Medical Treatments for Breast Cancer

Earlier detection has made a positive impact on the survival of women who have been diagnosed with breast cancer.

There's often more than one treatment option for breast cancer. Discuss the options that are best for you with your doctor. Research your options and get all your questions answered before making a decision.

Breast cancer treatments have progressed significantly. Most women can function close to full capacity when undergoing any of these treatments. Earlier detection has made a positive impact on the survival of women who have been diagnosed with breast cancer and most women can look forward to long healthy lives.

Whatever treatment plan you and your doctor choose, it will usually consist of some of the following components:

Most women can function close to full capacity when undergoing breast cancer treatment.

Surgery

In the past, the only surgical option for breast cancer was a radical mastectomy, which removed the entire breast, the chest muscle, and lymph nodes. There are now breast saving surgeries and less radical mastectomies.

Part of your surgery usually entails the removal of lymph nodes; either a sentinel lymph node analysis or lymph node dissection. This allows your surgeon to determine if the cancer has spread beyond the breast. If your surgeon opts not to remove lymph nodes for testing, make sure you understand why.

After a mastectomy, many women feel self-conscious about their appearance. Options following a mastectomy include doing nothing, wearing a prosthesis, or having reconstructive surgery. A plastic surgeon can discuss the options in more detail regarding implants or tissue transfer reconstruction.

Following are some of the common surgical options:

Lumpectomy

With a lumpectomy, the cancer and some surrounding normal tissue is surgically removed. Your surgeon is likely to also do a sentinel node analysis to determine if the cancer has spread.

A lumpectomy is usually accompanied by radiation. Both together usually have the same survival rate as a mastectomy.

Not every woman with breast cancer is a candidate for a lumpectomy. Based on the number and locations of tumors and sensitivity to radiation, lumpectomy may not be an option.

Partial Mastectomy

A partial mastectomy is a breast sparing technique that removes the tumor(s), surrounding tissue, and the lining of the chest muscles. Your surgeon is likely to also do a sentinel node analysis to determine if the cancer has spread. This surgery is usually followed by radiation therapy.

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Simple Mastectomy

With a simple mastectomy, all breast tissue is removed. All lobules, ducts and fatty tissue are removed, as well as a strip of skin with the nipple and areola. Your surgeon is likely to also do a sentinel node analysis to determine if the cancer has spread. The chest muscles are left intact, which makes breast reconstruction less complicated. Radiation, chemotherapy or hormone therapy may also be required, depending on the outcome of the surgery and follow-up tests.

Modified Radical Mastectomy

During this procedure, the surgeon removes your entire breast and some underarm lymph nodes (axillary node dissection). The chest muscles are left intact, which makes breast reconstruction less complicated. Since lymph nodes are removed, lymphedema (serious arm swelling) is more likely to occur as a result of this procedure than a simple mastectomy.

Your lymph nodes will be tested to see if the cancer has spread. The results of those tests will indicate whether further treatment is needed.

Sentinel Node Analysis

The sentinel nodes are the first lymph nodes to receive drainage from breast tumors and therefore the first to develop breast cancer. By testing these nodes first, the surgeon can determine with a high degree of reliability if the cancer has spread. If no cancer is found in the sentinel nodes, it is unlikely that cancer will be found in other lymph nodes. In this case, the lymph nodes under the arm are spared, reducing the possibility of lymphedema that can occur after lymph node removal. If cancer is found in the sentinel nodes, more lymph nodes may be removed.

Preparation for the sentinel node analysis is completed before surgery, as follows:

  1. A small amount of radioactive material is injected into the breast tissue surrounding a diagnosed breast cancer using ultrasound guidance. You may feel a brief stinging sensation.
  2. In one hour, the axilla (underarm) is scanned with a special nuclear medicine camera to locate the greatest concentration of the radioactive material, or tracer.
  3. A hand-held instrument is used to locate the exact lymph node(s) where there is uptake of the tracer. This does not indicate the presence of cancer cells.
  4. The area is anesthetized with local anesthesia and a tiny wire is placed to assist the surgeon in locating the appropriate lymph node during the lumpectomy or mastectomy.

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Axillary Node Dissection

With axillary node dissection, the lymph nodes in the underarm are surgically removed and examined for cancer. This may be done when treating invasive/infiltrating cancers; however, sentinel node analysis is now the standard of care for most breast cancer surgeries.

The outcome of the lymph node examination may affect treatment recommendations. About 10-30% of women who undergo this procedure will experience lymphedema as a side effect.

Radiation Therapy

Your oncologist may recommend radiation therapy if you’re having a lumpectomy or if cancer was found in more than four lymph nodes.

Radiation may be administered externally from a machine or locally at the site of the tumor using a radioactive material (brachytherapy). External radiation is most commonly used to treat breast cancer.

External Radiation

External radiation therapy uses high-energy x-rays to destroy cancer cells that may be left in the breast or lymph nodes after surgery.

External radiation is a cumulative therapy, with treatments usually occurring five days per week for six or seven weeks. Treatments are painless and last around 30 minutes. Radiation therapy usually begins three to four weeks after surgery.

By the end of the treatment series, you may become tired and experience swelling or tenderness in your breast, as if it were sunburned. There is no nausea or hair loss. Serious side effects from radiation therapy are rare.

Brachytherapy

Radiation can be given by placing a catheter or a balloon system to hold a radioactive material at the tumor site. Brachytherapy may be used in conjunction with external radiation. These methods are being studied as a solitary source of radiation. Results have been good; however, long-term results are limited.

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Chemotherapy

Chemotherapy is a treatment in which anti-cancer drugs are given by IV or pills to destroy cancer cells that have escaped to other parts of the body. Several drugs are usually used together. Your medical oncologist will discuss the options, risks, and benefits of chemotherapy with you.

There are several ways in which an oncologist can choose to use chemotherapy. It may be used as the main treatment for women whose breast cancer has already spread past the breast and lymph nodes. It may be used after surgery to reduce the chance of the breast cancer returning. Chemotherapy may also be used before surgery to reduce the size of a tumor and make it easier to remove.

Chemotherapy drugs also damage healthy cells, which can lead to side effects. Not everyone experiences side effects, but many people suffer from hair loss, nausea, vomiting, mouth sores, changes in menstruation, and fatigue. The specific side effects vary depending on the drugs used. There are now better ways to control side effects, including medications for nausea, exercise, guided imagery and meditation. Most side effects go away after the treatment is over.

Chemotherapy is given on an outpatient basis. It’s done in cycles with breaks in between. The total course of treatment may take up to six months. Many women are able to continue working while receiving chemotherapy.

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Hormonal Therapy

Hormone therapy is usually used to treat women who have metastatic breast cancer (that has spread to other body parts) or to prevent a recurrence of breast cancer in women with estrogen-receptor-positive breast cancer.

With some types of breast cancer, the female hormones estrogen and progesterone can bind to the cancer cells and accelerate their reproduction. When your doctor is diagnosing your breast cancer, he or she will perform tests to determine if your particular cancer has receptors to bind to estrogen or progesterone. If your cancer has these receptors, it is referred to as estrogen-receptor-positive breast cancer. This type of breast cancer is often treated with hormone therapy. Hormone treatments reduce the amount of estrogen binding the cancer cells thereby slowing or preventing their growth.

The two most common drugs used for hormone therapy are listed below.

Tamoxifen

Tamoxifen has been used for 25 years to treat estrogen-receptor-positive breast cancer. It works by binding to the estrogen receptors in the cancer cells so that estrogen cannot bind there. It is used to treat women with metastatic breast cancer to slow the growth of the breast cancer cells that have traveled to other parts of the body. It is also used to prevent the recurrence of cancer in women with early stage breast cancer. Tamoxifen is also used as a treatment for high-risk women to prevent the initial development of breast cancer.

Tamoxifen is less toxic than other cancer medications, but it is not trouble-free. It may cause menopausal symptoms, such as hot flashes, irregular menstruation, fatigue and fluid retention. In both men and women, it may cause headaches, nausea, skin rash, and sexual side effects. Serious complications are possible, but uncommon.

Aromatase Inhibitors

These drugs work by preventing the body from making estrogen. They are used to treat metastatic breast cancer and to prevent the recurrence of early stage breast cancer, but only in post-menopausal women. Aromatase inhibitors may be used after or instead of tamoxifen to lessen the possibility of breast cancer coming back.

Since these drugs remove estrogen from the body, they can cause the bones to thin and fracture. You may benefit from a bone density test as a baseline before treatment. Discuss these drugs and their side effects with your oncologist.

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