Females want to know everything about their choices of treatment which can help them fight the cancer. The stress and anxiety after diagnosis makes it difficult for doctor to ask questions to patient. The best thing is to prepare a question list before being visited. Patients can have a notebook and take note what their doctor says, or they can ask for permission and record the doctor’s voice. Some doctors can ask patient’s family members to particpate in their discussion. Doctor can recommend the patient to consult with a specialist. The specialists of breast cancer treatment are surgeons, medical oncologists and radiational oncologists.
There are many types of treatments available for female which are surgery, chemotherapy, radiation therapy and hormone therapy each of which are explained below.
The most important factor for determination of treatment method is the staging of cancer. There can be more than one method used to treat a patient.
* Local Therapy: Local therapy removes the cancer from a limited (local) area, such as the breast, chest wall and lymph nodes in the underarm area. It also helps ensure the cancer doesn’t come back in that area. Local therapy includes surgery, with or without radiation therapy to the breast and nearby lymph nodes based on the type of your breast cancer and how advanced it is.
Systemic Treatment: Drugs used to treat breast cancer are considered systemic therapies because they can reach cancer cells almost anywhere in the body. They can be given by mouth or put directly into the bloodstream. Depending on the type of breast cancer, different types of drug treatment might be used, including chemotherapy, hormone therapy, targeted drug therapy and immunotherapy.
Surgery:
The most common therapy for breast cancer is surgery. There are many types of surgeries for breast cancer mentioned below.
* Breast Conserving Surgery: (also called a lumpectomy, quadrantectomy, partial mastectomy, or segmental mastectomy) is a surgery in which only the part of the breast containing the cancer is removed. The goal is to remove the cancer as well as some surrounding normal tissue. How much breast is removed depends on where and how big the tumor is, as well as other factors. Lymph nodes may need to be removed which is called lymph node dissection. In order to clean the breast from tumor remains, radiotherapy may get added. This type of surgery is applied in stage 1 and 2 of breast cancer.
* Mastectomy: is a surgery in which the entire breast is removed, including all of the breast tissue and sometimes other nearby tissues. There are several different types of mastectomies. Some women may also get a double mastectomy, in which both breasts are removed.
In stage 1 and 2, breast conserving surgery and radiotherapy together have the same efficiency as mastectomy.
Questions may be asked before operation:
* What type of operations can I think about? What about my lymph nodes? Will they be dissected?
* How will Ifeel my self after operation?
* Do I need to learn how to care myself after operation?
* What will my wounds look like? And where will they appear in?
* Can I have aesthetic surgery at the same time?
* Do I need to have extra exercise to recover my physical ability?
* When can I return back to my normal activities?
* May I talk to someone who has experienced the same operation?
Sentinel Lymph Node Biopsy:
A sentinel lymph node biopsy (SLNB) is a procedure in which the sentinel lymph node is identified, removed, and examined to determine whether cancer cells are present. It is used in people who have already been diagnosed with cancer.
A negative SLNB result suggests that cancer has not yet spread to nearby lymph nodes or other organs. A positive SLNB result indicates that cancer is present in the sentinel lymph node and that it may have spread to other nearby lymph nodes and possibly other organs.
To do so, a surgeon injects a radioactive substance, a blue dye, or both near the tumor. The surgeon then uses a device to detect lymph nodes that contain the radioactive substance or looks for lymph nodes that are stained with the blue dye. Once the sentinel lymph node is located, the surgeon makes a small incision (about 1/2 inch) in the overlying skin and removes the node.
The sentinel node is then checked for the presence of cancer cells by a pathologist. If cancer is found, the surgeon may remove additional lymph nodes, either during the same biopsy procedure or during a follow-up surgical procedure. SLNB may be done on an outpatient basis or may require a short stay in the hospital.
SLNB is usually done at the same time the primary tumor is removed. In some cases the procedure can also be done before or even after (depending on how much the lymphatic vessels have been disrupted) removal of the tumor.
Radiotherapy:
Radiation therapy is a type of cancer treatment that uses beams of intense energy to kill cancer cells. Radiation therapy most often uses X-rays, but protons or other types of energy also can be used.
Mostly radiation therapy for breast cancer is delivered through external radiation. Radiation therapy may be used to treat breast cancer at almost every stage. Radiation therapy is an effective way to reduce your risk of breast cancer recurring after surgery. In addition, it is commonly used to ease the symptoms caused by cancer that has spread to other parts of the body (metastatic breast cancer). Your doctor may recommend radiation after your procedure to kill any cancer cells that might remain. Adding radiation after surgery reduces the risk that cancer will return in the affected breast. After radiotherapy the changes in skin and breast tissue will be removed after 6 to 12 months.
Another way is to place a radioactive material just beside breast inside the breast tissue. Researches about this topic is continuing but the last results can prove that this method has been useful.
There is another method called Mammosite. Your doctor will make a small incision in your breast. An uninflated MammoSite balloon catheter is gently placed inside your lumpectomy cavity. The balloon is filled with saline solution, saltwater, so that it fits snugly in the cavity. A small section of the catheter tube remains outside of your breast. It is secured to a gauze pad to prevent movement. Most women do not experience discomfort during the placement process.
Chemotherapy:
Chemotherapy for breast cancer frequently is used in addition to other treatments, such as surgery, radiation or hormone therapy. Chemotherapy can be used to increase the chance of a cure, decrease the risk of the cancer returning, alleviate symptoms from the cancer or help people with cancer live longer with a better quality of life. If the cancer has recurred or spread, chemotherapy may control the breast cancer to help you live longer. Or it can help ease symptoms the cancer is causing Chemotherapy for breast cancer also carries a risk of side effects some temporary and mild, others more serious or permanent. Your doctor can help you decide whether chemotherapy for breast cancer is a good choice for you.
After you have surgery to remove the breast cancer, your doctor may recommend chemotherapy to destroy any undetected cancer cells and reduce your risk of the cancer recurring. This is known as adjuvant chemotherapy. Your doctor may recommend adjuvant chemotherapy if you have a high risk of the cancer recurring or spreading to other parts of your body (metastasizing), even if there is no evidence of cancer after surgery. You may have a higher risk of metastasis if cancer cells are found in lymph nodes near the affected breast.
Chemotherapy is sometimes given before surgery (known as neoadjuvant therapy or preoperative chemotherapy) to shrink larger cancers. After each period your doctor gives a break. Total time of neoadjuvant chemotherapy is about 3 to 6 months.
Hormon Therapy:
Hormone therapy (also called hormonal therapy, hormone treatment, or endocrine therapy) slows or stops the growth of hormone-sensitive tumors by blocking the body’s ability to produce hormones or by interfering with effects of hormones on breast cancer cells. Tumors that are hormone insensitive do not have hormone receptors and do not respond to hormone therapy.
Hormone therapy for breast cancer should not be confused with menopausal hormone therapy (MHT)—treatment with estrogen alone or in combination with progesterone to help relieve symptoms of menopause. These two types of therapy produce opposite effects: hormone therapy for breast cancer blocks the growth of HR-positive breast cancer, whereas MHT can stimulate the growth of HR-positive breast cancer. For this reason, when a woman taking MHT is diagnosed with HR-positive breast cancer she is usually asked to stop that therapy.
Hormon therapy is applied to:
* Reduce the risk of cancer if you do not have cancer but you are highly at risk.
* Reduce the risk of cancer in your tumor is non-invasive (DCIS)
* Reduce the risk of cancer repeatition after any type of treatment (surgery, chemotherapy, radiationtherapy).
* Cure metastatic cancers.
There are 4 strategies are used to treat hormone-sensitive breast cancer:
- Blocking estrogen production:
Drugs called aromatase inhibitors are used to block the activity of an enzyme called aromatase, which the body uses to make estrogen in the ovaries and in other tissues. Aromatase inhibitors are used primarily in postmenopausal women because the ovaries in premenopausal women produce too much aromatase for the inhibitors to block effectively. However, these drugs can be used in premenopausal women if they are given together with a drug that suppresses ovarian function.
Examples of aromatase inhibitors approved by the FDA are anastrozole (Arimidex) and letrozole (Femara), both of which temporarily inactivate aromatase, and exemestane (Aromasin), which permanently inactivates aromatase.
- SERMs bind to estrogen receptors, preventing estrogen from binding. Examples of SERMs approved by the FDA for treatment of breast cancer are tamoxifen (Nolvadex) and toremifene (Fareston).
- Estrogen receptor downregulators, called ERDs for short, block the effects of estrogen in breast tissue. ERDs work in a similar way to SERMs, such as tamoxifen. ERDs sit in the estrogen receptors in breast cells. If an ERD is in the estrogen receptor, there is no room for estrogen and it can’t attach to the cell. If estrogen isn’t attached to a breast cell, the cell doesn’t receive estrogen’s signals to grow and multiply.
- Blocking ovarian function:
Because the ovaries are the main source of estrogen in premenopausal women, estrogen levels in these women can be reduced by eliminating or suppressing ovarian function. Blocking ovarian function is called ovarian ablation. Ovarian ablation can be done surgically in an operation to remove the ovaries (called oophorectomy) or by treatment with radiation. This type of ovarian ablation is usually permanent.
Biological Therapy:
Targeted therapy, also called biologic therapy, uses the body’s immune system to fight breast cancer cells. That does less harm to healthy cells, so the side effects aren’t usually as bad as from better-known treatments like chemotherapy. One type of targeted therapy uses antibodies to kill cancer cells or block them from growing. Antibodies are a part of the immune system made by special white blood cells. They can be made in a lab and given as medicine.
A gene called HER2 makes too many copies of itself in about 20% of people with breast cancer. If you have that faulty version of the gene, your disease is called “HER2-positive.” If you don’t have the faulty version of the HER2 gene that makes too many copies of itself, your disease is “HER2-negative.” You’ll need different treatments.
Treatment Options by Stage:
* Ratio of tumor size to breast size
* Laboratory test results (e.g. hormon dependence of tumor)
* Menopausal situation
* General health
.
Stage 0:
Cancer in stage 0 can be either ductal carsinoma in situ (DCIS) or lobular carcinoma in situ (LCIS)
* LCIS: In this case, doctor recommends frequent follow-up; however, most of females do not need any other therapy in LCIS case. Observation of LCIS in one breast can increase the risk of cancer in both breast. This is why some females prefer to remove both of their breasts (called bilateral prophylactic mastectomy) as a preventive therapy.
* DCIS: Usually breast conserving surgery following radiotherapy is applied on DCIS patients. Some of them preder total bilateral mastectomy. In this case, generally axillary lymph nodes are not dissected. As a preventive treatment, they can use anti-estrogen drugs.
Stages I, II and IIIA
In these stages, combined therapies is applied on patients for example breast conserving surgery then radiation therapy (espeially stages Iand II). In other stages mastectomy may be required. If the tumor size is big or any cancer cell is detected in axillary ,ymph nodes, mastectomy + radiotherapy can be suggested.
Making a choice between breast conserving surgery and mastectomy depends on many factors:
* Size, location and stage of the tumor
* Size of the breast
* Some specifications of the cancer
* Patient’s feelings about conserving her breast
* Patient’s phobia against radiotherapy
* Patient’s ability of radiotherapy polyclinic.
Some patients recieve radiotherapy before surgery called neoadjuvant radiotherapy. Also neoadjuvant chemotherapy can be applied to decrease the size of tumor before surgery.
After operation, patients recieve radiotherapy or chemotherapy (adjuvant) in order to clean the tumor bed if any cancer cell is remaining.
Stages IIIB and IIIC
In these stages patients usually recieve chemotherapy. If chemotherapy reduces the tumor, doctor can add more therapies such as mastectomy, breast conserving operation with auxillary dissection, or he can apply radiotherpy instead of surgery. They can also prescribe hormone therapy, chemotherapy or both.
Stage IV
In this stage the cancer is metastatic and some therapy techniques can be applied together such as chemotherapy and hormone therapy. Radiotherapy can control the tumors in the specific parts of the body which can make the advancement of the cancer slower. These therapies cannot treat the cancer completely but they can help the patient live longer.