Treatment plans for breast cancer are developed based on a several factors. The type and stage of the cancer, the sensitivity of the cancer to certain hormones, and the medical history of the patient are all consideration. Also, whether or not the cancer overexpresses the HER-2/neu gene can determine treatment. Treatment plans usually include surgery to remove the cancer. Some type of drug or chemotherapy to aid the success of the surgery often follows. The ultimate aim of all therapies is to increase long-term survival rates and to help ease recovery.
During a lumpectomy, the surgeon removes the tumor and a small margin around it. A lumpectomy is usually effective on small tumors. This way they can be removed without involving too much surrounding tissue.
A mastectomy can be either simple or radical. A simple mastectomy (also called “partial mastectomy) involves removing all of the breast tissue. That includes skin, fatty tissue, lobules, and ducts. A radical mastectomy (also called “total mastectomy”) also removes the chest wall muscles and the surrounding lymph nodes in the armpit.
Adjuvant Therapy Treatment
In addition to surgery, breast cancer treatments usually include drug or radiation therapies. These are called adjuvant therapies. Neoadjuvant therapy treatments are used before surgery to shrink large tumors and make the surgery easier. Adjuvant therapy treatments are applied after the surgery to help with recovery. Both are intended to increase long-term, disease-free survival rates. These therapies may include:
- Biological or targeted therapy
- Hormone therapy
- Radiation, a local adjuvant therapy
In some cases, these therapies may be combined. The decision of which therapy to use will depend on many factors. The patient’s age and the size and type of the tumor and its cells, and whether it has spread to the lymph nodes are all weighed. How the cancer reacts to certain hormones is another factor. The human epidermal growth factor receptor 2 (Her-2/neu ) status must also be considered. Below are summaries of the four major adjuvant therapies.
Biological or Targeted Therapies
If the breast cancer cells throw off an excess of Her-2/neu (which triggers cancer cell growth) a biologic therapy called trastuzumab (brand name, Herceptin) may be necessary.
Herceptin can stop the growth of the cancer by inhibiting Her-2/neu actions on cancer cells. Herceptin is often used along with chemotherapy or hormone therapy. It is known as a “targeted therapy” because it kills only the cancer cells and does not damage any other cells. Other therapies, such as lapatinib (Tykerb) and bevacizumab (Avastin), also target specific parts of tumors.
There are now hundreds of chemotherapy drugs that have been approved by the F.D.A. for use in breast cancer treatments. These compounds may be taken by injection or in pill form. Some of the drugs have almost unlimited approval for breast cancer patients. But some restricted by the particulars of the patient involved or where she is in her battle against the cancer.
Chemotherapy offers several benefits. It not only destroys cancer cells in the breast (as adjuvant therapy, after surgery), but it also kills any that have spread to other parts of the body. When used before surgery, chemotherapy can shrink the size of large tumors. This makes the surgery simpler for the surgeon and the patient. Finally, when it comes to earlier stages of breast cancer, chemotherapy is known to reduce the risk of recurrence and to lengthen survival.
There are some drawbacks to chemotherapy. There can be short-term, possibly severe side effects. Also, there is a slight chance of some long-term diseases and condition. However, most breast cancer patients and their doctors decide the potential, long-term benefits of chemotherapy usually outweigh the risks.
If tests show the cancer cells are sensitive to hormone receptors, that patient is considered “receptor-positive” and likely to benefit from hormone therapy. In fact, a positive hormone status trumps any other factors of the disease that would impact its course. These factors include age, tumor size and grade, and lymph node status. For receptor-positive women, hormone therapy will most likely be part of their cancer treatment. The two major hormone therapy choices are
tamoxifen andaromatase inhibitors. Tamoxifen blocks the expression of estrogen. Andandaromatase inhibitors lower the estrogen output in the body.
Using high-powered, targeted X-rays to kill cancer cells can reduce the risk of cancer recurrence. Radiation is commonly used to destroy any cells that escaped the surgery. Radiation is regularly used for high-risk women after a mastectomy. There are other cases where radiation is used: 1) when a tumor about 2 inches across or larger; 2) if multiple lymph nodes were involved; or 3) the tumor had invaded the chest muscles. Radiation therapy can be delivered in two forms: external beam radiation is delivered by an X-ray machine and internal seed radiation is implanted next to the tumor site, either with a needle or catheter.
After about a month has passed since the surgery, radiation treatments can begin. These may continue daily for up to two months. If chemotherapy is also part of the patient’s treatment, radiation will come after the chemotherapy is finished. If hormone therapy is to be used instead of chemotherapy, radiation can begin immediately. What is the risk that the cancer will return? Women who choose lumpectomies and radiation have about the same