An oncologists prescribe the method of breast cancer treatment according to:
- the size of malignant tumor;
- stages of tumor development;
- presence of metastases;
- the age of a patient;
- planning of pregnancy.
The methods of breast cancer treatment are divided into:
- hormonal therapy;
- target therapy;
Surgical treatment of breast cancer
The surgical method is considered as the radical one. The main goal of surgery is complete removal of the tumor and the lymph nodes (if necessary) in the initial stages of cancer.
Lumpectomy is an organ-preserving kind of surgery for breast cancer treatment. During the operation a surgeon removes tumor with some healthy tissue and axillary lymph nodes. After the procedure, the oncologists provide radiation therapy of the remaining tissues to damage possibly remaining malignant cells.
Mastectomy is the complete removal of the mammary gland performing when the tumor is large in size or spreads over the mammary gland. Also the specialists remove axillary lymph nodes (if necessary).
Providing of mastectomy or lumpectomy depends on such factors:
- whether a patient has contraindications for radiation therapy;
- whether a doctor will perform the breast reconstruction;
- probability of relapse after the mastectomy;
- importance of preserving the breast for a woman;
- planning the pregnancy.
Types of surgical treatment
Lumpectomy and radiotherapy are called breast-preserving types of surgical treatment.
Lymph nodes resection during the breast tumor surgery
The oncologists remove the lymph nodes (lymph node dissection) due to prevent the spread of the tumor throughout the body. However, if breast cancer has spread to other organs and tissues, the specialists perform systemic treatment.
Performing the lymph nodes dissection, the surgeon removes the nearby lymph nodes (axillary).
The sentinel lymph node is the first one receives lymph from the chest.
If the tumor has spread to the lymphatic ducts, its cells can be found in the sentinel node.
Axillary lymph dissection is the removal of not only the sentinel nodes, but also the distant ones. In cases of extensive lesion, the oncologists remove at least 10 axillary, supraclavicular, subclavian and intrathoracic nodes.
The specialists do not perform axillary lymphadenectomy if a biopsy shows tumor cells in the sentinel nodes. But if lymph node lesion is detected with another method, the lymph nodes are removed.
Type of lymph node dissection
Cases of performing
Removing of sentinel nodes
- if the clinical examination (palpation) or the results of ultrasound imaging and MRI show no signs of tumor in the lymph nodes.
Axillary lymph node dissection
- if malignant cells are found with a biopsy;
- if 3 or more lymph nodes are affected;
- if the tumor is over 5 cm in size;
- if a mastectomy has been performed;
- if you do not receive radiation therapy or neoadjuvant chemotherapy.
Side effects after the surgical treatment
The side effects after the tumor removal depends on the surgical method (complete or partial) has been carried out.
The most common side effects are pain, weakness, lymphedema.
Specialists provide mastectomy under the general anesthesia which leads to dizziness, headache, confusion, throat pain, nausea, vomiting, itching and pain in the muscles.
The most serious side effect of mastectomy is lymphedema.
Lymphedema is the swelling of the limbs caused by lymph stagnation during surgical the tumor and lymph nodes surgical removal.
Lymphedema can develop immediately after surgery or after some time.
Signs of lymphedema after the tumor and lymph nodes removal are:
- limbs swelling;
- heavy arms;
- reduced flexibility of the limb;
- clothes, watches, bracelets, which were sitting on their hands freely, become tight.
If you observe unpleasant symptoms after lumpectomy or mastectomy, tell a doctor about it.
Chemotherapy and targeted therapy for breast cancer
For breast cancer treatment the oncologists use drugs that destroy malignant cells and inhibit tumor growth, so-called cytotoxic drugs. The specialists provide the drugs as:
- neoadjuvant chemotherapy used to reduce the tumor (over 2 cm in size);
- basic therapy - oncologists prescribe chemotherapy drugs in case of the tumor inoperability to facilitate the disease;
- adjuvant chemotherapy used after surgical removal of the formation to destroy the remaining malignant cells and prevent relapse.
As an adjuvant treatment, chemotherapy is prescribed to reduce the chances of a tumor returning. The prognosis of relapse is individual and is based on many factors, but it is established that many types of breast cancer are prone to spread throughout the body.
Patients with a diagnosis are exposed to a risk:
- invasive lobular (lobular) carcinoma;
- invasive ductal carcinoma;
- metaplastic carcinoma;
- carcinoma of mixed type.
Ask your doctor what are the chances of recovering breast cancer after treatment in your case.
Chemotherapy is not recommended if the tumor is less than 0.5 cm and does not spread. If the tumor is more than 1 cm or at least one lymph node is affected, chemotherapy may be prescribed.
Some chemotherapy drugs kill malignant cells, affecting their DNA, and some - regulate the growth of cells.
Slow down the development of tumor cells HER2-inhibitors, which are used if HER2 receptors were detected in immunohistochemical studies. This approach is called targeted therapy.
To help the body recognize and fight malignant cells, monoclonal antibodies have been created - proteins that attack malignant cells without damaging the healthy.
Biological treatment is effective if an HER2 gene defect has been detected in immunohistochemical studies.
The HER2 / neu gene is responsible for the growth and division of cells in the body.
HER2-positive breast cancer is aggressive and less amenable to standard treatment.
Side effects of chemotherapy
The drugs are prescribed by cycles and include days of medication and rest days.
Before prescribing chemotherapy, a doctor may cancel the taking of certain medicines. You may also be prescribed a diet. With chemotherapy, you can not take alcohol and smoke.
Chemotherapy for breast cancer
Response to drugs in different patients is different. It depends on the type of drug, the duration of its use, the individual characteristics of the organism.
Side effects are caused by cell damage and include:
- hair loss
- lack of appetite,
- nausea and vomiting, diarrhea,
- a decrease in the number of blood cells,
- memory changes, weakness, fatigue;
- accelerated menopause.
Chemotherapy is not prescribed if the patient is in the first trimester of pregnancy.
Drugs for targeted therapy also cause side effects, such as headache, weakness, allergies, muscle pain, fever. Also, hair falls out, rashes on the skin and ulcers in the mouth may appear. If any side effects occur, consult a doctor. He can prescribe additional medications that will help you feel better.
Hormonal therapy for breast cancer
For the treatment of breast cancer hormonal drugs are used to:
- reducing the likelihood of breast cancer at high risk;
- additional treatment after surgery at an early stage to reduce the risk of relapse;
- treatment of metastatic breast cancer.
Treatment with hormonal therapy reduces the risk of recurrence of breast cancer by 30-40% and the appearance of a tumor in another gland.
For hormonal therapy of breast cancer are used:
- antiestrogens are substances that bind the hormonal receptor of estrogen, blocking the growth of malignant cells (Tamoxifen and Fareston drugs). They are prescribed for treatment at an early stage or with metastatic cancer.
- aromatase inhibitors are substances that reduce the production of estrogens and reduce tumor growth. Drugs are prescribed only to women in menopause.
- ablation of the ovaries - "turning off" the function of the ovaries, which stops the production of estrogen. Can be radial (through the impact of radiotherapy) or surgical - a bilateral oophorectomy, in which the ovaries are removed.
- substances to suppress ovarian function (suppression) - stimulate the ovaries to produce less estrogen.
If the patient is pregnant, breast hormone therapy can be administered after the birth of the child.
Hormone therapy is not prescribed if the tumor size is less than 1 cm, except when the breast is affected by an invasive lobular or ductal carcinoma. In this case, hormone therapy can be prescribed even if the tumor size is less than 0.5 cm.
Side effects of hormone therapy
With hormonal therapy for breast cancer, the patients observe symptoms of menopause, hot flashes, thinning of hair and bones, overweight, mood changes.
Rare uterine and blood clots (Tamoxifen); aromatase inhibitors cause the formation of blood clots, osteoporosis.
The appearance of side effects of hormonal therapy may differ in different patients.
Radiation therapy (radiotherapy) for breast cancer
Treatment of breast cancer also includes radiation therapy (radiotherapy). It can be used:
- before surgery to reduce the tumor and destroy metastases;
- after surgery (lumpectomy) to destroy the remaining malignant cells and prevent recurrence;
- Instead of surgery as a palliative therapy - to improve the patient's life.
Radiation therapy is based on the fact that irradiation damages or destroys malignant cells, preventing their reproduction.
Radiotherapy is often prescribed after the end of chemotherapy. If the patient is pregnant, radiotherapy can be prescribed after the birth of the child.
Irradiation is prescribed after lumpectomy, except when:
- the patient is more than 70 years old;
- the tumor has a size of less than 2 cm;
- hormone sensitivity of cancer cells was revealed;
- malignant cells were not found in the lymph nodes.
Prior to the appointment, a CT scan is performed, which allows to precisely locate the tumor in the chest and determine the exact dose of radiation.
Breast cancer uses external irradiation, in which the beam is aimed at the tumor and does not affect the surrounding healthy tissue.
To limit the impact on the body, the following methods are also used:
- Do not direct the ray toward the heart;
- lie down face during the procedure;
- to hold your breath during radiotherapy;
- Use fixatives to avoid moving during exposure to beams.
- Radiotherapy is usually prescribed for a period of 5 to 7 weeks.
- Side effects of radiotherapy
- Radiotherapy for breast cancer strongly affects the skin, causing a sensation of sunburn. Characterized by dryness, redness, pain when touching.
The general effect is manifested in fatigue and drowsiness, which usually go away a few months after treatment.