Breast Cancer Treatments: Overview
Once there is a diagnosis of breast cancer, the medical team will evaluate all diagnostic criteria and consider the best treatments and management approach for a particular breast cancer patient.
Determining the best treatments for breast cancer will depend upon the:-
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Adjuvant Breast Cancer Treatments
The most common and historically effective adjuvant breast cancer treatments include
- radiation treatment
- chemical therapy (or chemotherapy)
- hormone therapy (sometimes called endocrine therapy)
The above are the main 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.
Your breast cancer team will plan the treatments and they are usually sequential. So, 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 Breast Cancer Treatments
If your breast cancer physicians discover and treat the breast cancer 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 can return to the same area.
So, to help prevent local recurrence, a surgeon will try to remove the tumor with wide margins and also possibly treat the area with radiation.
Doctors may apply chemotherapy or hormone therapy, even for localized breast cancer, 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 not 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 treatments
An adjuvant breast cancer therapy is one that doctors prescribe 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 systemic breast cancer therapies.
A neoadjuvant breast cancer treatment is one that doctors apply 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 necessary. In addition, in some cases, physicians may apply a neoadjuvant treatment in the hope of making the surgery more effective and lasting.
Breast cancer surgical interventions
Diagnosis and subsequent breast cancer treatments usually involve a certain amount of either major or minor surgery.
Sometimes, in order to learn more about a breast cancer tumor itself, a surgeon will excise (surgically remove) a small portion of it for histological evaluation.
If the tumor is small or early stage enough, (or not 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.
There are several types of breast surgery so let’s take a look:-
If the surgeon can easily remove the tumor mass, because it is small and well defined, then surgeons will perform a simple ‘lumpectomy’ (sometimes called tumorectomy).
Full or Simple Mastectomy
When the surgeon needs to remove the entire breast.
A Partial Mastectomy
If the surgery removes only a part of the affected breast, it is a partial mastectomy.
If the surgeon removes the entire breast and also some of the underlying muscle tissue and some lymph nodes.
Breast cancer will eventually metastasize without treatment
Malignant breast cancer spreads or metastasizes to other areas of the body without treatment. So, 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. Thus, 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 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.
Medics sometimes use chemotherapy, to treat early stage breast cancer. Also physicians may prescribe chemotherapy 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, doctors will use a combination of agents. 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 is really chemotherapy. For example, the taking of antibiotics, or 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) and 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. In some breast cancer cases, hormones can fuel the tumor growth.
No one exactly knows or can predict what brings about the production of certain hormones and the exact changes and interactions that hormones will cause. However, histology procedures test and analyze each breast cancer tumor to reveal particular hormones. Histology determines which hormones are either present or absent, or possibly over expressed in a breast cancer.
Based on these hormonal profiles, which will be specific to each case, (and often different for various types of breast cancer), doctors will prescribe chemical-hormonal agents. So, these drugs 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 treatments
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 for monitoring and preventing local recurrence and distant metastasis.
So, the modern approach to breast cancer treatments tend to be multi-modal. This implies some combination or permutation of surgery, radiation and chemical or endocrine therapies. Furthermore, physicians apply the treatments at various stages in the management of the disease.
Statistically, breast cancers that specialists treat 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, for benign or likely-benign breast lesions, not yet or not necessarily a threat for breast cancer, the treatment will be a more simplistic approach. (usually simple excision).
Additional and future breast cancer treatment approaches
Other treatment methods for breast cancer at the present time include:-
- biological therapy
- gene therapy
- stem cell-bone marrow transplantation
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.
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