Treatments for Breast Cancer


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Treatment list for Breast Cancer: The list of treatments mentioned in various sources for Breast Cancer includes the following list. Always seek professional medical advice about any treatment or change in treatment plans.

  • Local therapy
  • Systemic therapy
  • Chemotherapy
  • Tamoxifen - used to interfere with estrogen for tumors that require estrogen.
  • Radiation therapy
  • Hormone therapy
    • Hormone inhibition medications
    • Surgical ovary removal
  • Biological therapy
    • Herceptin® (trastuzumab) - a monoclonal antibody blocking HER-2.
  • Surgery
    • Lumpectomy
    • Lumpectomy with radiation combination
    • Surgical biopsy - sometimes a biopsy is combined with a lumpectomy.
    • Segmental mastectomy - remove a part of the breast.
    • Radical mastectomy - also "Halsted radical mastectomy"; removal of breast, chest muscles, underam lymph nodes, and other skin or fat; now rarely used unless cancer has spread to chest muscles.
    • Modified radical mastectomy - removal of breast, underarm lymph nodes and often chest muscle lining (but not the actual muscles).
    • Simple mastectomy
    • Subcutaneous mastectomy - nipple-saving mastectomy
    • Axillary lymph node dissection - surgical underarm lymph node removal
    • Breast reconstruction surgery - because of mastectomy; often done with the mastectomy; can also be done later.
  • Adjuvant therapy - getting additional chemotherapy or hormone therapy after surgery or radiation.
  • Neoadjuvant therapy - additional chemotherapy or hormone therapy before surgery or radiation.
  • Breast prosthesis - an alternative to breast reconstruction surgery after mastectomy.

Treatment of Breast Cancer: medical news summaries: The following medical news items are relevant to treatment of Breast Cancer:

Treatments of Breast Cancer discussion: There are treatments for all patients with breast cancer. Four types of treatment are used: surgery (taking out the cancer in an operation), radiation therapy (using high-dose x-rays to kill cancer cells), chemotherapy (using drugs to kill cancer cells), and hormone therapy (using hormones to stop the cells from growing). Biological therapy (using your body’s immune system to fight cancer) and bone marrow transplantation are now being tested in clinical trials. Several treatments may be combined, and specific treatment recommendations depend on the type and location of the tumor, the stage at which it has been detected, and the patient’s age and general health.1

Most women who are newly diagnosed with early-stage breast cancer have a choice: breast-conserving surgery (such as lumpectomy) or a mastectomy (also called a modified radical mastectomy). The decision is not between your breast and your life. Women with early-stage breast cancer who undergo breast-conserving surgery with radiation therapy live just as long as those who undergo mastectomy. Life expectancy is the same regardless of which choice a woman makes.

When the patient is told that the survival rate for lumpectomy with radiation is the same as for mastectomy, some women may be surprised or skeptical. 2

Studies have shown that tamoxifen improves the chances of survival and helps prevent recurrence of breast cancer, if the cancer cells are estrogen receptor-positive. Tamoxifen is not an effective treatment for breast cancer that is estrogen receptor-negative, and therefore should not be taken for those cancers. Tamoxifen may have unpleasant side effects that are similar to menopause, such as hot flashes, vaginal dryness, irregular periods, and weight gain. Tamoxifen also slightly increases the risk of uterine cancer and blood clots. Studies suggest that Tamoxifen should not be taken for more than five years 2

Breast cancer may be treated with local or systemic therapy. Some patients have both kinds of treatment.

Local therapy is used to remove or destroy breast cancer in a specific area. Surgery and radiation therapy are local treatments. They are used to treat the disease in the breast. When breast cancer has spread to other parts of the body, local therapy may be used to control cancer in those specific areas, such as in the lung or bone.

Systemic treatments are used to destroy or control cancer throughout the body. Chemotherapy, hormonal therapy, and biological therapy are systemic treatments. Some patients have systemic therapy to shrink the tumor before local therapy. Others have systemic therapy to prevent the cancer from coming back, or to treat cancer that has spread.

Surgery is the most common treatment for breast cancer, and there are several types of surgery. The doctor can explain each type, discuss and compare their benefits and risks, and describe how each will affect the patient's appearance.

  • 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. After breast-sparing surgery, most women receive radiation therapy to destroy cancer cells that remain in the area.

  • 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.

  • In most cases, the surgeon also removes lymph nodes under the arm to help determine whether cancer cells have entered the lymphatic system. This is called an axillary lymph node dissection.

In lumpectomy, the surgeon removes the breast cancer and some normal tissue around it. (Sometimes an excisional biopsy serves as a lumpectomy.) 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 lymph nodes under the arm may also be removed.

In total (simple) mastectomy, the surgeon removes the whole breast. Some 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 also may be taken out to help in removing the lymph nodes.

In radical mastectomy (also called Halsted radical mastectomy), the surgeon removes the breast, both 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 almost never used today. In rare cases, radical mastectomy may be suggested if the cancer has spread to the chest muscles.

Breast reconstruction (surgery to rebuild the shape of a breast) is often an option after mastectomy. Women considering reconstruction should discuss this with a plastic surgeon before having a mastectomy.

Radiation therapy (also called radiotherapy) is the use of high-energy rays to kill cancer cells. The radiation may be directed at the breast by a machine (external radiation). The radiation can also come from radioactive material placed in thin plastic tubes that are placed directly in the breast (implant radiation). Some women have both kinds of radiation therapy.

For external radiation therapy, the patient goes to the hospital or clinic, generally 5 days a week for several weeks. For implant radiation, a patient stays in the hospital. The implants remain in place for several days. They are removed before the woman goes home.

Sometimes, depending on the size of the tumor and other factors, radiation therapy is used after surgery, especially after breast-sparing surgery. The radiation destroys any breast cancer cells that may remain in the area.

Before surgery, radiation therapy, alone or with chemotherapy or hormonal therapy, is sometimes used 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.

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 in a pill or by injection. Either way, the drugs enter the bloodstream and travel throughout the body.

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 her general health, however, a woman may need to stay in the hospital during her treatment.

Hormonal therapy keeps cancer cells from getting the hormones they need to grow. This treatment may include the use of drugs that change the way hormones work, or surgery to remove the ovaries, which make female hormones. Like chemotherapy, hormonal therapy can affect cancer cells throughout the body.

Biological therapy is a treatment designed to enhance the body's natural defenses against cancer. For example, Herceptin® (trastuzumab) is a monoclonal antibody that targets breast cancer cells that have too much of a protein known as human epidermal growth factor receptor-2 (HER-2). By blocking HER-2, Herceptin slows or stops the growth of these cells. Herceptin may be given by itself or along with chemotherapy.3

A woman's treatment options depend on a number of factors. These factors include her age and menopausal status; her general health; the size and location of the tumor and the stage of the cancer; the results of lab tests; and the size of her breast. Certain features of the tumor cells (such as whether they depend on hormones to grow) are also considered. In most cases, the most important factor is the stage of the disease. The stage is based on the size of the tumor and whether the cancer has spread. The following are brief descriptions of the stages of breast cancer and the treatments most often used for each stage. (Other treatments may sometimes be appropriate.)3

After a mastectomy, some women decide to wear a breast form (prosthesis). Others prefer to have breast reconstruction, either at the same time as the mastectomy or later on. Each option has its pros and cons, and what is right for one woman may not be right for another. What is important is that nearly every woman treated for breast cancer has choices. It is best to consult with a plastic surgeon before the mastectomy, even if reconstruction will be considered later on.

Various procedures are used to reconstruct the breast. Some use implants (either saline or silicone); others use tissue moved from another part of the woman's body. The safety of silicone breast implants has been under review by the Food and Drug Administration (FDA) for several years. Women interested in having silicone implants should talk with their doctor about the FDA's findings and the availability of silicone implants. Which type of reconstruction is best depends on a woman's age, body type, and the type of surgery she had. A woman should ask the plastic surgeon to explain the risks and benefits of each type of reconstruction.3

Exercising the arm and shoulder after surgery can help a woman regain motion and strength in these areas. It can also reduce pain and stiffness in her neck and back. Carefully planned exercises should be started as soon as the doctor says the woman is ready, often within a day or so after surgery. Exercising begins slowly and gently and can even be done in bed. Gradually, exercising can be more active, and regular exercise becomes part of a woman's normal routine. (Women who have a mastectomy and immediate breast reconstruction need special exercises, which the doctor or nurse will explain.)

Often, lymphedema after surgery can be prevented or reduced with certain exercises and by resting with the arm propped up on a pillow. If lymphedema occurs, the doctor may suggest exercises and other ways to deal with this problem. For example, some women with lymphedema wear an elastic sleeve or use an elastic cuff to improve lymph circulation. The doctor also may suggest other approaches, such as medication, manual lymph drainage (massage), or use of a machine that gently compresses the arm. The woman may be referred to a physical therapist or another specialist.3

Regular followup exams are important after breast cancer treatment. Regular checkups ensure that changes in health are noticed. Followup exams usually include examination of the breasts, chest, neck, and underarm areas, as well as periodic mammograms. If a woman has a breast implant, special mammogram techniques can be used. Sometimes the doctor may order other imaging procedures or lab tests. 3

Footnotes:
1. excerpt from Breast Cancer: NWHIC
2. excerpt from Early Stage Breast Cancer: NWHIC
3. excerpt from What You Need To Know About Breast Cancer: NCI

Last revision: April 9, 2003

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