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Breast Cancer Treatment
The information contained on
this page is provided courtesy of the National Cancer Institute's Web
site (http://www.cancer.gov) which provides accurate, up-to-date
information about many types of cancer, information about clinical
trials, resources for people dealing with cancer, and information for
researchers and health professionals.
There are different types of
treatment for patients with breast cancer.
Different types of treatment are available
for patients with
breast
cancer.
Some treatments are
standard
(the currently used treatment), and some are being tested in
clinical trials.
Before starting treatment, patients may want to think about
taking part in a clinical trial. A treatment clinical trial is a
research study meant to help improve current treatments or
obtain information on new treatments for patients with cancer.
When clinical trials show that a new treatment is better than
the standard treatment, the new treatment may become the
standard treatment.
Clinical trials are taking
place in many parts of the country. Information about ongoing
clinical trials is available from the
NCI Web site
1.
Choosing the most appropriate cancer treatment is a decision
that ideally involves the patient, family, and health care team.
Four
types of standard treatment are used:
Surgery
Most patients with breast
cancer have
surgery
to remove the cancer from the breast. Some of the
lymph nodes
under the arm are usually taken out and looked at under a
microscope to see if they contain cancer
cells.
Breast-conserving surgery,
an operation to remove the cancer but not the breast itself,
includes the following:
Breast-conserving surgery. Dotted lines show area
containing the tumor that is removed and some of the
lymph nodes that may be removed.
Patients who are treated
with breast-conserving surgery may also have some of the lymph
nodes under the arm removed for
biopsy.
This procedure is called
lymph node dissection.
It may be done at the same time as the breast-conserving surgery
or after. Lymph node dissection is done through a separate
incision.
Other types of surgery
include the following:
-
Total mastectomy:
A surgical procedure to remove the whole breast that
contains cancer. This procedure is also called a simple
mastectomy. Some of the lymph nodes under the arm may be
removed for biopsy at the same time as the breast surgery or
after. This is done through a separate incision.
Total mastectomy. Dotted line
shows entire breast is removed. Some lymph nodes
under the arm may also be removed.
-
Modified radical mastectomy:
A surgical procedure to remove the whole breast that
contains cancer, many of the lymph nodes under the arm, the
lining over the chest muscles, and sometimes, part of the
chest wall muscles.
Modified radical mastectomy.
Dotted line shows entire breast and some lymph nodes
are removed. Part of the chest wall muscle may also
be removed.
-
Radical mastectomy:
A surgical procedure to remove the breast that contains
cancer, chest wall muscles under the breast, and all of the
lymph nodes under the arm. This procedure is sometimes
called a Halsted radical mastectomy.
Even if the doctor removes
all of the cancer that can be seen at the time of surgery, the
patient may be given
radiation therapy,
chemotherapy,
or
hormone therapy
after surgery to try to kill any cancer cells that may be left.
Treatment given after surgery to increase the chances of a cure
is called
adjuvant therapy.
If a patient is going to
have a mastectomy,
breast reconstruction
(surgery to rebuild a breastās shape after a mastectomy) may be
considered. Breast reconstruction may be done at the time of the
mastectomy or at a future time. The reconstructed breast may be
made with the patientās own (nonbreast) tissue or by using
implants filled with saline or silicone gel. The Food and Drug
Administration (FDA) has decided that breast implants filled
with silicone gel may be used only in clinical trials. Before
the decision to get an implant is made, patients can call the
FDAās Center for Devices and Radiologic Health at
1-888-INFO-FDA (1-888-463-6332) for more information.
Radiation therapy
Radiation therapy is a
cancer treatment that uses high-energy
x-rays or
other types of
radiation
to kill cancer cells. There are two types of radiation therapy.
External radiation
therapy uses a machine outside the body to send radiation toward
the cancer.
Internal radiation
therapy uses a
radioactive
substance sealed in needles,
seeds,
wires, or
catheters
that are placed directly into or near the cancer. The way the
radiation therapy is given depends on the type and
stage of
the cancer being treated.
Chemotherapy
Chemotherapy is a cancer
treatment that uses
drugs to
stop the growth of cancer cells, either by killing the cells or
by stopping the cells from dividing. When chemotherapy is taken
by mouth or
injected
into a vein or muscle, the drugs enter the bloodstream and can
reach cancer cells throughout the body (systemic
chemotherapy). When
chemotherapy is placed directly into the spinal column, an
organ, or
a body cavity such as the
abdomen,
the drugs mainly affect cancer cells in those areas (regional
chemotherapy). The way the
chemotherapy is given depends on the type and stage of the
cancer being treated.
Hormone
therapy
Hormone therapy is a cancer
treatment that removes
hormones
or blocks their action and stops cancer cells from growing.
Hormones are substances produced by
glands in
the body and circulated in the bloodstream. The presence of some
hormones can cause certain cancers to grow. If tests show that
the cancer cells have places where hormones can attach (receptors),
drugs, surgery, or radiation therapy are used to reduce the
production of hormones or block them from working.
Hormone therapy with
tamoxifen
is often given to patients with early stages of breast cancer
and those with
metastatic
breast cancer (cancer that has spread to other parts of the
body). Hormone therapy with tamoxifen or estrogens can act on
cells all over the body and may increase the chance of
developing
endometrial
cancer. Women taking tamoxifen should have a
pelvic
examination every year to look for any signs of cancer. Any
vaginal
bleeding, other than
menstrual
bleeding, should be reported to a doctor as soon as possible.
New
types of treatment are being tested in clinical trials. These
include the following:
Sentinel
lymph node biopsy followed by surgery
Sentinel lymph node biopsy
is the removal of the
sentinel lymph node
(the first lymph node the cancer is likely to spread to from the
tumor) during surgery. A
radioactive
substance and/or blue dye is injected near the tumor. The
substance or dye flows through the lymph
ducts to
the lymph nodes. The first lymph node to receive the substance
or dye is removed for biopsy. A
pathologist
views the tissue under a microscope to look for cancer cells. If
cancer cells are not found, it may not be necessary to remove
more lymph nodes. After the sentinel lymph node biopsy, the
surgeon
removes the tumor (breast-conserving surgery or mastectomy).
Sentinel lymph node biopsy.
Radioactive substance and/or blue dye is injected near
the tumor (first panel), the injected material is
followed visually or with a probe (middle panel), and
the first lymph nodes to take up the material are
removed and checked for cancer cells (last panel).
High-dose
chemotherapy with stem cell transplant
High-dose chemotherapy
with
stem cell transplant
is a method of giving high
doses of
chemotherapy and replacing
blood-forming
cells destroyed by the cancer treatment.
Stem cells
(immature blood cells) are removed from the blood or
bone marrow
of the patient or a donor and are frozen and stored. After the
chemotherapy is completed, the stored stem cells are thawed and
given back to the patient through an
infusion.
These reinfused stem cells grow into (and restore) the bodyās
blood cells.
Studies have shown that
high-dose chemotherapy followed by stem cell transplant does not
work better than standard chemotherapy in the treatment of
breast cancer. Doctors have decided that, for now, high-dose
chemotherapy should be tested only in clinical trials. Before
taking part in such a trial, women should talk with their
doctors about the serious side effects, including death, that
may be caused by high-dose chemotherapy.
Monoclonal antibodies as adjuvant therapy
Monoclonal antibody
therapy is a cancer treatment that uses
antibodies
made in the laboratory, from a single type of
immune system
cell.
These antibodies can identify substances on cancer cells or
normal substances that may help cancer cells grow. The
antibodies attach to the substances and kill the cancer cells,
block their growth, or keep them from spreading. Monoclonal
antibodies are given by
infusion.
They may be used alone or to carry
drugs,
toxins,
or
radioactive
material directly to cancer cells. Monoclonal antibodies are
also used in combination with chemotherapy as
adjuvant therapy.
Trastuzumab
(Herceptin) is a monoclonal antibody that blocks the effects of
the
growth factor
protein
HER2,
which transmits growth signals to breast cancer cells. About
one-fourth of patients with breast cancer have tumors that may
be treated with trastuzumab combined with chemotherapy.
This summary section refers
to specific treatments under study in clinical trials, but it
may not mention every new treatment being studied. Information
about ongoing clinical trials is available from the
NCI Web site
1.
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