How is breast cancer treated?

Tweet

The treatment of breast cancer depends on the clinical stage of the cancer, the pathological type, as well as the patient’s age and wishes. Treatment for invasive cancers Invasive cancers are staged according to the size of the primary breast cancer, the spread to the auxiliary nodes and evidence of spread elsewhere in the body. * Stage 1: the tumor in the breast is small and there is no evidence of spread anywhere * Stage 2: the primary tumor is 5cm or there is evidence of obvious lymphatic spread * Stage 4: there is evidence of spread to other organs such as lung, liver or bone The treatment may be thought of as being aimed at the primary tumor, the lymph nodes or the whole body. Treatment plans are divided into local and systemic therapy. Local therapy, such as surgery and radiation, aims to remove or kill cancer cells in the breast and adjacent lymph nodes. Systemic therapy may be in the form of chemotherapy or hormonal therapy. This may mean a tablet once a day or intravenous drugs. In general: * Stage 1 disease is treated locally, usually with surgery. There is a growing tendency to give patients hormonal therapy even when the disease is in such early stages. * Stage 2 disease is usually treated by surgery first and then systemic treatment afterwards. Systemic treatment given after local treatment when there is no sign of disease is known as adjuvant therapy. * Stage 3 disease is increasingly treated with systemic treatment first to ‘downstage’ the disease and with surgery afterwards. Systemic treatment given before local treatment is known as neoadjuvant therapy. * Stage 4 disease is usually treated systemically, although radiotherapy may be used. Radiation therapy uses high-energy rays to reduce the size of the tumor or destroy cancer remaining in the breast area after surgery. It may be used to control the local tumor in stage 4 disease or may be used to treat local recurrence at a later date. It is generally painless and given as an outpatient. Side effects include fatigue, swelling and sunburn-like skin changes in the treated area. These changes usually disappear in six to 12 months. Radiation therapy is nearly always given after a lumpectomy. Cancer can be cured by local therapy if it has not spread further. Unfortunately, cancer can spread even though the primary cancer is small and there is no evidence of spread to lymph nodes. Breast cancer does not always follow predictable growth patterns, and a prognosis cannot be predicted with absolute certainty. Therefore, systemic therapy is incorporated to treat the potential and actual risk of cancer spreading. Chemotherapy and hormonal therapy are systemic therapies, given via the bloodstream to kill cancer cells that have spread beyond the breast. Chemotherapy comprises drugs received intravenously or by mouth. Hormone therapy involves drugs that change the way hormones work, or the removal of hormone-producing organs such as the ovaries. More patients are being put on systemic treatment after apparently curative surgery as there is increasing evidence that patients are less likely to develop problems, such as recurrence, second primary in the remaining breast tissue or metastatic disease, if they take systemic treatment. The traditional roles of hormonal treatment and chemotherapy are constantly being challenged and are changing, although hormonal therapy in a tablet form is still the most common form of adjuvant therapy. The surgical options must be considered from various angles: the treatment of the breast, the treatment of the lymph nodes and the question of reconstruction. Mastectomy means removal of all the breast tissue. If this is done by a breast surgeon, 3-5% of the breast tissue will still be left between the muscle bundles or in the skin. Originally, radical mastectomy was done as a standard procedure. It entails removal of the breast, underarm lymph nodes and chest muscles under the breast. Because of disfigurement and side effects, and because modified radical mastectomy has proved equally effective, radical mastectomy is now rarely done. Modified radical mastectomy entails removal of the breast tissue, the fascia on top of the muscle and the lymph nodes. It is less disfiguring and may be done to achieve a flat chest wall or may be done through the nipple to allow immediate reconstruction. Simple or total mastectomy removes the breast, but not underarm lymph nodes nor muscle tissue beneath the breast. In certain circumstances, if the tumor is