Breast Cancer Treatment
Breast cancer is one of the most commonly diagnosed cancers in women worldwide. Thankfully, due to advances in early detection and treatment options, survival rates continue to improve. When breast cancer is detected early, treatment is often highly effective. However, choosing the right approach can feel overwhelming for patients.
This article provides a comprehensive overview of the main treatments used for breast cancer today. We’ll cover the various tests used for diagnosis, different surgery and radiation options, therapies using medication, and complementary supportive care. The goal is to educate patients on the latest breast cancer treatments, along with potential side effects and how they are managed.
Diagnosing Breast Cancer
An early and accurate diagnosis significantly improves outcomes in breast cancer. Your doctor will perform a clinical breast exam, feeling for any abnormal lumps or changes. They may order breast imaging tests to pinpoint any suspicious areas that need further assessment. Common diagnostic tests include:
Mammogram: This specialized X-ray creates images of breast tissue. Both digital and 3D mammography are used to screen for early tumors. Diagnostic mammograms help evaluate abnormalities found on a screening test.
Breast Ultrasound: Ultrasound uses sound waves to produce images deep within the breast tissue. It can determine if a lump is solid or fluid-filled.
Breast MRI: Magnetic resonance imaging uses magnets and radio waves, not radiation, to see inside the breast. MRIs may be used along with mammograms in screening high-risk women.
Biopsy: A biopsy removes a small sample of breast tissue for examination under a microscope. This is the only definitive way to diagnose cancer. If cancer is found, the biopsy helps categorize the type and grade of the tumor.
Once breast cancer is diagnosed, your cancer care team will determine the stage. Staging evaluates the size and extent of the tumor, whether it has invaded nearby tissue, and if it has spread to lymph nodes or elsewhere. Staging is essential for selecting the most effective treatment options.
Let’s now explore the main treatments used for breast cancer, starting with commonly performed surgeries.
Breast Cancer Surgery Options
Surgery is usually part of the treatment plan for breast cancer. The goal is to remove the tumor and margins of healthy tissue around it. Surgery also lets doctors assess nearby lymph nodes to see if cancer has spread. The two main surgeries for breast cancer are:
Lumpectomy
Also called breast-conserving surgery, a lumpectomy removes only the tumor and some surrounding tissue. It spares the rest of the breast. Lumpectomy is often a good choice for smaller, early-stage cancers.
After a lumpectomy, radiation therapy is usually given to the remaining breast tissue. This destroys any residual cancer cells and lowers the risk of recurrence in that breast. Lumpectomy and radiation together have similar long-term survival rates as mastectomy. However, there is a slightly higher risk of recurrence compared to mastectomy.
Mastectomy
This surgery removes the entire breast. There are several types of mastectomies:
• Simple or total mastectomy – Removes the whole breast including nipple/areola and overlying skin.
• Skin-sparing mastectomy – Preserves breast skin envelope for reconstruction. The nipple may also be spared.
• Nipple-sparing/total skin-sparing mastectomy – Saves the nipple, areola, and skin for optimal reconstruction results.
• Modified radical mastectomy – Removes the entire breast and also lymph nodes under the arm.
• Radical mastectomy – Removes the breast, chest muscles, and all armpit lymph nodes. This disfiguring surgery is rarely performed today.
For larger or more advanced cancers, mastectomy is often recommended over lumpectomy. However, survival rates are similar between the two if radiation therapy is added to lumpectomy.
With any mastectomy, breast reconstruction can begin right away or be delayed. Reconstruction recreates the breast contour using implants or natural tissue flaps. Patients should discuss all surgical options and reconstruction goals with their cancer team.
Lymph Node Evaluation
Breast cancer can spread to lymph nodes located under the arm and around the collar bone. Evaluating nearby nodes helps determine treatment and prognosis. Common techniques include:
• Sentinel node biopsy – Identifies the first few lymph nodes that drain from the tumor. If they are clear, more node removal may not be needed.
• Axillary lymph node dissection – Surgery to remove many lymph nodes for examination. This carries a higher risk of chronic side effects like lymphedema.
Most patients will have a sentinel node biopsy, allowing a more limited node surgery. Axillary dissection is reserved for cases where cancer has extensively spread to nodes. Patients should discuss risks and benefits of lymph node procedures with their surgeon.
Recovery after Breast Cancer Surgery
Breast cancer surgery often leads to temporary side effects like pain, tightness, numbness, arm swelling, and restricted mobility. Seromas, fluid buildup around the scar, can also occur. Fatigue from the surgery and emotional toll of treatment is common.
Following the surgeon’s post-op instructions carefully can aid proper healing after surgery. Most patients can resume normal activities after 4-6 weeks. Pain medication and physical therapy also help manage common surgical side effects.
Surgery remains a mainstay for removing tumors in the breast. However, many patients now receive drug therapies before or after surgery. We’ll cover these systemic treatments next.
Systemic Drug Therapies for Breast Cancer
In addition to surgery, systemic drug therapies are often used before (neoadjuvant) or after (adjuvant) surgery. They can also be given to treat metastatic disease. Systemic drugs travel through the bloodstream, reaching cancer cells throughout the body. The main types used for breast cancer include:
Chemotherapy
Chemotherapy uses cytotoxic drugs to destroy rapidly dividing cancer cells. It may be given neoadjuvantly to shrink tumors before surgery. Or it can be administered after surgery to eliminate any remaining cancer cells. This lowers the risk of recurrence.
Chemotherapy is also used to treat metastatic breast cancer. Common chemotherapy drugs used include:
• Anthracyclines like doxorubicin, epirubicin
• Taxanes like paclitaxel, docetaxel
• Antimetabolites like capecitabine, methotrexate
• Alkylating agents like cyclophosphamide
• Platinum agents like carboplatin
Patients often receive a combination of these medications. Chemotherapy is typically given in cycles over a period of months. Side effects like fatigue, infection risk, nausea, hair loss, and neuropathy may occur. However, medications can help manage many chemo side effects.
Hormonal Therapy
Hormonal therapy blocks or lowers the hormones estrogen and progesterone that can fuel breast cancer growth. The main types of hormonal therapies include:
• Tamoxifen – Prevents estrogen from binding to receptors on cancer cells. Used for pre and post-menopausal women.
• Aromatase inhibitors – Block the enzyme aromatase that produces estrogen in tissues outside the ovaries. Used for post-menopausal women.
• Ovarian suppression – Medications or surgery stop estrogen production in ovaries. For pre-menopausal patients.
Hormonal therapy is very effective for estrogen receptor positive cancers. It may be used neoadjuvantly or adjuvantly for up to 10 years to reduce recurrence risk. Side effects like hot flashes, joint pain, and osteoporosis can occur.
Targeted Therapy
Targeted drugs attack specific proteins that cancer cells need to grow and spread. They cause less harm to healthy cells than chemotherapy. Types used for breast cancer include:
• HER2 targeted therapy – Blocks the HER2 protein that controls cancer cell growth. Used for HER2 positive breast cancers.
• PARP inhibitors – Prevent cancer cells from repairing DNA damage. May benefit BRCA mutation carriers.
• mTOR inhibitors – Block a pathway that stimulates cancer cell division.
• CDK 4/6 inhibitors – Stop cancer cell cycle progression and division.
Targeted therapy provides more tailored treatment based on the molecular characteristics of each patient’s cancer. Side effects are often milder than chemo but still need to be carefully managed.
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Immunotherapy
Immunotherapy boosts the body’s immune system to better recognize and destroy cancer cells. Checkpoint inhibitor drugs are a type of immunotherapy used for some breast cancers including:
• Pembrolizumab – Approved for high-risk, early triple negative breast cancers with PD-L1 expression.
• Atezolizumab – May benefit advanced triple negative breast cancers with PD-L1 expression.
• Nivolumab – Being studied for advanced, metastatic hormone receptor positive disease.
Immunotherapy is a promising new approach for breast cancer. Ongoing clinical trials are investigating its efficacy in various settings. As with other systemic therapies, side effects need careful monitoring and management
Supportive Care for Breast Cancer Patients
In addition to treatments that target the cancer itself, managing symptoms and side effects is crucial for breast cancer patients. This supportive or palliative care focuses on improving overall quality of life.
Cancer and its treatments often cause physical symptoms like pain, nausea, fatigue, neuropathy, and cognitive dysfunction. Emotional distress, relationships stresses, and financial burden may also occur. Integrative therapies that complement medical treatment can help alleviate many of these effects.
For physical symptoms, medications, nutrition changes, relaxation techniques, counseling, and other therapies bring relief. Treating anxiety and depression is key for emotional health. Support groups connect patients who are facing similar challenges.
Some integrative therapies recommended for breast cancer patients include:
• Acupuncture – Helps reduce chemotherapy-induced nausea.
• Music therapy – Improves anxiety and stress.
• Mindfulness meditation – Benefits depression and overall quality of life.
• Yoga – Reduces stress and fatigue.
• Massage – Relieves muscle tension and pain.
• Nutritional counseling – Ensures optimal eating to maintain strength.
• Occupational therapy – Addresses upper body mobility problems after surgery.
• Physical therapy – Restores flexibility and strength through exercise.
• Talk therapy and support groups – Provide emotional and social support.
Patients should inform their cancer care team about any integrative therapies they are using or interested in trying. Palliative care is now considered a key component of comprehensive breast cancer treatment.
Metastatic Breast Cancer
Metastatic or stage IV breast cancer has spread to distant sites like the bones, brain, liver, or lungs. While not curable, treatments can often effectively control it for many years as a chronic illness. Options include:
• Local therapies such as surgery or radiation to treat isolated metastases causing symptoms
• Systemic drug therapies – Chemotherapy, hormonal therapy, and targeted drugs used singly or in combination
• Clinical trials evaluating novel therapies and treatment combinations
• Palliative treatments including medications, integrative therapies, and supportive care to maintain quality of life
New developments in treating metastatic disease include:
• CDK 4/6 inhibitor drugs combined with hormonal therapy for metastatic hormone receptor positive cancers
• Immunotherapy agents like pembrolizumab showing promise for metastatic triple negative disease
• Targeted radionuclide therapy delivering radiation directly to widespread bone metastases
Treatment plans are tailored to each patient based on the cancer’s characteristics, prior therapy response, sites of metastases, and goals of care. Living years productively is now possible for many with stage IV breast cancer.
Takeaways for Patients
• Be well-informed about options for treating both early and advanced breast cancers. Seek multiple opinions, ideally from a dedicated breast cancer center.
• Ask about genetic testing and molecular profiling of your tumor, so therapy can be personalized.
• Report all side effects and symptoms to your care team for prompt management. Don’t suffer in silence.
• Communicate your values, priorities and lifestyle needs so your treatment fits your circumstances. Share decision-making with your doctors.
• Take advantage of supportive care services. Integrative therapies complement medical treatment.
• Connect with fellow patients in person or online support communities. You are not alone.
• Focus on living fully and doing what matters most to you. Set short and long-term goals to strive towards.
Dealing with a breast cancer diagnosis is often an emotional rollercoaster. But arm yourself with information, utilize all resources available, and maintain a hopeful attitude. The breast cancer landscape offers more reasons for optimism today despite the challenges that remain.
In Conclusion
Advances in screening and diagnosis, surgical techniques, systemic drug therapies, radiation, and integrative care are improving outcomes for breast cancer patients. With proper treatment tailored to their specific type and stage of disease, most women go on to live full, active lives as survivors.
Staying informed about the latest options empowers patients to make the best decisions regarding their breast cancer care. Seeking opinions from cancer specialists at dedicated treatment centers also ensures access to state-of-the-art therapies. Along with expert medical care, addressing quality of life concerns remains imperative.
While a breast cancer diagnosis is frightening, today’s greatly enhanced treatment capabilities offer more grounds for hope than ever before. By reviewing the information provided throughout this overview, patients gain a broader perspective on the complexities of breast cancer care. Most importantly, they realize they do not have to face this challenge alone.
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