Breast Cancer I 14 Treatment For Breast Cancer

Breast cancer is one of the most striking conditions a woman can have. However, it is also one of the types of cancer with the highest survival rate. It all depends on how early it is diagnosed and how prompt treatment options are started for the patient. The sooner you get diagnosed, the better your prognosis will be. Most people think cancer treatment is just a surgical procedure followed by chemotherapy, but as you will see in this article, there are many different approaches and treatment options according to each type of cancer and its extent.

After diagnosing cancer, your doctor might consider starting one of these treatment options with you:

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Lumpectomy

It is one of the surgical procedures to treat cancer. Lumpectomy is a surgery in which only the tumor is taken out, not the whole breast. The surgeon additionally takes out the surrounding tissue, which is called the margin of the tumor. According to the most recent guidelines, lumpectomy with whole-breast irradiation may be a suitable option for most patients, even in stage II of invasive breast cancer. However, margins should be analyzed, and if there’s a positive involvement that would increase the risk of tumor recurrence.

Post-lumpectomy radiation therapy

Radiation therapy is performed in breast cancer to destroy any trace of cancer cells that may be left after lumpectomy. It reduces the rate of recurrence in 75% of patients, and it is considered a standard of therapy in every stage of the disease, even in low-grade breast cancer, and even if the patient has the best prognosis. There are two types of post-lumpectomy radiation therapy: partial breast radiation and whole breast radiation, and the dosage is also variable, usually administered for 5 days. However, in some cases of low-grade cancer, a single dose of radiotherapy might be the best option after lumpectomy.

Mastectomy

Mastectomy is the surgical procedure to remove the whole breast. It is divided into various types according to the tissue that is removed. A total mastectomy, which is a removal of the entire breast with no removal of muscle tissue and no dissection of axillary nodes. In a modified radical mastectomy, besides removing the breast, the surgeon removes the axillary lymph nodes as well. In a radical mastectomy, whole breast, lymph nodes and chest wall muscles are removed. Of course, the type of mastectomy your doctor chooses depends on the extent of the tumor.

Post-mastectomy radiation therapy

Similar to what we mentioned in the case of lumpectomy; mastectomy is always followed with radiation therapy. After doctors have taken out the tumor, there’s no way to know whether or not there’s a remaining tumor cell that might start to grow and create problems once again. This is why post-mastectomy radiation is a standard of care, especially in tumors larger than 5 centimeters and when 4 or more lymph nodes are taken. Side effects of this type of therapy include breast swelling and pain, skin problems, and fatigue. In some cases, especially after large doses, patients may experience late toxicity that includes fibrosis, pain that lasts for 6 months after treatment, and breast edema.

Adjuvant therapy in ductal carcinoma in situ

Adjuvant therapy is important to treat cancer without any major metastasis but with a possible micrometastatic involvement, which means that metastatic cells might be circulating in the blood without yet creating a visible clue. In carcinoma in situ, the tumor is restrained in only one area, and the patient is a candidate for lumpectomy with radiation therapy. However, 10% of these patients may have a micro-metastasis. Thus, sometimes, your doctor might advice certain drugs such as tamoxifen, raloxifene, or a group of drugs called aromatase inhibitors. In other cases, diet, exercise, and avoiding hormonal treatment might be enough to prevent a recurrence.

Adjuvant therapy in lobar carcinoma in situ

In case of lobar carcinoma in situ, there is no therapeutic benefit after performing an axillary dissection, chemotherapy, or radiotherapy. However, studies have found that there is a 55% reduction in risk when patients use tamoxifen. Thus, patients with lobar carcinoma in situ are sometimes treated with tamoxifen and might need mastectomy in some cases, depending on the size of the tumor.

Lymph node extraction and evaluation

Lymph node involvement is an important data to take in consideration. In some cases, lymph nodes are visibly taken by cancer, but in other cases, there’s no apparent involvement. Even patients with negative involvement of their lymph nodes should get an especial lymph node extracted. This lymph node is called sentinel lymph node, and it is a common place of dissemination of cancer. Evaluation of the lymph nodes prior to surgery is performed through ultrasonography, but magnetic resonance imaging might also be helpful.

Hormonal therapy in breast cancer

In some types of cancer with a positive hormone receptor, studies have shown that chemotherapy leads to higher toxicity levels without extending the lifespan of patients. That is why it is recommended to initiate endocrine therapy instead of chemotherapy. This hormonal manipulation consists of using drug therapy with aromatase inhibitors to reduce the production of estrogens by the enzyme aromatase. Tamoxifen is also used in this hormonal manipulation, as well as luteinizing hormone-releasing hormone in pre-menopausal women.

Chemotherapy in breast cancer

It is probably the most popular treatment, but as you have seen in this article, it is not the only one, and it is definitely not the first-line option in every case of breast cancer. When patients require chemotherapy, it is usually administered with 2 or more agents instead of only one. This is particularly the case of life-threatening disease and severe complications that would have a clinical benefit that is higher than the risks. Sometimes, cytotoxic chemotherapy is combined with a special type of drug called targeted chemotherapeutic agents, but it all depends on the patient, the stage of cancer, and whether or not this patient has a previous history of exposure to the drug.

Poly ADP Ribose Polymerase (PARP) inhibitors

Since January 2018, there’s a new drug called olaparib for breast cancer patients. It is an enzyme inhibitor that works for a type of cancer with a mutation in the BRCA1 or BRCA2 genes. These are tumor suppressor genes, which means that they normally work to prevent cancer cells. A mutation would override their protection and cause trouble. PARP inhibitors suppress an enzyme that prepares DNA previous to cell division. By having this drug around, PARP is not activated, and mutated DNA becomes sensitive to several breaks that ultimately lead to cell death. Thus, it is a drug administered to patients after examining the nature of the tumor and what type of genetic alterations it has.

Treatment of unresectable metastatic breast cancer

When cancer becomes too aggressive and there’s a very large amount of tissue taken and active metastasis, there’s a chance doctors would recommend not removing cancer cells. This is called unresectable metastatic cancer, and it has a very poor prognosis. Even so, it is possible to start a combination therapy with atezolizumab in combination with nab-paclitaxel. The former binds with cancer proteins and helps the immune system clearing off cancer cells. The latter stops the multiplication of cancer cells.

Surgery in metastatic breast cancer

We have mentioned that there’s a type of cancer that should no be removed, especially when a large extension of tissue is taken, and there’s active metastasis. However, there’s still a chance to remove breast cancer after metastasis has started, especially when primary tumors are intact. Thus, it is not always true that metastatic breast cancer is never operated, and you would need to have your case analyzed to see what therapeutic options you still have left.

Prophylactic mastectomy

In some cases, women are at such risk of breast cancer that doctors might suggest a prophylactic mastectomy. It means removing your breasts as a preventative measure to avoid breast cancer. This type of therapy is a suitable option for women with a strong genetic predisposition, known mutations in BRCA genes, and possible mutation of other genes associated with breast cancer. In these cases, patients need to consider all the benefits and risks associated with this intervention, including their psychosocial effects. In most cases, these decisions are made after examining the case with a multidisciplinary team and with breast reconstruction in mind.

Follow up, and rehabilitation

Most breast cancer relapses occur after 3 years of the initial treatment, but how often a patient should be back for a follow up after surviving cancer depends on each case. Recommendations for follow-up include mammography 6 months after therapy and every 6-12 months, depending on the type of cancer and the health status of the patient. Pelvic examination is also part of the follow-up, especially in patients under tamoxifen.

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After surgery, radiotherapy, chemotherapy, and pharmacologic reduction of cancer, most patients require some degree of rehabilitation to improve their quality of life. Shoulder mobility is often impaired and typically improves with physical therapy and exercise. Depression and anxiety, as well as sleep disturbance, are likely to be improved with mindful meditation, yoga, and other relaxation techniques. There are also psychosocial interventions after treatment, and they have very positive effects in reducing mood swings, depression, and related problems.