Treatment is a very important stage after testing and diagnoses of Breast cancer. Treatment varies with the stages and type of breast cancer diagnosed in the testing. Large members of the team are responsible for the treatment of cancer. In this article, we will discuss the important question related to breast.
How Is Breast Cancer Treated?
Before discussing the different treatment methods of cancer, it is very important to know about the team that is responsible for the care and treatment of cancer patients. Following are listed the team members with their responsibilities:
- Anesthesiologist: A medical doctors, that administrators drugs and gases for making you unconscious or sleep for pain-free surgical procedure.
- Breast Specialist: A doctor diagnosis and treatment of a disorder of the breast.
- Dietitian: A specially trained Dietitian helps to take healthy diet choices, weight maintenance before, during, and after the treatment.
- Genetic Counselor: Health care professionals trained to help people through genetic testing. It is responsible for guide the patient about the and cons as well as addresses the patients must-have.
- Medical Oncologist: A specialist doctor for cancer that is will treat you after diagnosis of stage and type of cancer. The oncologist guides the patients about their treatment, causes, and their side effects for their treatment. They are responsible for prescribing medicine for treatment.
- Nurses: During Treatment, patients will be in contact with different fields of nurses includes case manager, Clinic Nurse specialist, Oncology certified nurse, Occupational Therapist, Pain Specialist, etc.
- Pathologist: A medical doctor trained for diagnoses microscopic cancer cells. They are responsible for the diagnosis of cancerous cells, Stage, and Aggressiveness of breast cancer. Based on their reports, the Doctor made their treatment plan.
- Physical Therapist: A health care professional who helps restore, maintain, and promote overall fitness and health.
- Psychologist: A licensed mental health professional who provides counseling on emotional and psychological issues.
- Radiologist: A medical doctor specialized in imaging the internal parts of the body such as X-rays, Ultrasonic tests, MRI, and Bones Scan.
- Surgeon: Many types of surgeons are responsible for the treatment of breast cancer. A general surgeon can operate any type of operations but for cancer treatment, specialized surgeons are recommended.
General Types of Treatment for Breast Cancer
Treatments are classified into many categories depending on how they work and when they are used. Some general types are given as:
Local versus Systematic therapy
Local therapy is intended to treat the tumor at the site without affecting the other part of the breast. The example of local therapy is Surgery and Radiation Therapy. While in Systematic Therapy, drugs are given to the cancer patients through the mouth or directly through the bloodstream to reach out to cancer cells. Chemotherapy and hormone therapy are examples of Systematic Therapy.
Adjuvant and Neo-adjuvant therapy
Women have no detectable cancer, after surgery, often given an Adjuvant therapy. In some cases, microscopic cancer cells spread in the body through the bloodstream after a break away from the primary tumor cells. These cancerous cells have no symptoms and cannot be diagnosed through Mammography, X-ray, or Ultrasonic tests. These cells can multiply more cells and make tumors in other organs of the body especially in bones. The goal of adjuvant therapy is to kill these hidden cells.
The technique of Neo-Adjuvant therapy is used to contract and minimizes the cancerous cells in the body. Some women are given the treatment of chemotherapy or hormone therapy before the surgery to make it less extensive.
Surgery for Breast Cancer
Most women having breast cancer have some surgery. Breast tumor removes through surgery in most of the cases, either breast-conserving surgery or mastectomy. Surgery is also used to check the axillary lymph nodes for metastasis.
In breast-conserving surgery, which is sometimes called partial or segmental mastectomy, only part of the affected breast is removed. The size and location of the tumor (and other factors) will dictate how much of the breast is removed. If radiation therapy is to be given after breast-conserving surgery, small metallic clips (which will be visible on x- rays) may be placed inside the breast during surgery to mark the area for the radiation treatments.
A Lumpectomy removes only the breast lump with a surrounding margin of normal tissue. After lumpectomy, radiation therapy is usually given to the patient. Quadrantectomy knows as partial mastectomy removes one-quarter of breast tissues. In both cases, radiography delayed after surgery if chemotherapy is done very well.
The decision of Radiography after Surgery of Breast Cancer
Mostly radiography is excluded from breast cancer surgery but it is still controversial. The following characteristic should be satisfied by the patient to use radiography:
- Age should be greater than or equal to seventy years.
- The tumor should be less than or equal to 2cm that have been completely removed.
- No lymph node involvement
Side Effects of Breast Cancer Surgery
Side effects of breast-conserving surgeries can include pain, temporary swelling, tenderness, and hard scar tissues on the surgical site. Bleeding and infection are also possible on the surgery site. If the breast looks very different from the normal breast, then the reconstruction of the breast has to do after surgery on the recommendation of the doctor.
The treatment involves the removes all the breast tissues with nearby tissues of the body known as Mastectomy. In a total mastectomy, the surgeon removes the entire breast from the body including nipples. The axillary lymph nodes or muscle tissues remains with the body beneath the breast.
In a double mastectomy, both breasts removed from the body in surgery. This treatment is the result of the most critical condition of breast cancer. After surgery, some women want to reconstruct the breast by using the technique named Skin-Sparing mastectomy. It is used only when immediate breast reconstruction is planned. It is more preferable among women because it looks like a natural breast after the treatment.
The procedure of nipple-sparing mastectomy is applied to breast cancer patients, who have the early stage of cancer. The breast cancer tissues are removed in this procedure by sparing the nipples. Before and duration of surgery, radiations are applied to reduce the factor of microscopic cancer cells. If doctors found the cancer cells in the nipples, breast tissues with nipples removed from the body but without the skin. Skin use in the reconstruction of the breast after surgery.
Side Effects of Mastectomy
The possible side effects of Mastectomy are given below:
- Change the shape of the breast after surgery
- Wound Infection
- Hematoma (Buildup od blood in the wound)
- Seroma ( Buildup of Clear fluid in the wound)
Axillary Lymph Node Dissection (ALND)
Some of the lymph nodes may be removed to examine the spread of breast cancer to axillary (Underarm) lymph nodes. This is an important process to determine the stage as well as a treatment plan. Cancer cells can be spread to the whole body through the bloodstream if lymph nodes are affected. ALND is part of a radical or modified radical mastectomy. It may also be done as part of a breast-conserving procedure such as lumpectomy. Anywhere from about 10 to 40 (though usually less than 20) lymph nodes are removed. Axillary dissection is used as a test to help guide other breast cancer treatment decisions.
Side Effects of ALND
The possible long term side effects of removing axillary lymph nodes are:
- Lymphedema (Swelling of arm)
- Limitation in moving your arm or shoulder
- Numbness of the skin of the upper inner arm
Sentinel Lymph Node Biopsy (SLNB)
Due to low side effects, doctors choose SLNB to check lymph nodes for cancer. In this procedure, the spread of cancer is to check without removing all lymph nodes. First of all, choose the Sentinel Lymph Node to remove it in the breast. Sentinel Lymph node is the first lymph node into which a tumor drains. To do this, Surgeon injects a radioactive substance into the tumor or in the surrounding of the tumor. Lymphatic nodes carry the substance into the sentinel node. The doctor then uses a special device to detect the lymph nodes that have attracted the radioactive solution or to look for lymph nodes that have turned blue.
If there is no cancer in the sentinel node(s), it is very unlikely that cancer has spread to other lymph nodes. Therefore, no further lymph node surgery is needed. The person can avoid the potential side effects of an axillary lymph node dissection. If cancer cells are found in the sentinel node(s), the surgeon will perform an axillary lymph node dissection to see how many other lymph nodes are involved.
Side Effects of SLNB
- Lymphedema of the arm
Treatment of breast cancer with high energy rays or particles known as Radiation therapy. This therapy is used to kill the cancer cells even after a mastectomy if the tumor size is 5cm or larger than that. Two ways of Radiation therapy as:
- External Beam Radiation Therapy
External Beam Radiation Therapy
The most common type of radiation therapy for women with breast cancer. The radiation is focused on a machine outside the body on the area affected by cancer. When given after surgery, external beam radiation therapy is usually not started until the tissues have healed, often a month or longer.
Accelerated breast irradiation
The standard treatment schedule, in which a woman receives external radiation for 5 days a week over many
weeks can be inconvenient for many women. This approach was studied in a large group of women who had been treated with breast-conserving surgery and did not have cancer spread to underarm lymph nodes.
3D Conformal Radiotherapy
With 3Dconformal radiotherapy, the radiation is given using special machines so that the radiation is more precisely aimed at the cancerous area. This allows more of the healthy breast to be spared. Treatments are given twice a day for 5 days.
Side Effects of External Bream Radiation Therapy
- Heaviness in the breast
- Sun burn like skin changes in the affected area of radiations
- Sometimes Damage the nerves of the arm (Brachial Plexopathy)
- Weaken the Ribs
In Brachytherapy, Instead of aiming radiation beams from outside the body, radioactive seeds or pellets are placed directly into the breast tissue next to cancer, also known as Internal Radiation Therapy. There are several different types of Brachytherapy are given below:
- Interactevartery Brachytherapy
- Interstitial Brachytherapy
Intracavitary brachytherapy consists of a small balloon attached to a thin tube. The deflated balloon is inserted into the space left by the lumpectomy and is filled with a saltwater solution. (This can be done at the time of the lumpectomy or up to several weeks afterward).The balloon and tube are left in place throughout the treatment (with the end of the tube sticking out of the breast). Twice a day, a source of radioactivity is placed into the middle of the balloon through the tube and then removed. This is done for 5 days as an outpatient treatment. The balloon is then deflated and removed. This system goes by the brand name Mammosite.
With interstitial brachytherapy, several small catheters (hollow tubes) are inserted into the breast around the area of the lumpectomy and are left in place for several days. Radioactive pellets are inserted into the catheters for short periods each day and then removed. This method of brachytherapy has been around longer and has more evidence to support it, but it is not used as much anymore.
Chemotherapy is a treatment of cancer with cancer-killing drugs, injected through veins or mouth. it is a systematic therapy means, drugs travel through the bloodstream in veins to reach cancer cells in the body. Chemotherapy is given in cycles, lasts for several months.
When Chemotherapy is used?
There are several situations in which doctors recommend chemotherapy. Situations with explanation are listed below:
Systemic therapy given to patients who have no evidence of cancer after surgery is called adjuvant therapy. Adjuvant therapy after breast-conserving surgery or mastectomy, chemotherapy reduces the risk of breast cancer recurrence. Both chemotherapy and hormone therapy can be used as adjuvant therapies.
Chemotherapy is given before surgery is called neoadjuvant therapy. Neoadjuvant therapy often uses the same chemotherapy drugs used in adjuvant therapy (only before surgery instead of after). The major benefit of neoadjuvant chemotherapy is that it can shrink large cancers so that they are small enough to be removed by lumpectomy instead of mastectomy.
Side Effects of Chemotherapy
The side effects of chemotherapy depend on the type of drugs, the amount taken, and the length of treatment. These are some of the most common possible side effects:
- hair loss
- mouth sores
- loss of appetite
- nausea and vomiting
- increased chance of infections (due to low white blood cell counts)
- easy bruising or bleeding (due to low blood platelet counts)
- fatigue (due to low red blood cell counts and other reasons)
Chemotherapy drugs work by attacking cells that divide quickly, which is why they work against cancer cells. Cells that are also dividing quickly like bone marrow, the lining of mouth and intestine, and the hair follicles. These cells are likely to be affected by chemotherapy. Due to this, the above mentioned side effects faced by breast cancer patients.
Several other side effects due to chemotherapy also possible that are rare but fatal for the patient.
1. Menstrual Changes
It is the most common side effect among young girls, proceeding with chemotherapy. Premature menopause (not having any more menstrual periods) and infertility (not being able to become pregnant) are possible permanent complications of chemotherapy. From the research, it cannot be assumed that it will become a hurdle to conceive a pregnancy during chemotherapy. But it can be dangerous to be pregnant during the chemotherapy process. If breast cancer diagnosed after conceiving a pregnancy, chemotherapy can be given safely during the last 2 trimesters of pregnancy.
A condition that affects certain nerves in the body. It causes numbness and other sensations in certain parts of the body, especially the hands and feet. Several drugs used to treat breast cancer including the taxanes
(docetaxel and paclitaxel), platinum agents (carboplatin, cisplatin), and ixabepilone—can damage nerves outside of the brain and spinal cord. This damage can sometimes lead to symptoms (mainly in the hands and feet) such as numbness, pain, burning or tingling sensations, sensitivity to cold or heat, or weakness. In most cases, this side effect goes away once treatment ends, but it may last longer in some women.
3. Heart Damage
Doxorubicin, epirubicin, and some other drugs may cause permanent heart damage if administered in high doses or used for an extended time.
4. Hand-foot Syndrome
Certain chemotherapy drugs, such as capecitabine and liposomal doxorubicin, can cause problems with irritation that affects the palms of the hands and the soles of the feet. This is called hand-foot syndrome. Early symptoms include numbness, tingling, and redness.
Many women who undergo chemotherapy for breast cancer report a slight decrease in mental functioning, a side effect is known as “chemo brain.”
6. Increased Risk of Leukemia
Very rarely, certain chemotherapy drugs can permanently damage the bone marrow, leading to acute myeloid leukemia, a life-threatening cancer of the white blood cells.
Hormone therapy is another form of systematic therapy. It is mostly used to prevent the recurrence of cancer cells after the surgery. It can be used in combination with several different types of treatments. In women, ovaries are the main source of hormone estrogen until menopause. After menopause, smaller amounts are still made in the body’s fat tissue, where a hormone made by the adrenal gland is converted into estrogen.
Estrogen promotes the growth of about 2 of every 3 of breast cancers—those containing estrogen receptors (ER-positive cancers) and/or progesterone receptors (PR–positive cancers). Several approaches to blocking the effect of estrogen or lowering estrogen levels are used to treat ER-positive and PR– positive breast cancers. Hormone therapy does not help patients whose tumors are not ER– or PR–positive.
Following drugs are used in Hormone Therapy are given below
- Tamoxifen and toremifene (Anti-estrogen drugs, temporarily block estrogen receptors on breast cancer cells).
- Fulvestrant ( also act on estrogen, but eliminates it instead of temporary blocking)
- Aromatase inhibitors (drugs that stop estrogen production in postmenopausal women)
- Ovarian ablation
In this therapy, with the help of drugs, specific cancerous cells are targeted to kill or detect. These targetted drugs work differently from other chemotherapy drugs. They often have different but less severe side effects. Drugs that target specific area are as follows:
- Trastuzumab and Lapatinib that target the HER2/neu protein.
- Bevacizumab (Avastin) drugs that target new tumor blood vessels