Breast Cancer (cont.)
Jerry R. Balentine, DO, FACEP
Jerry R. Balentine, DO, FACEP
Dr. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983. He completed his internship at St. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident.
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
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What is the treatment for breast cancer?
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Patients with breast cancer have many treatment options. Most treatments are adjusted specifically to the type of cancer and the staging group. Treatment options should be discussed with your health care team. Below you will find the basic treatment modalities used in the treatment of breast cancer. Treatment modalities are always changing and developing. It is important that you discuss the different options with your health care team.
Most women with breast cancer will require surgery. Broadly, the surgical therapies for breast cancer can be divided into breast conserving surgery and mastectomy.
This surgery will only remove part of the breast (sometimes referred to as partial mastectomy). The extent of the surgery is determined by the size and location of the tumor.
In a lumpectomy, only the breast lump and some surrounding tissue are removed. The surrounding tissue (margins) is inspected for cancer cells. If no cancer cells are found, this is called "negative" or "clear margins." Frequently, radiation therapy is given after lumpectomies.
During a mastectomy (sometimes also referred to as a simple mastectomy), all the breast tissue is removed. If immediate reconstruction is considered, a skin-sparing mastectomy is sometimes performed. In this surgery, all the breast tissue is removed as well but the overlying skin is preserved.
During this surgery, the surgeon removes the axillary lymph nodes as well as the chest wall muscle in addition to the breast. This procedure is done much less frequently than in the past, as in most cases a modified radical mastectomy is as effective.
Modified radical mastectomy
This surgery removes the axillary lymph nodes in addition to the breast tissue.
Depending on the stage of the cancer, your health care team might give you a choice between a lumpectomy and a mastectomy. Lumpectomy allows sparing of the breast but usually requires radiation therapy afterward. If lumpectomy is indicated, long-term follow-up shows no advantage of a mastectomy over the lumpectomy.
Radiation therapy destroys cancer cells with high energy rays. There are two ways to administer radiation therapy:
External beam radiation
This is the usual way radiation therapy is given for breast cancer. A beam of radiation is focused onto the affected area by an external machine. The extent of the treatment is determined by your health care team and is based on the surgical procedure performed and whether lymph nodes were affected or not.
The local area will usually be marked after the radiation team has determined the exact location for the treatments. Usually the treatment is given 5 days a week for 5 to 6 weeks.
This form of delivering radiation uses radioactive seeds or pellets. Instead of a beam from the outside delivering the radiation, these seeds are implanted into the breast next to the cancer.
Chemotherapy is treatment of cancers with medications that travel through the bloodstream to the cancer cells. These medications are given either by intravenous injection or by mouth.
Chemotherapy can have different indications and may be performed in different settings as follows:
Adjuvant chemotherapy: If surgery has removed all the visible cancer, there is still the possibility that cancer cells have broken off or are left behind. If chemotherapy is given to assure that these small amounts of cells are killed as well, it is called adjunct chemotherapy.
Neoadjuvant chemotherapy: If chemotherapy is given before surgery it is referred to as neoadjuvant chemotherapy. Although there seems to be no advantage to long-term survival whether the therapy is given before or after surgery, there are advantages to see if the cancer responds to the therapy and by shrinking the cancer before surgical removal.
Chemotherapy for advanced cancer: If the cancer has metastasized to distant sites in the body, chemotherapy can be used for treatment. In this case, the health care team will need to determine the most appropriate length of treatment.
There are many different chemotherapeutic agents that are either given alone or in combination. Usually these drugs are given in cycles with certain treatment intervals followed by a rest period. The cycle length and rest intervals differ from drug to drug.
This therapy is often used to help reduce the risk of cancer reoccurrence after surgery, but it can also be used as adjunct treatment.
Estrogen (a hormone produced by the ovaries) promotes the growth of a few breast cancers, specifically those containing receptors for estrogen (ER positive) or progesterone (PR positive).
The following drugs are used in hormone therapy:
Tamoxifen (Nolvadex): This drug prevents estrogen from binding to estrogen receptors on breast cells.
Fulvestrant (Faslodex): This drug eliminates the estrogen receptor and can be used even if tamoxifen is no longer useful.
As we are learning more about gene changes and their involvement in causing cancer, drugs are being developed that specifically target the cancer cells. They tend to have fewer side effects then chemotherapy (as they target only the cancer cells) but usually are still used in adjunct with chemotherapy.
Targeting HER2/Neu protein
Monoclonal antibody: Trastuzumab is an engineered protein that attaches to the HER2/Neu protein on breast cancer cells. It helps slow the growth of the cancer cell and may also stimulate the immune system to attack the cancer cell more effectively. Other drugs that target this protein include pertuzumab (Perjeta), ado-trastuzumab emtansine (Kadcyla), and lapatinib (Tykerb).
Drugs that target new tumor blood vessels
Tumors need new blood vessels to grow. The process of blood vessel growth is known medically as angiogenesis. New drugs are being developed to target this growth and fight certain cancers, including breast cancer.
Bevacizumab is a monoclonal antibody directed against blood vessel cells. Newer study results seem to indicate that this drug slows the cancer growth in some patients with metastatic cancer. The use of this medication is still under investigation and should be discussed with your health care team.
Whenever a disease has the potential for much harm and death we search for alternative treatments. As a patient or the loved one of a patient you want to try everything and leave no option unexplored. The danger in this approach is usually found in the fact that the patient might not avail themselves of existing, proven therapies. You should discuss your interest in alternative treatments with your health care team and together explore the different options.
Medically Reviewed by a Doctor on 9/25/2013
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