Treatments and drugs

breast cancer treatments

Your doctor determines your breast cancer treatment options based on your type of breast cancer, its stage, whether the cancer cells are sensitive to hormones, your overall health and your own preferences. Most women undergo surgery for breast cancer and also receive additional treatment, such as chemotherapy, hormone therapy or radiation.
There are many options for breast cancer treatment, and you may feel overwhelmed as you make complex decisions about your treatment. Consider seeking a second opinion from a breast specialist in a breast center or clinic. Talk to other women who have faced the same decision.

Breast cancer surgery

Operations used to treat breast cancer include:

Removing the breast cancer (lumpectomy)

During lumpectomy, which may be referred to as breast-sparing surgery or wide local excision, the surgeon removes the tumor and a small margin of surrounding healthy tissue. Lumpectomy is typically reserved for smaller tumors that are easily separated from the surrounding tissue.

Removing the entire breast (mastectomy)

Mastectomy is surgery to remove all of your breast tissue. Mastectomy can be simple, meaning the surgeon removes all of the breast tissue — the lobules, ducts, fatty tissue and some skin, including the nipple and areola. Or mastectomy can be radical, meaning the underlying muscle of the chest wall is removed along with breast tissue and surrounding lymph nodes in the armpit. Radical mastectomies are less commonly done today. Some women may be able to undergo a skin-sparing mastectomy, which leaves the skin overlying the breast intact and may help with reconstruction options.

Removing one lymph node (sentinel node biopsy)

Breast cancer that spreads to the lymph nodes may spread to other areas of the body. Your surgeon determines which lymph node near your breast tumor receives the lymph drainage from your cancer. This lymph node is removed using a procedure called sentinel node biopsy and tested for breast cancer cells. If no cancer is found, the chance of finding cancer in any of the remaining lymph nodes is small and no other nodes need to be removed.

Removing several lymph nodes (axillary lymph node dissection)

found in the sentinel node, your surgeon may remove additional lymph nodes in your armpit. However, there is good evidence that removal of additional affected lymph nodes does not improve survival in cases of early breast cancer following a lumpectomy, chemotherapy and whole-breast irradiation for tumors less than 2 inches (5 centimeters) in size, and where the cancer has spread to just a few lymph nodes in the armpit. In such cases, chemotherapy and radiation treatment after the lumpectomy have proved to be equally effective. This avoids the serious side effects, including chronic swelling of the arm (lymphedema), that often occur after lymph node removal.
However, axillary lymph node dissection may still be performed if the sentinel lymph node contains cancer following a mastectomy, in the case of larger breast tumors or when a lymph node is large enough to be felt on physical exam. It may also be performed in situations when a woman elects to receive partial breast irradiation.
Complications of breast cancer surgery depend on the procedures you choose. Surgery carries a risk of bleeding and infection.
Some women choose to have breast reconstruction after surgery. Discuss your options and preferences with your surgeon. Consider a referral to a plastic surgeon before your breast cancer surgery. Your options may include reconstruction with a synthetic breast implant or reconstruction using your own tissue. These operations can be performed at the time of your mastectomy or at a later date.

Radiation therapy

Radiation therapy uses high-powered beams of energy, such as X-rays, to kill cancer cells. Radiation therapy is typically done using a large machine that aims the energy beams at your body (external beam radiation). But radiation can also be done by placing radioactive material inside your body (brachytherapy).
External beam radiation is commonly used after lumpectomy for early-stage breast cancer. Doctors may also recommend radiation therapy after mastectomy for larger breast cancers. When external beam radiation is used after a woman has tested negative on a sentinel node biopsy, there is evidence that the chance of cancer occurring in other lymph nodes is significantly reduced.
Side effects of radiation therapy include fatigue and a red, sunburn-like rash where the radiation is aimed. Breast tissue may also appear swollen or more firm. Rarely, more-serious problems may occur, including arm swelling (lymphedema), broken ribs, and damage to the lungs or nerves.

Chemotherapy

Chemotherapy uses drugs to destroy cancer cells. If your cancer has a high chance of returning or spreading to another part of your body, your doctor may recommend chemotherapy to decrease the chance that the cancer will recur. This is known as adjuvant systemic chemotherapy.
Chemotherapy is sometimes given before surgery in women with larger breast tumors. Doctors call this neoadjuvant chemotherapy. The goal is to shrink a tumor to a size that makes it easier to remove with surgery. This may also increase the chance of a cure. Research is ongoing into neoadjuvant chemotherapy to determine who may benefit from this treatment.
Chemotherapy is also used in women whose cancer has already spread to other parts of the body. Chemotherapy may be recommended to try to control the cancer and decrease any symptoms the cancer is causing.
Chemotherapy side effects depend on the drugs you receive. Common side effects include hair loss, nausea, vomiting, fatigue and a small increased risk of developing infection.

Hormone therapy

Hormone therapy — perhaps more properly termed hormone-blocking therapy — is often used to treat breast cancers that are sensitive to hormones. Doctors sometimes refer to these cancers as estrogen receptor positive (ER positive) and progesterone receptor positive (PR positive) cancers.
Hormone therapy can be used after surgery or other treatments to decrease the chance of your cancer returning. If the cancer has already spread, hormone therapy may shrink and control it.
Treatments that can be used in hormone therapy include:

Medications that block hormones from attaching to cancer cells

Tamoxifen is the most commonly used selective estrogen receptor modulator (SERM). SERMs act by blocking estrogen from attaching to the estrogen receptor on the cancer cells, slowing the growth of tumors and killing tumor cells. Tamoxifen can be used in both pre- and postmenopausal women. Possible side effects include fatigue, hot flashes, night sweats and vaginal dryness. More significant risks include cataracts, blood clots, stroke and uterine cancer.

Medications that stop the body from making estrogen after menopause

One group of drugs called aromatase inhibitors blocks the action of an enzyme that converts androgens in the body into estrogen. These drugs are effective only in postmenopausal women. Aromatase inhibitors include anastrozole (Arimidex), letrozole (Femara) and exemestane (Aromasin). Side effects of aromatase inhibitors include joint and muscle pain, as well as an increased risk of bone thinning (osteoporosis). Another drug, fulvestrant (Faslodex), directly blocks estrogen, which keeps tumors from getting the estrogen they need to survive. Fulvestrant is generally used in postmenopausal women for whom other hormone-blocking therapy is not effective or who can't take tamoxifen. Side effects that may occur include fatigue, nausea and hot flashes. Fulvestrant is given by injection once a month.

Surgery or medications to stop hormone production in the ovaries

In premenopausal women, surgery to remove the ovaries or medications to stop the ovaries from making estrogen can be an effective hormonal treatment. This type of surgery is known as prophylactic oophorectomy and may be called surgical menopause.

Targeted drugs

Targeted drug treatments attack specific abnormalities within cancer cells. Targeted drugs approved to treat breast cancer include:

Trastuzumab (Herceptin)

Some breast cancers make excessive amounts of a protein called human growth factor receptor 2 (HER2). Trastuzumab targets this protein that helps breast cancer cells grow and survive. If your breast cancer cells make too much HER2, trastuzumab may help block that protein and cause the cancer cells to die. Side effects may include heart damage, headaches and skin rashes.

Lapatinib (Tykerb)

Lapatinib targets the HER2 protein and is approved for use in advanced metastatic breast cancer. Lapatinib is reserved for women who have already tried trastuzumab and their cancer has progressed. Potential side effects include nausea, vomiting, diarrhea, fatigue, mouth sores, skin rashes, and painful hands and feet.

Bevacizumab (Avastin)

Bevacizumab is a drug designed to stop the signals cancer cells use to attract new blood vessels. Without new blood vessels to bring oxygen and nutrients to the tumor, the cancer cells die. Possible side effects include fatigue, high blood pressure, mouth sores, headaches, slow wound healing, blood clots, heart damage, kidney damage, high blood pressure and congestive heart failure. Research suggests that although this medication may help slow the growth of breast cancer, it doesn't appear to increase survival times. Even if the Food and Drug Administration does revoke bevacizumab's approval, doctors can prescribe this medication for what's known as off-label use. Use of bevacizumab in breast cancer is currently very controversial.
Side effects of targeted drugs depend on the drug you receive. Targeted drugs can be very expensive and aren't always covered by health insurance.

Clinical trials

Clinical trials are used to test new and promising agents in the treatment of cancer. Clinical trials represent the cutting edge of cancer treatment, but they're by definition unproven treatments that may or may not be superior to currently available therapies. Talk with your doctor about clinical trials to see if one is right for you.
Examples of treatments being studied in breast cancer clinical trials include:

New combinations of existing drugs

Researchers are studying new ways of combining existing chemotherapy, hormone therapy and targeted-therapy drugs. Testing new combinations may help determine if certain breast cancers are more susceptible to specific combinations.

Bone-building drugs to prevent breast cancer recurrence

Previous research found that adding a bone-building drug to hormone therapy treatment after surgery for premenopausal women reduced the risk of breast cancer recurrence. The drug used in the study, zoledronic acid (Reclast, Zometa), is a type of drug called a bisphosphonate that's used to treat bone loss (osteoporosis) and other bone diseases. The group of women who received zoledronic acid experienced fewer cancer recurrences than did the group that didn't receive the drug during the study, which lasted four years. But, newer studies haven't shown that zoledronic acid improves breast cancer risk of recurrence.

Using higher doses of radiation over a shorter period of time on a smaller portion of the breast

Researchers are studying partial breast irradiation in women who've undergone lumpectomy. Partial breast irradiation involves higher doses of radiation aimed at only a portion of the breast, rather than the entire breast. Radiation used in partial breast irradiation can come from a machine outside your body, or it can come from tubes or catheters placed within the breast tissue.

Alternative medicine

There are no alternative medicine treatments that have been found to cure breast cancer. What's more, some alternative medicine may cause adverse reactions with standard treatments, or might cause you to delay getting treatments that have been proven effective. If you're considering any type of alternative therapy, be sure to discuss the pros and cons with your doctor.
But complementary and alternative medicine therapies may help you cope with side effects of treatment when combined with your doctor's care.

Alternative medicine for fatigue

Many breast cancer survivors experience fatigue during and after treatment that can continue for years. When combined with your doctor's care, complementary and alternative medicine therapies may help relieve fatigue. Ask your doctor about:

Gentle exercise

If you get the OK from your doctor, start with gentle exercise a few times a week and add more if you feel up to it. Consider walking, swimming, yoga or tai chi.

Managing stress

Take control of the stress in your daily life. Try stress-reduction techniques such as muscle relaxation, visualization, and spending time with friends and family.

Relaxation strategies

Balance activity with periods of relaxation. Try listening to music, writing in a journal, meditating or taking a warm bath.

Coping and support

A breast cancer diagnosis can be overwhelming. And just when you're trying to cope with the shock and the fears about your future, you're asked to make important decisions about your treatment.
Every woman finds her own way of coping with a breast cancer diagnosis. Until you find what works for you, it might help to:

Learn what you need to know about your breast cancer

If you'd like to know more about your breast cancer, ask your doctor for the details of your cancer — the type, stage and hormone receptor status. Ask for good sources of up-to-date information on your treatment options. Knowing more about your cancer and your options may help you feel more confident when making treatment decisions. Still, some women may not want to know the details of their cancer. If this is how you feel, let your doctor know that, too.

Talk with other breast cancer survivors

You may find it helpful and encouraging to talk to other women with breast cancer. Talk to the nearest group you can find. Talk to us through Telephone: Monica - 0727 564 917

Find someone to talk to about your feelings

Find a friend or family member who is a good listener or talk with a clergy member or counselor. Ask your doctor for a referral to a counselor or other professional who works with cancer survivors.

Keep your friends and family close

Your friends and family can provide a crucial support network for you during your cancer treatment. As you begin telling people about your breast cancer diagnosis, you'll likely get many offers for help. Think ahead about things you may want help with, whether it's having someone to talk to if you're feeling low or getting help preparing meals.

Maintain intimacy with your partner

In many cultures, women's breasts are associated with attractiveness, femininity and sexuality. Because of these attitudes, breast cancer may affect your self-image and erode your confidence in intimate relationships. Talk to your partner about your insecurities and your feelings.

Take care of yourself

Make your well-being a priority during cancer treatment. Get enough sleep so that you wake feeling rested, choose a diet full of fruits and vegetables, make time for gentle exercise on days you feel up to it, and find time for things you enjoy, such as reading or listening to music. If you need to, let others take care of you for a while. This doesn't mean you're helpless or weak. It means you're using all your energy to get well.

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Document partialy by: Mayo Clinic.