Highlights of Breast Cancer Treatment
The Three 'Tools' for Treating Breast Cancer
There are three categories of treatment for breast cancer: surgery, radiation therapy, and drug therapy. Each of these tools has a different role.
The choice of treatment is based on many factors. Aggressive cancers may be treated with surgery, radiation therapy and several types of drug therapy. Less aggressive cancers may be treated with surgery only.
Learn More about Surgery, Radiation Therapy, and Drug Therapy
Different types of operations that may be used for breast cancer are listed below. A given patient will have some but not all of these surgeries.
- Lumpectomy: removal of the cancerous lump only, also known as partial mastectomy
- Mastectomy: complete removal of the breast
- Sentinel lymph node surgery: removal of one or a few lymph nodes from the armpit area
- Axillary dissection: removal of many lymph nodes from the armpit area
- Breast reconstruction: plastic surgery to re-create a breast after mastectomy
Illustration: This illustration shows the steps of a Lumpectomy and Mastectomy.
Radiation therapy is a type of focused energy. Radiation therapy is useful because cancers are much more vulnerable to radiation than healthy tissues. Radiation is safest when given in many small treatments over one or more weeks.
Radiation is extremely effective in eliminating small amounts of breast cancer left behind after surgery or chemotherapy. Radiation may be given to the breast or chest area, and sometimes to the lymph node areas. Generally, the cure rate is higher when radiation is added to surgery for breast cancer. Some patients cannot be cured without radiation therapy.
There are two main categories of radiation therapy used for breast cancer.
- External Beam Radiation Therapy is administered with specially shaped 'beams' of focused energy from a machine called a linear accelerator. It is very effective in treating larger areas of the body such the whole breast or the surrounding lymph node areas.
- Brachytherapy (internal radiation) is administered by temporarily placing a tiny radioactive source inside the breast after lumpectomy.
It allows for very 'targeted' treatment of the area at-risk for containing residual cancer, with less radiation scatter to the nearby healthy tissues.
One or more flexible tubes called catheters are temporarily placed within the breast to guide and contain the radiation source. Treatments are 5-10 minutes each and are usually
given twice daily for 5 days.
Most radiation therapy treatments for breast cancer fall into one of four categories:
- External Beam Radiation Therapy to the intact breast after lumpectomy as part of breast conservation. Breast conservation is treating the cancer while preserving the breast.
- Breast Brachytherapy delivered to the breast after lumpectomy as part of breast conservation. Breast Brachytherapy is faster (one week) than External Beam Radiation Therapy (six weeks) and may be an option for some patients with early breast cancer.
- External Beam Radiation Therapy delivered to the chest and lymph node areas after surgery for more advanced breast cancers. This might include patients with large cancers or those with many involved lymph nodes.
- Palliative Radiation Therapy for treatment of symptoms from cancer that has spread to another organ, such as a cancer spot in a bone causing pain.
Illustration: This illustration shows where the beam is targeted during radiation.
Drug Therapy for Breast Cancer
Drug Therapy is our term for drugs used to eliminate cancer from the body. Drugs travel throughout the body and eliminate cancer not reachable with surgery and radiation. More importantly, these drugs can attack and eliminate cancer cells that are too small to see on any scan. Some patients cannot be cured without drug therapy.
- Estrogen-blocking drugs. These drugs can be effective against breast cancers that are stimulated by estrogen, a female hormone. Cancers stimulated by estrogen are described as 'estrogen-receptor positive,' usually abbreviated as 'ER positive.' Estrogen-blocking drugs are usually given for many years. Most are taken as a pill. Commonly used examples are tamoxifen and anastrazole.
- Chemotherapy drugs. These are powerful drugs. Many are synthetic versions of plant and animal toxins. They can be very effective but may cause more side effects. These side effects are generally tolerable and temporary. Chemotherapy is given for several months, and the drugs may be given by vein or in pill form. Some chemotherapy drugs include cyclophosphamide, taxotere, doxorubicin, and carboplatin. Usually two or three are used in combination. A combination is abbreviated using the first letter of each drug. For example, taxotere and carboplatin used together is referred to as TC.
- Targeted or Biologic Therapy. These drugs attack specific proteins present in some (but not all) breast cancers. The concept is like having the right key for a certain lock. The Targeted Therapy drug is the 'key.' Some breast cancers have the 'lock' but others do not. These drugs may be given with chemotherapy or as stand-alone treatment. Examples include trastuzumab and lapatinib.
When and How Are These Drugs Used?
Some patients do not receive drug therapy, because there is little or no concern that invisibly small amounts of cancer are left behind after surgery or radiation. Other patients may be offered an estrogen-blocking drug alone, chemotherapy alone, or some combination of two (or all three) types of drug therapy. Many things factor into the doctor's decision to recommend one drug or another.
A common patient question is "Do I need chemotherapy?" An honest explanation will always be more complicated than a simple 'Yes' or 'No' reply. The decision to use any drug is based on balancing the benefits of drug therapy against the risks (side effects) of such therapy. Consultation with a skilled specialist (a medical oncologist) is very important.