Breast Cancer Treament Types
There are two major goals of breast cancer treatment:
- To rid the body of the cancer as completely as possible.
- To prevent cancer from returning.
The type of treatment will vary from case to case and will depend on the size and location of the tumour in the breast, the results of lab tests done on the cancer cells and the stage or extent of the disease.
Breast cancer treatments are local or systemic.
Local treatments are used to remove, destroy or control the cancer cells in a specific area, such as the breast. They include:
- Surgery, either mastectomy or lumpectomy -- also called breast-conserving therapy. There are also different types of mastectomies and lumpectomies including partial mastectomy, total mastectomy, radical mastectomy and modified radical mastectomy.
- Radiation therapy.
Systemic treatments are used to destroy or control cancer cells all over the body. They include:
- Chemotherapy
- Hormone therapy
- Biological Therapy
Systemic therapy can be given after local treatment (adjuvant therapy) or before (neoadjuvant therapy). Adjuvant therapy is used after local treatments to kill any cancer cells that remain in the body and may be in other parts of the body. A patient may have just one form of breast cancer treatment or a combination, depending on her needs.
Chemotherapy for Breast Cancer
Chemotherapy is a chemical, or group of chemicals, designed to stop the growth of cancer cells. Chemotherapy drugs may be given intravenously, orally, or as a combination of the two. When breast cancer is limited to the breast or lymph nodes, chemotherapy may be given after a lumpectomy or mastectomy. This is done to help reduce the chance of breast cancer coming back.
If the breast tumour is large, chemotherapy is sometimes given before surgery in order to shrink the tumour so it can be removed more easily or so that a lumpectomy can be performed instead of a mastectomy. Chemotherapy may also be given as the main treatment for women whose cancer has spread to other parts of the body outside of the breast and lymph nodes.
Chemotherapy can be used for three major purposes:
- Adjuvant therapy:The goal is to prevent or postpone cancer from coming back after the initial surgery and radiation. Even when the cancer seems to be confined to the breast and lymph glands under the arm, there is a chance that cells may have already spread to other areas that cannot be seen. Chemotherapy is given to try and kill these cells.
- Neo-adjuvant therapy:Sometimes the cancer in the breast is so big that shrinking it first with chemotherapy may make it easier to do surgery.
- To treat metastatic disease:If the cancer shows up in parts of the body other than the breast and lymph glands under the arm, it is called metastatic disease. Chemotherapy can be one of the main ways to kill cancer cells that have spread to other parts of the body, and help women live longer with a good quality of life. When to start chemotherapy, what drugs to use, and what side effects to expect varies from woman to woman.
Invasive breast cancer treatment
Invasive breast cancer treatments may be local or systemic. Local treatments, including surgery and radiation therapy, are used to remove the breast cancer tumour and destroy or control the remaining cancer cells. Systemic treatments include:
- surgery
- chemotherapy
- radiation therapy
- hormone therapy
- biological therapy
One or more breast cancer treatments may be used in combination to provide the patient the best prognosis. The choice of treatment is determined by different factors which include
- size of the breast cancer tumour
- location of the breast cancer tumour
- results of lab tests done on the cancer cells
- stage of the breast cancer
- age and general health
- menopause status
Radiation Therapy for Breast Cancer
Radiation therapy involves using a large machine called a linear accelerator to deliver precise amounts of high-energy radiation to kill cancer cells. The radiation stops the reproduction of cancer cells while minimizing damage to healthy tissues. Radiation therapy has been shown to improve survival in women with breast cancer.
Radiation therapy for breast cancer can be used:
- After lumpectomy or mastectomy, either alone or in combination with chemotherapy and/or hormone therapy, to reduce the risk of cancer re-growing in the breast.
- As the main treatment for breast cancer if the surgeon believes the tumour cannot be safely removed, if a woman's health does not allow surgery, or if the woman chooses not to have surgery.
- To treat cancer that has spread into the bones or the brain.
- To relieve pain or other problems if the cancer recurs.
Hormone Therapy for Breast Cancer
Hormone therapy -- also called hormonal therapy, hormone treatment, or endocrine therapy -- is any treatment that adds, blocks, or removes hormones and thus slows or stops the growth of certain cancers such as prostate and breast cancer. The female hormones oestrogen and progesterone, for e.g., promote the growth of some breast cancer cells. So hormone therapy may be given to block the body's naturally occurring oestrogen and fight the cancer's growth. Sometimes surgery is needed to remove the source of the hormone in question -- in the case of breast cancer, the ovaries may be removed.
Common Hormone Drugs Used for Breast Cancer
Tamoxifen .The gold standard of hormone therapy in breast cancer is tamoxifen, marketed as Nolvadex, a drug in pill form that interferes with the activity of oestrogen. Known as the "anti-oestrogen," tamoxifen is a pill that has been used for more than 30 years to treat patients with advanced (metastatic or stage IV) breast cancer.
Arimidex and Femara. The most well-known of these drugs, Arimidex and Femara, belong to a class of medications known as aromatase inhibitors. After menopause, a woman's main source of oestrogen comes through a process called aromatization, in which male hormones called androgens (produced by the adrenal glands located at the top of the kidneys) are converted into oestrogen. This process takes place throughout the body, in the fatty tissue. These drugs fight tumour growth by stopping the conversion of androgens into oestrogen.
Biological Therapy for Breast Cancer
Biological therapy for breast cancer takes advantage of the body's own immune or hormonal system to act on cancer cells - while leaving healthy cells relatively intact. This approach is designed to minimize the side effects associated with traditional treatments like chemotherapy.
One strategy is to use antibodies to attack cancer cells or block their activities. An antibody is a protein that can attach to specific proteins in the body, called antigens. Antibodies can be natural, made by one's own immune system, or made artificially. One e.g. of a manufactured antibody is trastuzumab, or Herceptin.
Herceptin is believed to act in three ways to stop cancer cells from growing quickly and out of control:
- It sticks to special receptors on the cancer cells, stopping them from growing.
- It signals the body's own natural killer cells to attack the cancer cells.
- It can work with chemotherapy medications, stopping cancer cells damaged by chemo from repairing themselves.
But Herceptin can work only if the woman carries the HER-2 gene in those tumour cells. About 25% of breast cancer patients carry this gene. (They are considered HER-2 positive). It currently is the first-line treatment of HER-2-positive metastatic breast cancer in combination with one of the drugs known as taxanes.
Another form of biological therapy is the use of drugs composed of small molecules the interrupt the hormonal or chemical pathways that cancer cells need to grow. Lapatinib, or Tykerb, is an example of a small molecule that is used in combination with chemotherapy to treat some advanced cases of breast cancer. One disadvantage of antibody treatment is that it is generally only available by injection. Small molecule treatment can be taken in pill form.
Other types of antibodies and small molecules that are being researched to fight breast cancer include:
- Angiogenesis inhibitors. These antibodies prevent the growth of new blood vessels, cutting off the supply of oxygen and nutrients to cancer cells. Bevacizumab (Avastin) is this type of drug and is currently used in combination with a taxane to treat certain metastatic breast cancers.
- Signal transduction inhibitors. These antibodies block signals inside the cancer cell that helps the cells divide, stopping the cancer from growing.
Stage 0 Breast Cancer Treatment Options
When needed, treatment for stage 0 breast cancer is very successful. The five-year survival rate is about 100%. This very early stage of the disease is not always actually cancer. Instead, it's often a precancerous condition. Treatment isn't always needed, and close observation may be enough. Treatments differ depending on the stage of cancer.
Ductal carcinoma in situ (DCIS) or intraductal carcinoma: This type of breast cancer is being seen more often due to increased use of mammogram screenings. Here's a list of the typical treatments:
- Surgery
- Radiation therapy
- Hormone therapy
Lobular carcinoma in situ (LCIS) is the other type of stage 0 cancer. LCIS develops when abnormal cells appear in the lobes of the breast. With LCIS, there is no palpable tumour, no consistent changes on mammography, and is usually found when doing a breast biopsy for something else. The risk of developing an invasive cancer is 20% to 25% over a 15-year period. Therefore, most women don't need treatment right away. It's key to have frequent check-ups. Here are some treatment options:
- Hormone therapy
- Bilateral mastectomy
Stage I Breast Cancer Treatment Options
This is a very early stage of breast cancer in which the cancer hasn't spread beyond the breast at all. The eight-year survival rate for women with stage I breast cancer is about 90%. This doesn't mean that these women will only live eight years. Women usually do well with a combination of treatments.
- Surgery
- Radiation therapy
- Chemotherapy
- Hormone therapy
- Biological therapy
Stage II Breast Cancer Treatment Options
With stage II breast cancer, the cancer is still contained within the breast and (in some cases) in nearby lymph nodes. The eight-year survival rate for women with stage II cancer is estimated to be about 70%. As with stage I cancer, combination of treatments may be used to treat stage II cancer.
- Surgery
- Radiation therapy
- Chemotherapy
- Hormone therapy
- Biological therapy
Stage III Breast Cancer Treatment Options
In stage III, the cancer still hasn't spread far beyond the breast and nearby lymph nodes. However, in this stage there are higher numbers of lymph nodes involves (four to more than ten) or the tumour is so large it extends to the chest wall or involves the skin of the breast. Even though the breast cancer is more advanced, the eight-year survival rate is still about 40%. A combination of different treatments often works best.
- Chemotherapy
- Surgery
- Hormone therapy
- Biological therapy
- Radiation therapy
Stage IV Breast Cancer Treatment Options
In stage IV breast cancer, the cancer has spread elsewhere in the body. Affected areas may include the bones, brain, lungs, or liver. Because multiple areas may be involved, focused treatments like surgery or radiation alone are not sufficient. So far, treatment of stage IV breast cancer does not provide a cure for the disease. By shrinking the cancer, treatment can slow down the disease, making the patient feel better and possibly live longer. Although patients with stage IV breast cancer may live for years, it is usually life-threatening at some point. Many factors influence this.
- Chemotherapy
- Hormone therapy
- Biological therapy
- Surgery and radiation