Breast Cancer treatments: Overview
Once breast cancer has been diagnosed, the medical team with evaluate all diagnostic criteria and consider the best treatment and management approach for a particular breast cancer patient. The type of breast cancer, the tumor stage and grade, and also the age and health of the patient play a role in determining the best treatment approach.
The main or ‘primary‘ approach to breast cancer treatment is usually through surgery. Other treatments are usually, but not always, employed in addition to surgery, and these are referred to as ‘adjuvant‘ therapies.
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The most commonly used and historically effective adjuvant breast cancer therapies include radiation treatment, chemical therapy (or ‘chemotherapy’), and hormone therapy (sometimes called endocrine therapy). Those are the main tried-and-tested treatments for successfully treating breast cancer. There are additional ‘supplemental‘ treatments which might increase the effectiveness of the above, but essentially surgical intervention, along with chemical, radiation, and hormonal treatments, is the ‘first line‘ of treatment for breast cancer.
Treatments are well planned and sequential, and the choice of a given treatment modality will mostly depend on whether the cancer is being treated at a local or at a systemic level. And remember, that almost 90% of breast cancers are curable.
Localized vs. systemic treatment for breast cancer
If the breast cancer is discovered and treated while still ‘contained‘ in the breast regions, the treatment is called a ‘localized‘ treatment. In addition to removing the existing cancer, the concern is that the breast cancer could return to the same area. So, to help prevent local recurrence, a surgeon will try to remove the tumor with ‘wide margins‘, and the area might be treated with radiation.
Chemotherapy or hormone therapy might be applied, even for localized breast cancer treatment, depending on the nature of an individual tumor. But, if there is evidence that the breast cancer has spread or ‘metastasized‘ to the lymph nodes, (which would then be considered an advanced stage III or stage IV breast cancer), the treatment would be more ‘systemic‘ in nature. At that point surgery alone can’t be curative, and treating a systemic breast cancer is really the area where therapy with medicines comes into its forte.
Adjuvant vs Neo-adjuvant breast cancer treatment
An adjuvant breast cancer therapy is one applied after the initial surgery, or at the same time. Most of the time, surgery is the main or ‘primary‘ treatment, while radiation, chemotherapy, and hormone therapy are given as adjuvant treatments.
A ‘neoadjuvant‘ breast cancer treatment is one applied before the use of surgical intervention. Sometimes the hope is that a neoadjuvant chemical or radiation treatment will actually stop the cancer and no surgery will be needed, and in some cases a neoadjuvant treatment may be applied in the hopes of making the surgery more effective and lasting.
Breast cancer surgical interventions
Diagnosis and subsequent treatment of breast cancer usually involves a certain amount of either major, or minor surgery.
Sometimes in order to learn more about a suspected breast cancer tumor itself, a small portion of the tumor is ‘excised‘ (surgically removed) for histological evaluation. If the tumor is small or ‘early stage‘ enough, (or not considered cancer or a cancer threat), that sample-biopsy excision can often remove the entire lesion in question and result in a cure. But once the biopsy report comes back and confirms the the lesion to be either malignant breast cancer or some other breast disease that suggests aggressive surgical intervention, then a decision is made to remove the lump and possibly the breast itself.
If just the tumor mass can be easily removed (because it is small and well defined), then a simple ‘lumpectomy‘ (sometimes called ‘tumorectomy’) is performed. If the entire breast is removed, the procedure is termed a full or simple mastectomy, and if only a part of the affected breast is removed, it is termed a partial mastecomy. If the entire breast and also some of the underlying muscle tissue and some lymph nodes are also surgically removed, then the term ‘radical mastectomy‘ is generally used.
Breast cancer will metastasize (if left untreated long enough)
Malignant breast cancer spreads or ‘metastasizes‘ to other areas of the body if left untreated, and the first place the spreading is likely to show up is in the lymph nodes, particularly the lymph nodes in the armpit or ‘axilla‘ region. So, breast cancer treatment may involve the surgical excision of a number of these axillary lymph nodes to evaluate whether or not the breast cancer has spread. If breast cancer is found in the lymph nodes, they too may be surgically removed.
Radiation treatment for breast cancer
Radiation treatment for breast cancer is primarily aimed at preventing local recurrence of carcinoma at the site of surgery. These areas are ‘irradiated‘, which essentially destroys any ‘missed‘ or ‘hiding‘ malignant cancer cells at a molecular level, so they cannot multiply. Of course, radiation therapy kills healthy cells in the area as well. In effect, radiation damages all the cells in the path of the beam, but healthy cells are able to repair, while cancer cells, which are more ‘poorly organized‘, have a harder time repairing, and so die off. Statistically, the combination of radiation therapy following surgery has proven to be a very effective treatment for early to mid stage breast cancers (which have not yet metastasized). However, if the cancer has spread to the lymph nodes, these areas are still sometimes treated with radiation, either with or without surgery, and with or without chemotherapy.
Breast cancer chemotherapy with medicines
Treatment of breast cancer by chemical medications, taken either orally or intravenously, is a common method of treating breast cancer which has either metastasized, or is threatening to metastasize, to the lymph nodes or other body areas. It can also be used, though rarely, to treat early stage breast cancer, and sometimes chemotherapy is used ‘prior‘ to breast cancer surgery in hopes of lessening odds of recurrence.
Breast cancer chemotherapy is a very large and confusing topic, especially for the patient. Very often, a combination of agents is used. Breast cancer chemical medications are a major thrust of the drug companies, with new medications and combinations being tested and coming out all the time. But essentially chemical breast cancer therapy aims to weaken or destroy the cancer cells in the body, by interfering with their ability to grow and divide.
Breast cancer chemotherapy
“Chemotherapy” is in some ways an over-arching term, because anything taken in the form of a medication would really be considered chemotherapy. For example, the taking of antibiotics, or taking medications which involve hormones, are really also types of chemotherapy. But in general breast cancer chemotherapy refers to the use of specific agents which are ‘toxic‘, (cytotoxins) which kill the cells, essentially by poisoning them.
Hormone or ‘endocrine’ breast cancer therapy
Hormone therapy, also called endocrine therapy, is a very specific or ‘targeted‘ approach to treating breast cancer in a ‘systemic‘ way. Breast cancer growth is ‘fueled‘ by hormones. No one exactly knows or can exactly predict what brings about the production of certain hormones and exactly the changes and interactions that hormones will cause. However, each breast cancer tumor may be tested and analyzed histologically to reveal particular hormones which are either present or absent, or possibly ‘over expressed‘ in a given patient. Based on these hormonal profiles, which will be specific to each case, (and often different for various types of breast cancer), chemical-hormonal agents may be administered which either suppress the growth potential of hormones characteristic to a given breast cancer tumor, or, enhance the potential of hormones which tend to suppress or stop cell proliferation.
Multi-modal breast cancer treatment
Breast cancer diagnosis and treatment can be a complex and dynamic process. The medical team has to consider treatments before and after the primary treatment of the breast cancer. And, they must also consider follow-up evaluations and follow-up treatments aimed at monitoring and preventing local recurrence and distant metastasis. So, the modern approach to breast cancer treatment tends to be ‘multi-modal‘, which implies some combination or permutation of surgery, radiation, and chemical or endocrine therapies, and applied at various stages in the treatment and management of the disease. Statistically, breast cancers treated with an individualized, multi-modal approach, tend to have a stronger prognosis than a single treatment method. Of course, early stage and ‘in situ‘ breast cancers may not require a multi-modal approach. Likewise, benign or likely-benign breast lesions, not yet or not necessarily a threat for breast cancer, may also be treated with a more simplistic approach. (Usually simple excision).
Additional and future breast cancer treatment approaches
Among other treatment methods being utilized or tested at the present time, include ‘biological‘ therapy, gene therapy, immunotherapy, and stem cell-bone marrow transplantation therapies.
For further reading, I suggest you visit this page that has a brief overview of typical treatments for pre-invasive breast cancers, you can go to this page for breast cancer stages and progression, as well as this page to go to the breast cancer screening index.
- Montgomery, AC, Greening, WP, Levene, AL. Clinical study of recurrence rate and survival time of patients with carcinoma of the breast treated by biopsy excision without any other therapy. J R Soc Med 1978; 71:339.
- Fisher, B, Anderson, S, Bryant, J, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 2002; 347:1233.
- Haffty, BG, Goldberg, NB, Rose, M, et al. Conservative surgery with radiation therapy in clinical stage I and II breast cancer. Results of a 20-year experience. Arch Surg 1989; 124:1266.
- von Minckwitz, G (March 2007). "Docetaxel/anthracycline combinations for breast cancer treatment". Expert Opinion on Pharmacotherapy 8 (4): 485495.
- Wilcken, N., Dear, R., Chemotherapy in metastatic breast cancer: A summary of all randomised trials reported 20002007. European Journal of Cancer October 2008 ) Volume 44, Issue 15 , Pages 2218-2225,
- Epstein RJ. Adjuvant breast cancer chemotherapy during late-trimester pregnancy: not quite a standard of care. BMC Cancer. 2007 May 30;7:92.
- Cole BF, Gelber RD, Gelber S, Coates AS, Goldhirsch A: Polychemotherapy for early breast cancer: an overview of the randomised clinical trials with quality-adjusted survival analysis. Lancet 2001 , 358(9278):277-286.
- Regan MM, Gelber RD: Predicting response to systemic treatments: learning from the past to plan for the future.Breast 2005 , 14(6):582-593.
- Pritchar, K. Endocrinology and hormone therapy in breast cancer: Endocrine therapy in premenopausal women. Breast Cancer Res. 2005; 7(2): 7076.
- Early Breast Cancer Trialists’ Collaborative Group Effects of adjuvant tamoxifen and of cytotoxic therapy on mortality in early breast cancer: an overview of 61 randomized trials among 28,896 women. N Engl J Med. 1988;319:16811692.
- Beatson GT. On the treatment of inoperable cases of carcinoma of the mamma: suggestions for a new method of treatment with illustrative cases. Lancet. 1896;2:104107.
- Engelsman E, Klijn JC, Rubens RD, Wildiers J, Beex LV, Nooij MA, Rotmensz N, Sylvester R. Classical CMF versus a 3-weekly intravenous CMF schedule in postmenopausal patients with advanced breast cancer. Eur J Cancer. 1991;27:966970.
- Seymour, HL, Khan, FM., Boen, JR., Potish, RA., Bowers, BJ. Multimodal therapy in the treatment of breast cancer. American Journal of Clinical Oncology: August 1983 – Volume 6 – Issue 4 – ppg 387-392
- Buzdar AU. Role of biologic therapy and chemotherapy in hormone receptor- and HER2-positive breast cancer.Ann Oncol. 2009 Jun;20(6):993-9
- Roy, V., Perez, EA. Biologic therapy of breast cancer: focus on co-inhibition of endocrine and angiogenesis pathways. Breast Cancer Research and Treatment. Volume 116, Number 1, 31-38
- Obermiller, PS., Tait, DL, Holt, JT., Gene therapy for carcinoma of the breast: Therapeutic genetic correction strategies. Breast Cancer Res 2000, 2:28-31
- Soliman, HS. Developing an Effective Breast Cancer Vaccine. Cancer Control. 2010;17(3):183-190.
- Beug, Hartmut., Breast Cancer Stem Cells: Eradication by Differentiation Therapy? Cell,(august 2009) Volume 138, Issue 4, 623-625, 21.