After a diagnosis of breast cancer and planning for treatment, it comes time for treatment to begin. Breast cancer treatments can vary a great deal and generally depend on the cancer’s stage. Treatments normally fall into one of two categories. One is a targeted approach with the goal of protecting the rest of the body from the spread of cancer. This includes neoadjuvant and adjuvant chemotherapy. The other is a targeted approach with the goal of killing or removing the existing tumor. This is done through surgery and radiation therapy.
Various treatments and therapies for breast cancer are described below. Treatments can be a combination of the two aforementioned categories. You may require several kinds of treatment. It’s common to go through both of these treatment approaches, just not at the same time.
Your treatment plan may begin with surgery depending on the stage, size, and location of the tumor. In some cases, neoadjuvant therapy may be recommended before surgery. Neoadjuvant therapy means targeted chemotherapy or anti-hormone therapy before surgery. It can help shrink the size of the tumor for a better outcome.
If surgery is part of your treatment plan, you may undergo a lumpectomy or mastectomy. A lumpectomy removes the lump and surrounding tissue. A mastectomy removes the entire breast. The best option for you depends mainly on the size of your tumor. Often one or more nearby lymph nodes may also be removed. This is typically the first place breast cancer will spread, so your oncologist may want to check for cancer cells in these tissues.
Chemotherapy, or “chemo,” may be used to stop cancer cells from spreading, to kill cancer cells, or to slow their growth. Treatment is provided by administering chemicals into your blood stream so that they travel anywhere in your body to kill cancer cells where they are. As mentioned, neoadjuvant chemotherapy may be used to shrink a tumor before surgery. Chemotherapy provided after surgery is called adjuvant therapy. It can help destroy any remaining cancer cells that can’t be seen after surgery.
Biotherapy or immunotherapy is a form of treatment that uses the immune system to fight off disease. It’s done along with chemotherapy. It’s a relatively new kind of treatment, but recent early research shows positive results.
Radiation therapy is a treatment that destroys cancer cells with high-energy rays or particles. It is focused only on the breast, or on any areas of metastasis if the cancer has spread such as the lymph nodes. While it can be used as a neoadjuvant therapy, radiation therapy is generally used as an adjuvant therapy after surgery to target remaining cancer cells. Radiation therapy destroys the cancer cells and is effective in reducing the rate of recurrence. Side effects mostly affect the area being treated.
In some breast cancers, cancer growth can be stimulated by the hormones estrogen and progesterone. These types of breast cancers are called “hormone sensitive” or “receptor positive.” If you are positive for any of these hormones, you may be a candidate for anti-hormone therapy. If you are negative for these hormones, it means that anti-hormone therapy will not be effective in treating your cancer.
In order to determine if a breast cancer is hormone sensitive, tests are performed on tumor samples taken during surgery. There are two types of hormone-sensitive breast cancers:
- ER+ (estrogen receptor positive), in which the tumor cells contain estrogen receptors. 70 percent of all breast cancers are this type.
- PR+ (progesterone receptor positive), in which the tumor cells contain progesterone receptors. Most ER+ breast cancers are PR+.
Anti-hormone therapy (typically oral medications) is used to block the estrogen and progesterone hormones from being produced, and to slow the growth of tumors that are triggered by these same hormones.
Things You May Need to Think About During Chemotherapy
Being aware for some of the decisions you may need to think about during chemo may help you feel more empowered and help alleviate some stress, such as:
- Fertility/Sexual Side Effects
- Hidden Costs of Chemo
- Managing Chemo Side Effects
- Patient Perspectives