What Are My Treatment Options?
Physicians use the results of the diagnostic tests to determine the site of the cancer and to stage it—or tell how far it has spread. This helps determine the outlook for recovery and the best course of treatment.
While breast cancer is often treatable, it can be life threatening. Therefore, patients should work together with their physician to choose among several treatment options that may be used alone or in combination, and understand the risks and benefits of each.
Surgery is the most common form of treatment for breast cancer. It is often followed by radiation and sometimes chemotherapy and/or hormone therapy.
Breast Conserving Surgery There are two types of surgery aimed at sparing the breast:
- Lumpectomy - also called an “excisional biopsy,” a lumpectomy removes the lump as well as some of the healthy tissue around it to check for any remaining cancer cells.
- Partial Mastectomy - this surgery is more extensive and removes the area of the breast containing cancer, some of the tissue around it, the lining of the chest wall underneath the tumor and any affected lymph nodes.
Mastectomy With a mastectomy, one or both of the breasts are removed in their entirety, along with any affected lymph nodes. In 80% of cases, breast reconstruction or implant surgery is performed at the same time.
The female hormones, estrogen, progesterone and estrodial can promote the growth of breast cancer tumors. Hormone therapy uses drugs such as tamoxifen, fulvestrant and aromatase inhibitors, given orally or via IV, to counter the effects of these hormones or stop the body from producing them. They can be used as an adjunct to other therapies and also to reduce the threat of cancer for women at high risk. Another form of hormone therapy is removing the ovaries of a woman who has not reached menopause. Side effects of hormone therapy include fatigue, nausea, hot flashes, vaginal discharge, and mood swings.
Chemotherapy (also called “chemo”) employs oral or injected drugs to kill cancer cells. These drugs enter the bloodstream and travel throughout the body, making the treatment useful for cancers that have spread to distant organs. For breast cancer, chemo is most often used before surgery to shrink large tumors so that a lumpectomy can be performed instead of a mastectomy. It is also often used after surgery to kill any remaining cancer cells and lower the risk of recurrence. It is the primary treatment for breast cancers that have spread (metastasized).
Because chemo kills some normal cells in addition to malignant ones, it can cause side effects that vary depending on the type of drug used. These include, but are not limited to, fatigue, nausea, vomiting, loss of appetite, hair loss, mouth sores, changes in menstrual cycle and infertility. It can also cause low white blood cell and platelet counts resulting in higher risk of infection and easy bruising/bleeding.
This treatment uses natural or synthetic drugs to help the body’s own immune system fight the cancer. Biological therapy is sometimes called biological response modifier (BRM) therapy or immunotherapy.
Radiation that kills or shrinks tumors may be used alone or in combination with other treatments. For breast cancer, radiation is often used to shrink tumors prior to surgery or to kill any cancer cells that remain in the breast, chest wall or underarm afterwards. It can also be used to treat tumors in difficult locations. Radiation therapy can be delivered internally or externally. Side effects are usually limited to irritation around the radiation site, although many patients also report fatigue.
Brachytherapy With brachytherapy, low-dose radioactive seeds (pellets) are placed into the breast tissue, next to the cancer. The seeds give off small amounts of radiation over several weeks. This radiation method carries small risks associated with seed migration within the body.
High Dose Rate (HDR) Brachytherapy Like traditional brachytherapy, HDR brachytherapy delivers radiation from within the body to destroy cancer cells. Unlike traditional brachytherapy, HDR brachytherapy uses a higher dose of radioactive material that is delivered directly to the tumor during a series of outpatient treatments. The precision of this method more effectively destroys tumors with less damage to surrounding tissue, such as the lungs and opposite breast. Because of the high dose of internal radiation, treatment can typically be completed in just 1 week. While its short duration makes HDR brachytherapy an appealing option for all breast cancer patients, this treatment is most appropriate for those with small to medium-sized cancers and little involvement of the lymph nodes.
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Intensity Modulated Radiation Therapy (IMRT) and Image-Guided Radiation Therapy (IGRT) While traditional external beam radiation therapy is typically not the best option for breast cancer, IMRG/IGRT can be very effective. These methods deliver higher radiation doses more precisely to cancerous tumors while avoiding healthy tissue. With IMRT/IGRT, physicians can more effectively treat breast cancer while reducing the chance of side effects caused by damage to surrounding tissue, such as the unaffected breast and other organs. IMRT/IGRT can also potentially shorten the duration of therapy and enable physicians to treat some breast cancers for which traditional radiation therapy was not an option.
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