In recent years, there’s been an explosion of life-saving treatment advances against breast cancer, bringing new hope and excitement. Instead of only one or two options, today there’s an overwhelming menu of treatment choices that fight the complex mix of cells in each individual cancer. The decisions—surgery, then perhaps radiation, hormonal (anti-estrogen) therapy, and/or chemotherapy—can feel overwhelming.
For well over a century, surgery has been the first line of attack against breast cancer. But things have changed a lot in recent years. Today, the goal is precise, targeted surgery that aims to preserve as much of the healthy breast and surrounding areas as possible. Even mastectomy (breast removal) is a more refined, less drastic option than it was a generation ago.
The most important of these deciding factors are: the stage of the cancer, the overall “personality” of the cancer, and what is acceptable to you in terms of your long-term peace of mind.
You may hear many different terms used to describe the kinds of surgery that can be done, but there are really two main options:
• Breast-conserving surgery, (commonly known as lumpectomy) in which only the tumor is removed from the breast. This is usually followed by radiation therapy to the remaining breast tissue.
• Mastectomy, an operation in which the whole breast is removed. Sometimes radiation is given after mastectomy.
For invasive breast cancer, both of these procedures may also be accompanied by an axillary lymph node dissection. Recommendations for whole body or “systemic” treatments such as hormonal therapy, chemotherapy, or both, may follow either approach.
The need for systemic treatment is independent of which surgical procedure you choose. Do not elect to have a mastectomy thinking that this will eliminate the need for chemotherapy.
If you have early-stage breast cancer, ask your doctor about the sentinel lymph node dissection as an alternative to traditional lymph node dissection. Find out if you are a good candidate. If you are, ask if your surgeon has a high level of experience with this new technique, before proceeding.
Radiation therapy—also called radiotherapy—is a highly targeted, highly effective way to destroy cancer cells that may linger after surgery. Radiation can reduce the risk of recurrence by 50% to 66% (about a half to two-thirds reduction in risk). Despite what many women fear, radiation therapy is relatively easy to tolerate, and its side effects are limited to the treated area.
Radiation treatment is overseen by a radiation oncologist, a cancer doctor who specializes in radiation treatment.
Targeted cancer therapies are cancer treatments that target specific characteristics of cancer cells, such as a protein, an enzyme, or the formation of new blood vessels. Targeted therapies don’t harm normal, healthy cells. Most targeted therapies are antibodies that work like the antibodies made by the immune system. So targeted therapies are also called immune targeted therapies. In this way, targeted therapies are very different from more traditional types of anti-cancer therapies.
Herceptin (chemical name: trastuzumab) is the best known targeted therapy for breast cancer. Herceptin only works against breast cancers that have extra HER2 genes and make too many HER2 protein receptors. Herceptin does have a number of potentially serious side effects.
Tykerb (chemical name: lapatinib) is another targeted therapy that works against breast cancers that have extra HER2 genes. Tykerb has been approved by the FDA to be given in combination with Xeloda (chemical name: capecitabine) to treat advanced, HER2-positive breast cancer that has stopped responding to anthracyclines, taxanes, and Herceptin.
Avastin (chemical name: bevacizumab) is also a targeted therapy. Avastin targets the new blood vessels that feed cancer cells. Avastin has been approved by the FDA to treat certain types of advanced cancers of the lung, colon and rectum. Researchers are studying Avastin in combination with Taxol (chemical name: paclitaxel) to see if the combo can slow the progression of advanced breast cancer better than Taxol alone.
New targeted therapies are emerging on a regular basis.
Hormonal therapy is a very effective treatment against breast cancer that is hormone-receptor-positive. Sometimes called “anti-estrogen therapy,” hormonal therapy blocks the ability of the hormone estrogen to turn on and stimulate the growth of breast cancer cells.
For years, tamoxifen was the hormonal medicine of choice for all women with hormone-receptor-positive breast cancer. But in 2005, the results of several major worldwide clinical trials showed that aromatase inhibitors (Arimidex [chemical name: anastrozole], Aromasin [chemical name: exemestane], and Femara [chemical name: letrozole]) worked better than tamoxifen in post-menopausal women with hormone-receptive-positive breast cancer.
Aromatase inhibitors are now considered the standard of care for post-menopausal women with hormone-receptor-positive breast cancer. Tamoxifen remains the hormonal treatment of choice for pre-menopausal women.
Chemotherapy is a systemic therapy; this means it affects the whole body by going through the bloodstream. The purpose of chemotherapy and other systemic treatments is to get rid of any cancer cells that may have spread from where the cancer started to another part of the body.
Chemotherapy is effective against cancer cells because the drugs love to interfere with rapidly dividing cells. The side effects of chemotherapy come about because cancer cells aren’t the only rapidly dividing cells in your body. The cells in your blood, mouth, intestinal tract, nose, nails, vagina, and hair are also undergoing constant, rapid division. This means that the chemotherapy is going to affect them, too.
Still, chemotherapy is much easier to tolerate today than even a few years ago. And for many women it’s an important “insurance policy” against cancer recurrence. It’s also important to remember that organs in which the cells do not divide rapidly, such as the liver and kidneys, are rarely affected by chemotherapy. And doctors and nurses will keep close track of side effects and can treat most of them to improve the way you feel.
It’s important to remember that every woman’s ideal treatment plan is different. Be aware that your “chemo” regimen may be different from someone else’s, based on very individual—and sometimes subtle—breast cancer factors. These include: lymph node involvement, tumor size, hormone receptor status, grade, and oncogene expression. Be prepared for your doctor to recommend a combination of chemotherapies—together or in a series.
The goal of complementary medicine is to balance the whole person — physically, mentally, and emotionally — while conventional medicine does its work. For many people diagnosed with breast cancer, complementary medicine has helped to:
• relieve symptoms
• ease treatment side effects
• improve quality of life
Researchers are working to better understand the value and benefit of complementary medicine in breast cancer.
Complementary medicine is used to describe therapeutic techniques that are not part of conventional medicine (also called “regular,” “standard,” or “mainstream” medicine). Complementary therapies such as acupuncture and yoga to prayer, music therapy, and massage .are used as a “complement” or addition to conventional medicine. Because complementary medicine can be combined or integrated with conventional medical treatment, it is also called “integrative medicine.”
Why it’s so important to stick to your treatment plan, take the full course of medications, and continue with regular tests and doctors’ visits to keep yourself healthy into the future.
Shaney jo Darden: San Diego, CA, USA
Patti Balquiedra: Manila, Philippines
Catherine Brunelle: Canada
Gia B Sison: Manila, Philippines
Runi Limary: Austin, TX, USA
Terri Wingham: Vancouver, BC, Canada
Mailet Lopez: New York, NY, USA
Mary Lou Galantino: NJ, USA
Mel Majoris: Petoskey/Traverse City, MI, USA
AJ Ali: Los Angeles, CA, USA
Selma Schiemel: Los Angeles, CA, USA
Tricia Perry: Los Angeles, CA, USA
Maimah Karmo: Wahington, DC, USA
Young Survival Coalition: based out of New York, NY, USA
Team Shan: based out of Woodstock, ON, Canada
Keep A Breast: based out of San Diego, CA, USA
TigerLilly Foundation: based out of Washington DC, USA
Bright Pink: based out of Chicago, IL, USA
ICanServe Foundation: based out of the Philippines
This website is designed to provide additional information to patients and their loved ones when faced with intimidating diagnoses. A physician or medical professional should be consulted before making any health related decisions. We serve as a portal for information so that an informed and efficient decision can be concluded by all parties involved. The creators of this site are not responsible or liable, directly or indirectly, for any form of damages whatsoever resulting from the use (or misuse) of information contained in or implied by the content of this website. The purpose of the mAss Kickers is to empower people with knowledge, not to specifically advise people how to address each unique situation.