Breast Cancer Treatment
Treatment for breast cancer depends on the type of breast cancer, the stage of your cancer, your general health and personal preferences. The aim of treatment is to remove the breast cancer cells and prevent them from coming back (recurring).
Breast Cancer Treatment Options
The treatment options for breast cancer include surgery, radiation therapy, chemotherapy, hormone therapy, and targeted therapy. Patients usually have more than one treatment such as a combination of radiotherapy and chemotherapy, and the treatment can be given in different combinations.
Surgery is the most common type of treatment for breast cancer. The goal is to remove as much of the cancer cells as possible. There are two main types of breast cancer surgery:
Breast-conserving surgery (lumpectomy or partial mastectomy)
In this type of surgery, only the part of the breast containing the cancer is removed. How much of the breast is removed will depend on the size and location of the tumor.
In this type of surgery, the entire breast is removed, including all of the breast tissue and sometimes other nearby tissues. There are several different types of mastectomy procedures:
- Total (simple) mastectomy
For this procedure, a surgeon removes the entire breast, including the nipple, areola and skin. Underarm lymph nodes or muscles from underneath the breast are not removed.
- Radical mastectomy
This involves removing the entire breast, the axillary lymph nodes, as well as the chest wall muscles. Today, a radical mastectomy is rarely performed. It is now only performed on patients who have advanced breast cancer that has invaded the muscle wall under the breast tissue.
This surgery is considered the most disfiguring of the mastectomy procedures, leaving very little tissue other than skin over the rib bones.
- Modified radical mastectomy
This procedure involves removing the entire breast, including the nipple, areola, the overlying skin, and the lining over the chest muscles. In addition, some of the lymph nodes under the arm, also called the axillary lymph nodes, may be removed.
This surgery may be followed by radiation therapy, which is performed to kill any remaining cancer cells and minimize the chances of cancer recurrence. In some cases, chemotherapy, hormone therapy, and/or targeted therapy also follow a modified radical mastectomy.
Surgery side effects
Side effects of surgery will mainly depend on the type and location of the surgery, the patient’s overall health, and the effect of other cancer treatments (for example, tissue treated with radiation may not heal well after surgery). Some of the common side effects of surgery for cancer include:
- Sore throat
- Nausea and vomiting
- Wound infection
- Blood clots
- Gastrointestinal problems
Radiation therapy (radiotherapy) is a type of cancer treatment that uses energy x-rays or other types of radiation to kill cancer cells or prevent them from growing. There are two types of radiation therapy:
- External radiation therapy: This uses a machine to send radiation to the body.
- Internal radiation therapy: This uses a radioactive substance sealed in needles, seeds, or wires, and placed directly into or near the cancer cells.
The way the radiation therapy given depends on the type and stage of cancer being treated. Radiotherapy is commonly used to destroy any breast cancer cells that may be left in the surrounding tissues after surgery. It can also be used to reduce the size of the cancer before surgery. This form of treatment is usually given five days a week for about 5-6 weeks.
Radiation therapy side effects
The most common side effects of radiation therapy include:
- Loss of appetite
- Nausea and vomiting
- Swelling of the breast
- Skin reactions, such as redness, permanent pigmentation, and scarring, in the treated area
Chemotherapy is a type of cancer treatment that uses anti-cancer (cytotoxic) drugs to either destroy cancer cells or slow down the growth of cancer cells. Chemotherapy drugs may be given orally or intravenously (injected into your vein). The drugs travel through the bloodstream to reach cancer cells in most parts of the body.
You may be offered chemotherapy before surgery if the cancer is large or is growing more quickly. This is called neo-adjuvant chemotherapy. The aims are to shrink the tumour and to reduce chance of the cancer coming back.
Your cancer doctor may recommend you have chemotherapy after surgery if the cancer cells have spread to another part of the body. This is called adjuvant chemotherapy. The aim is to kill any remaining cancer cells that are too small to see. Adjuvant chemo can lower the risk of breast cancer coming back.
There are many different types of chemotherapy drugs used to treat breast cancer. You usually have a combination of two or three chemotherapy drugs. The type of drugs you have depends on the type of breast cancer, how far it has spread and whether you have other medical conditions, such as heart problems. Examples of chemotherapy drugs for early and locally advanced breast cancer include:
- Taxanes, such as docetaxel (Taxotere) and paclitaxel (Taxol)
- Anthracyclines, such as epirubicin (Ellence) and doxorubicin (Adriamycin)
- Fluorouracil (5-FU)
- Eribulin (Halaven)
- Vinorelbine (Navelbine)
- Capecitabine (Xeloda)
Most patients will have chemotherapy for 3–6 months. Some drugs are given once every three weeks, and some are given on a faster schedule (e.g. once every two weeks or once a week).
Chemotherapy side effects
Chemotherapy drugs may cause unpleasant side effects, but these depend on the type and dose of drugs given. Most are mild and go away after you stop taking the drug, but others can be more serious or permanent. Some of the possible side effects of chemotherapy include:
- Hair loss
- Mouth sores
- Loss of appetite
- Nausea and vomiting
- Increased risk of infection
- Loss of fertility
Other side effects are also possible. If side effects are affecting your daily life, it’s important to speak with your health care team. In some instances, your oncologist may be able to change your chemotherapy drug to one that has fewer side effects.
Hormones, like estrogen and progesterone, can stimulate some breast cancer cells to grow. Hormone therapy works by either lowering the amount of hormones in the body or by blocking them getting to breast cancer cells. It is usually given as tablets, or you may have an injection under your skin. It is often taken daily for at least five years after the completion of your other breast cancer treatments (surgery, chemotherapy and/or radiotherapy).
There are several types of hormone therapy used to treat early breast cancer. The type of hormone therapy you have will depend on the type of breast cancer, your age, and whether you have reached the menopause (for women).
Selective estrogen receptor modulators (SERMs)
Selective estrogen receptor modulators are compounds that prevent breast cancer cells from binding to estrogen. They block the effects of estrogen in breast tissue but not in other tissues within the body.
The most commonly used SERMs are tamoxifen (Nolvadex®) and toremifene (Fareston®). Both of these drugs are taken by mouth, most often as a pill, and can be used to treat women both before and after menopause.
Some common side effects of SERMs include tiredness, hot flushes, vaginal dryness or discharge, mood swings, nausea and vomiting.
Aromatase inhibitors (AIs)
Aromatase inhibitors lower estrogen levels in the body by blocking the enzyme aromatase, which turns the hormone androgen into estrogen. This means that less estrogen is available to stimulate the growth of breast cancer cells.
Aromatase inhibitors are mainly used on postmenopausal women whose ovaries no longer produce estrogen. AIs may also be given to younger women with drugs to stop the ovaries working, or after the ovaries have been removed.
Examples of aromatase inhibitors include anastrozole (Arimidex), exemestane (Aromasin), and letrozole (Femara). They are usually taken daily as a tablet for about 5 to 10 years. The side effects of taking aromatase inhibitors include muscle pain, joint stiffness, and osteoporosis.
Ovarian suppression is an option to prevent the ovaries from producing estrogen, which means less estrogen is available to help support the growth of breast cancer cells.
This is often recommended for women who haven’t been through menopause. It uses drugs to stop the ovaries from making estrogen and it causes a temporary menopause.
These medications are called luteinizing hormone-releasing hormone (LHRH) agonists. Some common examples of these drugs are goserelin (Zoladex), leuprolide (Lupron), and buserelin (Suprefact).
LHRH agonists are given by injection under the skin of the abdomen (tummy). They are usually given monthly for 3 to 5 years.
These drugs can cause menopausal side effects, such as hot flushes, night sweats, mood swing, trouble sleeping, and vaginal dryness.
Targeted therapy is a cancer treatment that uses drugs to target specific molecules (such as proteins) that play a role in the growth of cancer cells. By targeting these molecules, the drugs stop the growth of cancer cells and limit harm to healthy cells.
The most widely used targeted therapy drug for breast cancer is trastuzumab (Herceptin). It works by stopping the effects of HER2 and encouraging the body’s own immune cells to fight off the cancer cells.
HER2 is a growth-promoting protein located on the surface of some cancer cells. Some breast cancer cells make too much of this protein, which makes the cells grow faster than normal. This is called HER2-positive breast cancer.
Some people have it as an injection under the skin, but most people receive herceptin via a drip into a vein (infusion).
You will usually have a dose every three weeks, although some people may have weekly doses. The first infusion may take up to 90 minutes. This is called the loading dose. The following infusions take 30–60 minutes each, and they will continue for up to 12 months. The first four doses are given while you are having chemotherapy treatment.
Other targeted therapies that are available to treat HER2-positive metastatic breast cancer include ado-trastuzumab emtansine (T-DM1), pertuzumab (Perjeta), and lapatinib (Tykerb).
Targeted therapy side effects
Side effects of targeted therapy will depend on the type of drug, how it’s given, the dose, and your overall health. Some common side effects of targeted therapy for breast cancer include:
- Loss of appetite
- Nausea and vomiting
- Increased risk for infection
- Skin problems, including redness, itching and dryness
Some people may have a reaction when the drugs are given, including:
- Difficulty breathing or coughing
- Chest pain or irregular heartbeat
- Skin rash, itching or flushing
Trastuzumab can cause heart damage, especially when it is given with doxorubicin (Adriamycin), which is a chemotherapy drug commonly used for breast cancer.
Talk to your healthcare team if you have these side effects or others you think might be from targeted therapy. The sooner you tell them about the issue, the sooner your doctor can act to help you deal with them.