Breast Cancer
Treatment
Women now have more breast cancer treatment options and hope for survival than ever before, thanks to continuing research into new treatment methods. The breast cancer treatment options for each woman depend on the size and location of the tumor in her breast, the results of lab tests (including hormone receptor tests), and the stage (or extent) of the disease. To develop a breast cancer treatment plan to fit each patient's needs, the doctor also considers a woman's age and menopausal status, her general health, and the size of her breasts.
Planning Breast Cancer Treatment
Before starting treatment for breast cancer, a woman with breast cancer may want to get a second opinion about her diagnosis as well as the breast cancer treatment options available. Some insurance companies require a second opinion; others may cover a second opinion if the woman or doctor requests it. It may take time and effort to gather medical records (mammogram films, biopsy slides, pathology report, and proposed treatment plan) and arrange to see another doctor. In general, taking several weeks to get a second opinion does not make breast cancer treatment less effective.
Methods of Breast Cancer Treatment
Methods of treatment for breast cancer are local or systemic. Local breast cancer treatments are used to remove, destroy, or control the cancer cells in a specific area. Surgery and radiation therapy are local treatments. Systemic breast cancer treatments are used to destroy or control cancer cells throughout the body. Chemotherapy and hormonal therapy are systemic treatments. A patient may have just one form of treatment or a combination of breast cancer treatments. Different forms of treatment may be given at the same time or one after another.
Breast cancer surgery is the most common treatment for breast cancer. Several types of surgery may be used. The doctor can explain each of them in detail, discuss and compare the benefits and risks of each type, and describe how each will affect the patient's appearance. An operation to remove the breast (or as much of the breast as possible) is a mastectomy. Breast reconstruction is often an option at the same time as the mastectomy, or later on. An operation to remove the cancer but not the breast is called breast-sparing surgery or breast-conserving surgery. Lumpectomy and segmental mastectomy (also called partial mastectomy) are types of breast-sparing surgery. They usually are followed by radiation therapy to destroy any cancer cells that may remain in the area. In most cases, the surgeon also removes lymph nodes under the arm to help determine whether cancer cells have entered the lymphatic system.
In lumpectomy, the surgeon removes the breast cancer and some normal tissue around it. Often, some of the lymph nodes under the arm are removed.
In segmental mastectomy, the surgeon removes the cancer and a larger area of normal breast tissue around it. Occasionally, some of the lining over the chest muscles below the tumor is removed as well. Some of the lymph nodes under the arm may also be removed.
In total (simple) mastectomy, the surgeon removes the whole breast. Some of the lymph nodes under the arm may also be removed.
In modified radical mastectomy, the surgeon removes the whole breast, most of the lymph nodes under the arm, and often the lining over the chest muscles. The smaller of the two chest muscles is also taken out to help in removing the lymph nodes.
In radical mastectomy (also called Halsted radical mastectomy), the surgeon removes the breast, the chest muscles, all of the lymph nodes under the arm, and some additional fat and skin. For many years, this operation was considered the standard one for women with breast cancer, but it is very rarely used today and only in cases of advanced cancer in which the cancer has spread to the chest muscles.
Breast reconstruction (surgery to rebuild a breast's shape) is often an option after mastectomy. Women considering reconstruction should discuss this with a plastic surgeon before having a mastectomy.
Breast cancer radiation (also called radiotherapy) is the use of high-energy rays to kill cancer cells and stop them from growing. The rays may come from radioactive material outside the body and be directed at the breast by a machine (external radiation). The radiation can also come from radioactive material placed directly in the breast in thin plastic tubes (implant radiation). Some women receive both kinds of radiation therapy.
For external radiation therapy, patients go to the hospital or clinic each day. When this therapy follows breast-sparing surgery, the treatments are given 5 days a week for 5 to 6 weeks. At the end of that time, an extra "boost" of radiation is sometimes given to the place where the tumor was removed. The boost may be either external or internal (using an implant). Patients stay in the hospital for a short time for implant radiation.
Radiation therapy, alone or with chemotherapy or hormone therapy, is sometimes used before surgery to destroy cancer cells and shrink tumors. This approach is most often used in cases in which the breast tumor is large or not easily removed by surgery.
Breast cancer chemotherapy is the use of drugs to kill cancer cells. Chemotherapy for breast cancer is usually a combination of drugs. The drugs may be given by mouth or by injection. Either way, chemotherapy is a systemic breast cancer therapy because the drugs enter the bloodstream and travel throughout the body.
Breast cancer chemotherapy is given in cycles: a treatment period followed by a recovery period, then another treatment, and so on. Most patients have chemotherapy in an outpatient part of the hospital, at the doctor's office, or at home. Depending on which drugs are given and the woman's general health, however, she may need to stay in the hospital during her treatment.
Hormonal therapy for breast cancer keeps cancer cells from getting the natural hormones (estrogen and progesterone) they need to grow. If lab tests show that the breast tumor has hormone receptors, the woman may have hormonal therapy. Like chemotherapy, hormonal therapy can affect cells throughout the body.
This breast cancer treatment may be a medicine or surgery:
Medicine: The doctor may suggest a drug that can block the natural hormone. One example is tamoxifen, which blocks estrogen. Another type (aromatase inhibitor) prevents the body from making the female hormone estradiol, a form of estrogen.
Surgery: If a woman has not gone through menopause, she may have surgery to remove her ovaries. The ovaries are the main source of the body's estrogen. (After menopause, hormone production by the ovaries naturally declines so surgery would not be needed.)
Biological therapy for breast cancer uses the body's natural ability (immune system) to fight cancer. Some women with metastatic breast cancer receive a biological therapy called Herceptin ® (trastuzumab). It is a monoclonal antibody, a substance made in the laboratory that can bind to cancer cells.
Herceptin is given to women whose lab tests show that a breast tumor has too much of a specific protein known as HER2. By blocking HER2, Herceptin can slow or stop the growth of the cancer cells. Herceptin is injected into a vein. It may be given by itself or along with chemotherapy. Like chemotherapy and hormonal therapy, it can affect cancer cells throughout the body.