What are the treatments for breast cancer?

Treatments for breast cancer

There are many types of breast cancer and treatment is individually tailored to that particular breast cancer type and stage. Other considerations for choosing treatments depend on the patient’s age; whether the woman is menopausal; and whether the tumor is sensitive to estrogen hormones. Treatment options for breast cancer include: surgery, chemotherapy, radiotherapy, hormonal therapy, and targeted therapies. Surgery is usually the first option for treatment for breast cancer.

Surgery – Surgery involves removing the cancerous tissue along with boundary tissue (lumpectomy). Unfortunately, up to 1/3 of patients require a complete removal of the breast (mastectomy). Sometimes, the cancer cells are present in the lymph nodes and may need to be surgically removed. Breast cancer surgery is often combined with radiotherapy to further shrink the tumor size or prevent the cancer cells from spreading.

Chemotherapy – chemotherapy drugs work by shrinking the size of cancerous lumps. A combination of chemotherapy drugs may be given before surgery (neoadjuvant) or after surgery (adjuvant). The goal of neoadjuvant chemotherapy is to reduce the size of the tumor before surgical removal, while the objective of adjuvant therapy is to reduce the rate of reoccurrence and prevent the spread of cancer cells.

Adjuvant chemotherapy (after surgery) - Additional adjuvant chemotherapy after surgery is sometimes recommended for the following types of breast cancer:

• Cancer cells found in the lymph nodes (node-positive)
• Tumors larger than 2 centimeters in diameter
• HER2-Positive
• Estrogen receptor-negative
• Progesterone receptor-negative

Chemotherapy drugs affect cancerous cells as well as some normal cells, such as hair, bone marrow, and intestinal cells. Therefore, drugs are often given in staggered dosages, so that the normal cells have time to recover. Drugs are injected intravenously over 3 to 6 months after surgery.

Side effects of chemotherapy include:

• Nausea
• Vomiting
• Diarrhea
• Short term hair loss
• Depression or fatigue
• Premature menopause
• Low blood cell counts

Radiotherapy – high-energy radiation eliminates cancer cells that remain in the breast after a surgical procedure. Radiotherapy is generally given 5 times per week for at least 5 weeks.

Radiotherapy is recommended for:

• Invasive breast cancer
• Node –positive breast cancer - cancer cells found in the lymph
• Ductal carcinoma in situ (DCIS)
• Tumors larger than 2 inches

Hormonal Therapy – at least 50% of breast tumors are sensitive to estrogen and/or progesterone (hormone receptor positive). Hormonal therapy works by blocking the effects of those hormones. Hormonal therapy is not applicable to hormone receptor negative tumors. The type of hormonal therapy often depends on whether the patient is pre or post-menopausal.

Tamoxifen - blocks the ability of estrogen to attach to cell receptors. Tamoxifen is administered to pre and post menopausal women for 5 years.

Aromatase inhibitors (anastrozole, letrozole, or exemestane) - stops the production of estrogen in postmenopausal women. Aromatase inhibitors are often taken after several years of tamoxifen treatment.

Ovarian ablation – options include surgery or medications to prevent the ovaries from producing estrogen. Some medications are reversible and allow women to remain fertile.

Targeted Therapy – targeted drugs are more specific to cancer cells than chemotherapy, which attack cancerous as well as normal cells. As a result, targeted therapy has fewer side effects than chemotherapy.

Herceptin (trastuzumab) – an option for only HER2-positive breast tumors. About 20% of women with breast cancer are HER2-positive. Herceptin is a drug that attaches to HER2 receptors and blocks signals for tumor growth.

Avastin (bevacizumab) – an option for metastatic cancer that has spread to other parts of the body. Avastin prevents the formation of blood vessels that supply cancerous cells.