer cases the procedure is called mastectomy. The mastectomy can be partial or segmental, part of the breast is removed; or total, the entire breast is removed. lymphadenectomy). The type of mastectomy performed depends on the size of the tumor, its characteristics (aggressive or not) and its location in the breast. The general health status and preference of the patient are also taken into account before a final decision. 

a) Partial Mastectomy or Lumpectomy. In this procedure, the surgeon surgically removes the malignant tumor (cancer) as well as some normal tissue around the tumor to prevent remaining of cancer cells. Unlike total mastectomy, lumpectomy is a breast-conserving surgery. 

b)Total Mastectomy. As the name suggests, this procedure consists of total removal of breast tissues: mammary glands, fat tissue, the nipple and skin. This breast cancer surgery is recommended and performed when it is not possible to perform a partial mastectomy.  Totalmastectomy is done in up to 25% of cases of breast cancer. As appropriate, breast reconstruction may be performed at the same time as the mastectomy or at a later time.

 

c) Lymphadenectomy. Removal of some or all the lymph nodes of the patient is almost always recommended to determine the stage of the disease and to choose the best treatment after the surgery. This surgical procedure is essential to detect if the cancer cells have spread to the lymph nodes in the armpit on the affected side by doing a lab analysis of the sample obtained under-microscope, biopsy.

 

Adverse Effects of The surgery 

Mastectomy can lead to numbness and tenderness due to cutting of nerves during surgery. Accumulation of blood or clear fluid in the wound is common; this causes increased risk of infection. In addition, scar tissue can form and progressively build up in certain patients. Depending of the severity of the scars, breast reconstruction surgery can be required.  

Although helpful, Lymphadenectomy may cause complications such as lymphedema in one arm of the affected side. Lymphedema is an accumulation of lymph caused by damaged or removal of the drainage pathways (lymph vessels). This condition, however, is rare and occurs if only the sentinel node is removed.

   

Breast Cancer Radiation Therapy

 

Partial mastectomy is generally followed by radiation treatment in order to destroy cancer cells that may have remained in the breast. This is important to reduce the risk of recurrence. However, In case of total mastectomy, radiation therapy is not really necessary, given the entire breast tissue is removed. 

 

Intraoperative Radiation

 

Intraoperative radiotherapy is a new cancer treatment that uses electron beams to directly treat a tumor bed or residual tumor during surgery. The therapy is applied especially in breast cancer, although other malignant tumors such as gynecological, urological and neurological cancers can be considered.   

 

Intraoperative radiotherapy offers several advantages over conventional surgery followed by radiotherapy:  

  • The health specialist has a direct view of the tumor bed
  • No further radiotherapy for the patients (eliminating the 3-6 weeks of radiotherapy required the standard therapy);
  • The therapy is administered immediately after removal of the tumor; or at the same time as surgery;
  • optimizing the precision of the irradiation, thus allowing essential organs located in the beam field, such as the lungs and heart, to be better protected. 

Based on a prospective analysis of locoregional control and toxicity with a median of 2 years follow-up, intraoperative breast irradiation by Intrabeam caused no local or remote recurrence. Patients have good tolerance and experience few side effects. However, longer follow-up is needed to confirm these results. 


Breast Radiation Side Effects 


Side effects of the radiation therapy tend to vary from patient to another. Regardless, they are usually less serious than adverse reactions of mastectomy and chemotherapy. Common breast cancer radiation side effects include: burns, nausea and vomiting, hair loss, loss of appetite, and fatigue.

Breast Cancer Chemotherapy

Chemotherapy consists of using a class of medications known as antineoplastics (or anticancer drugs), to treat cancers. Unlike surgery and radiation which are local treatment, chemotherapy is a systematic therapy, the drugs affect the entire body. In breast cancer treatment, the chemo agents are usually administered after surgery to destroy cancer cells that may have escaped from the primary tumor.  The choice of whether to recommend chemotherapy to a breast cancer patient depends on the stage of evolution of the tumor, metastatic or not.
 
Duration of chemotherapy is variable. The pace and duration of the therapy varies according to each cancer, patient and established protocol established during the multidisciplinary team meetings (also known as tumor boards). It usually lasts 6 months for breast cancer. But in case of recurrence of the disease and / or occurrence of metastases, treatment may last longer.

Although some chemotherapy agents are taken in tablet form, most antineoplastic drugs are given intravenously. Before the therapy begins, the surgeon can set up, under local anesthesia in most cases, a central venous catheter, which he introduced under the skin in a deep vein. Injections are made through the skin and into the catheter, thus avoiding repeated injections. To treat breast cancer, the chemotherapy may comprise a single or multiple medications; it can be programmed before surgery (neoadjuvant chemotherapy), or after (adjuvant chemotherapy).

 

Breast Cancer Chemotherapy Side Effects 

 

Thanks to progressive advances in the medical field, chemotherapy side effects greatly reduce in breast cancer treatment. But some adverse reactions still exist and can be difficult to overcome by fragile patients. Severity of the side effects vary according to prescribed medication and protocol. The good news is that most breast cancer chemotherapy side effects are transient, and there are many drugs which can be prescribed to minimize them. 

 

Common breast cancer chemotherapy side effects include nausea and vomiting, hair loss, reduced red and white blood cells and the platelets, cessation or irregular periods in premenopausal women, inflammation and burning of the mouth and throat, skin dryness and sometimes itching, nail discoloration, and diarrhea or constipation

Breast Cancer Hormone Therapy 

 

In the treatment of breast cancer, hormonal therapy is mostly combined with surgery, radiotherapy and/or chemotherapy. It is recommended to women whose the cancer is hormone receptor, its development is stimulated by estrogen (estrogen receptor). Certain drugs can slow or stop the progression of the tumor by blocking the action of the hormone. 

 

Broadly there are 2 types of anti-hormonal drugs: 

1) Antiestrogens – this class of medications works by binding to the surface of cancer cells, receptors normally occupied by estrogens, in order to block the production or utilization of estrogens by the cancerous cells. The most common of the antiestrogens in breast cancer treatment is tamoxifen (Nolvadex-D®). This drug is taken orally in tablet form.  

2) Aromatase Inhibitors - these medications inhibit the production of estrogen by the fatty tissue and the adrenal glands, and they are used only in postmenopausal. Some of the aromatase inhibitors used in the treatment of breast cancer include anastrozole (Arimidex®), letrozole (Femara) and exemestane (Aromasin®).  They are available and taken orally, in tablet form. 

Hormone Therapy Side Effects  


Breast cancer hormone therapy can cause hot flashes and cessation of menstrual cycles. Some drugs may also lead to increased risk of thrombosis, blood clot in the veins.

Breast Cancer Targeted Therapy 

 

Women with invasive breast cancer, cancer cells overexpress the HER2 gene, can be recommended to undergo target therapy. HER2 gene overexpression causes a more rapid growth of the tumor. Breast cancer with this gene amplification can be treated with trastuzumab (Herceptin®), which specifically blocks the action of the HER2 gene. This drug is administered by intravenous injection. 


Targeted Therapy Side Effects  

 

The fact it is more targeted, target therapy usually causes fewer side effects than chemotherapy and hormonal therapy. The main adverse reactions of this treatment arediarrhea, Skin problems, nail problems, and hair depigmentation. Although rare liver damages (hepatitis and elevated liver enzymes) and problems with blood clotting and wound healing can occur.

 

      Stages                                                          Monitoring  

 

 

References:

  1. Cancer/Radiothérapie, Volume 18, Issue 5, Page 614 S. Key, P. Miglierini, O. Miranda, A. Lucia, S. Quillevère, O. Pradier
  2. Clarke M, Collins R, Darby S, et al. Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet 2005;366(9503):2087–106.
  3. Vaidya JS, Wenz F, Bulsara M, et al. Risk-adapted targeted intraoperative radiotherapy versus whole-breast radiotherapy for breast cancer: 5-year results for local control and overall survival from the TARGIT-A randomised trial. Lancet 2013;
  4. Veronesi U, Orecchia R, Maisonneuve P, et al. Intraoperative radiotherapy versus external radiotherapy for early breast cancer (ELIOT): a randomised controlled equivalence trial. Lancet Oncol 2013;
  5. Bartelink H, Horiot JC, Poortmans P, et al. Recurrence rates after treatment of breast cancer with standard radiotherapy with or without additional radiation. N Engl J Med 2001;345(19):1378–87.