Treatment of Breast Cancer
we will learn about all the significant treatments for breast cancer. You will know what every treatment is, when it is administered, how it is performed, which stages or which types of cancer it is used for, and how long it typically takes. Keep in mind, treatment is never one-size-fits-all. It is tailored to every patient according to his/her stage, tumour type, biology, and state of health.
1. Surgery
Surgery is the main treatment for most locally advanced and early breast cancers. It is performed to remove the tumour and minimize the risk of recurrence of the cancer. It is commonly performed first in Stage 0, 1, and 2 breast cancer. In Stage 3, surgery can be performed after chemotherapy to reduce the tumour size. In Stage 4, surgery is reserved only to manage symptoms such as bleeding, ulceration, or pain.
Following are the primary surgery types:
Lumpectomy: Removes the tumor and a small border of surrounding tissue. Preserves much of the breast and is usually followed by radiation therapy.
Breast-Conserving Surgery (BCS): An umbrella term including lumpectomy and other partial removals of the breast.
Reconstructive Surgery: Reshapes the breast with implants or tissue from another location on the body. It can be immediate (during mastectomy) or delayed.
Total (Simple) Mastectomy: Removes all of the breast but no lymph nodes or chest muscles.
Modified Radical Mastectomy: Takes out all of the breast and axillary (underarm area) lymph nodes.
Radical Mastectomy: Takes out the breast, chest wall muscles, and lymph nodes. Used very little anymore.
Skin-Sparing Mastectomy: Takes out breast tissue but leaves behind most of the breast skin to facilitate easier reconstruction.
Nipple-Sparing Mastectomy: Takes out breast tissue but retains the skin and nipple. Performed on chosen early-stage cases.
Double Mastectomy: Both breasts are taken out, typically in high-risk genetic cases or bilateral cancers.
Surgery is performed under general anaesthesia. The procedure lasts 1 to 3 hours. Patients are typically hospitalized for 1 to 3 days. Recovery is 2 to 4 weeks.
2. Drug Therapies
Chemotherapy Chemotherapy involves the use of medicines to destroy cancer cells that grow quickly anywhere in the body. It may be administered before surgery to reduce the size of the tumour (neoadjuvant), after surgery to kill remaining cells (adjuvant), or in advanced cases to relieve symptoms.
Methods of administration:
Central Line: A long catheter that is placed in a big chest vein and used many times.
PICC Line: A catheter placed in the arm for short-term chemo access.
Chemo Port: A subcutaneous port attached to a vein for long-term access.
Oral Chemo: Pills taken at home on a particular regimen.
Chemotherapy Schedule:
Neoadjuvant Chemotherapy: Shrinks tumours prior to surgery.
Adjuvant Chemotherapy: Kills microscopic cells after surgery.
Combination Therapy: Chemotherapy in combination with radiation, hormone therapy, or targeted therapy to maximize effect.
Chemo is delivered in cycles every 2 to 3 weeks. Patients generally require 4 to 8 cycles over 3 to 6 months. Side effects are hair loss, fatigue, nausea, vomiting, infections, and menstrual changes.
Immunotherapy Immunotherapy stimulates the body's immune system to combat cancer. It is employed in advanced-stage breast cancer and triple-negative breast cancer with positive PD-L1 status. It is administered through IV infusion every 2–3 weeks and is typically administered along with chemo. Side effects are fatigue, fever, rashes, and infrequent autoimmune disorders.
Hormone Therapy
This therapy stops the action of estrogen or progesterone in hormone receptor-positive cancers.
It is administered after surgery or chemo to decrease recurrence risk.
Hormone therapy consists of:
Oral drugs: Tamoxifen (in premenopausal), Letrozole or Anastrozole (in postmenopausal women)
Injections: For ovarian suppression in young patients
It is maintained for 5 to 10 years.
Side effects are hot flashes, weight gain, mood swings, joint pains, and premature menopause.
Targeted Therapy This therapy focuses on certain genetic markers such as HER2. Patients with HER2 are treated with medications such as Trastuzumab (Herceptin) via IV infusion every 1 to 3 weeks. Length is for 1 year. It is administered with or following chemotherapy. Side effects are less severe than chemo but monitoring of the heart is required.
3. Radiation Therapy
Radiation applies concentrated energy to destroy cancer cells within a specific location. It is typically administered following surgery to eradicate remaining cancer cells or in advanced disease for pain or bleeding management.
External Beam Radiation Therapy (EBRT): Most typical. A machine sends radiation from outside the body to the breast or chest wall. It is utilized:
Following lumpectomy to avoid recurrence
Following mastectomy if the tumour is large or the lymph nodes are positive Sessions take 10–20 minutes, 5 days a week, for 1 to 6 weeks.
Brachytherapy: A tiny radioactive source is inserted directly into the tumour cavity following lumpectomy. It gives high radiation to a targeted area. It is administered twice a day for 5 days and is indicated for certain early-stage patients.
Intraoperative Radiation Therapy (IORT): Radiation is administered during surgery, immediately after tumour removal. It treats the tumour bed directly and decreases the number of sessions later. It is applied in selected early-stage cases.
Radiation Schedule (Fractions): Radiation is administered in small fractions to decrease side effects.
Conventional Fractionation: 25–30 sessions in 5–6 weeks
Hypofractionation: 15–20 sessions in 3–4 weeks
Accelerated Hypofractionation: 5–7 sessions in 1–2 weeks
Side effects can be redness, swelling, tiredness, and darkening of the skin but are generally temporary and controllable.
4. Maintenance Therapy
Maintenance therapy is administered after completing active treatment. Its aim is to stop recurrence or postponing cancer growth. It comprises:
Hormone therapy (for ER/PR+ patients): Extended for 5 to 10 years
Targeted therapy (such as Herceptin): Extended to a maximum of 1 year
Oral chemo or immunotherapy (in advanced settings): Administered in cycles according to response Maintenance therapy is essential to prevent the return of cancer and needs to be taken on a regular basis with monitoring.
Conclusion Treatment of breast cancer involves surgery, chemotherapy, hormone therapy, targeted therapy, immunotherapy, radiation, and maintenance therapy. Every step has a particular function based on the stage, type, and biology of the cancer. Being a CancerMitr counsellor, your job is to explain this journey in simple terms and with compassion so that patients are led, encouraged, and hopeful at each step.
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