Treatment of breast cancer may include various methods, such as surgery with or without breast reconstruction, chemotherapy, radiation therapy, hormonal therapy and targeted therapy. Treatment options offered depend on a number of factors, such as the stage of cancer and likelihood of cure, your general health and your preference. Being diagnosed with breast cancer and having to decide on the treatment option is one of the most difficult decisions you will ever have to make. Have someone close to accompany you when visiting the doctor to discuss the result of your tests and treatment options.
A lumpectomy or mastectomy is one of the most common treatments for breast cancer. The type of surgical treatment depends on the stage of the cancer, size of the tumour, in relation to the breast size, whether breast preservation is desired and your feelings about the options.
Breast Conserving Surgery (BCS) Wide Excision/ Lumpectomy
Sentinel Lymph Node Biopsy (SLNB)
X-ray Guided or Ultrasound Guided Hookwire Localisation for Surgery
Mammoplasty (Breast lift / Breast reduction)
Partial breast reconstruction (volume replacement) with a perforator flap
Mastectomy with Breast Reconstruction
This treatment method uses anti-cancer drugs to kill cancer cells. They stop cancer cells from growing and reproducing themselves. These drugs can be given orally (by mouth) or by injection where it enters the blood stream and travels throughout the body. It may be used alone, before (neoadjuvant) or after (adjuvant) surgery, or together with radiation therapy to increase the effectiveness of treatment, depending on the stage of cancer.
Chemotherapy is given in cycles. Each cycle consists of a treatment period followed by a resting (recovery) period. As cancer drugs also affect normal cells, the resting period is to allow the body to recover before the next treatment cycle starts. There are side effects associated with chemotherapy such as hair loss, nausea and vomiting, loss of appetite, mouth ulcers and risk for infection. However, these are temporary and steps can be taken to prevent or reduce them.
High-energy rays are used to kill cancer cells or stop them from growing further. Although radiation therapy can affect both cancer cells as well as normal cells, the aim of radiation is to destroy more cancer cells and spare as many normal cells as possible. Radiation therapy is given to the affected breast after a lumpectomy. In some circumstances, it may be given to the chest wall after a mastectomy. It is given 5 days a week on weekdays, over a period of 5 or 6 weeks. Radiation therapy can cause some side effects which vary among individuals.
The most common side effect is redness and dryness of the skin. Skin texture also becomes darker and thicker. The breast may swell, and increase or decrease in sensitivity. Usually, these effects start to get better when your treatment is completed.
Intraoperative Radiation Therapy (IORT) involves the use of the Intrabeam® device to irradiate the tumour site during the surgery. The administration is done immediately after lumpectomy, also known as breast-conserving surgery. This procedure takes about 20 to 40 minutes. This radiotherapy regime is suitable for some early-stage patients. This treatment may be proposed to patients in the early stage of the disease who opt to keep their breasts.
Some breast cancers grow with the influence of hormones. Patients with both oestrogen receptor (ER) and progesterone receptor (PR) positivity have the best chance of responding to hormonal therapy. Hormone therapy in breast cancer is aimed at affecting oestrogen, a hormone that is required for the cancer to grow. For some women with early breast cancer, anti-cancer hormone treatment may be used as an additional treatment to reduce the chances of breast cancer recurrence. Hormone therapy can cause some side effects. These are dependent on the type of drugs taken and can vary from one patient to another.
Tamoxifen is the most common drug used in this treatment. This drug blocks the action of oestrogen on the body but does not stop oestrogen from being produced. Tamoxifen may cause hot flashes, depression or mood swings, vaginal discharge or irritation, irregular menstrual periods and sometimes menopause. Any unusual bleeding should be reported to the doctor.
Serious side effects from Tamoxifen are rare but Tamoxifen can cause the formation of blood clots in the veins, especially in the legs. In a very small number of women, Tamoxifen can cause cancer in the lining of the uterus. You may be referred to a gynaecologist to evaluate any unusual bleeding.
Aromatase Inhibitors (AI)
For post-menopausal women, another group of drugs called aromatase inhibitors (AIs) is also used in breast cancer hormonal treatment. Aromatase inhibitors work by blocking an enzyme called aromatase that the body uses to produce oestrogen. The current AIs such as anastrozole, letrozole and exemastane, are well tolerated and are used in the treatment of early stage and advanced breast cancer. Side effects of AI include hot flashes, mood changes, nausea, vagina dryness, joint pain/stiffness, tiredness, lethargy and osteoporosis (including a higher risk of fractures compared to Tamoxifen).
You can discuss with your doctor, Breast Care Nurse or pharmacist on what to expect and how to care for yourself during treatment. If there are more concerns, you can also contact the Cancer Helpline at tel: 6225 5655.
Targeted therapy is a form of cancer treatment that involves the use of antibodies or small molecules to bind to specific sites on cancer cells in order to prevent cell growth and division. The aim of the treatment is to reduce or eliminate existing cancer cells in the human body while minimizing side effects on normal cells.
An example of targeted therapy for breast cancer is Trastuzumab (Herceptin®). It is an antibody which targets the HER2 (Human Epidermal Growth Factor Receptor). This receptor is over expressed in about 25% of all breast cancers, the presence of which can be confirmed by laboratory tests performed on the biopsy specimen and which is required for the drug to be effective.
Herceptin® has been shown to prolong survival in patients with HER2 positive advanced breast cancer (Stage 4) and reduce the risk of relapse in patients with early stage HER2 positive breast cancer, when used in combination with chemotherapy.
An increasing number of targeted therapies are becoming available for the treatment of breast cancer, including:
Pertuzumab (Perjeta® targets HER2)
Lapatinib (Tykerb®targets HER2 and EGFR)
Palbociclib (Ibrance® targets cell cycle pathway in hormone positive breast
Ribociclib (Kisqali® targets cell cycle pathway in hormone positive breast cancers
in hormone positive breast cancers)
Everolimus (Afinitor® targets mTOR pathway in hormone positive breast cancers).
Patients who receive targeted therapies may still experience side effects but these are generally milder and less common compared to chemotherapy.
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