The type of treatment for breast cancer will depend on the type of breast cancer, the stage of the cancer, and whether the cancer cells are sensitive to hormones, as well as the patient’s overall health. The aim of treatment is to remove the cancer and prevent the cancer from spreading or 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, and treatments 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:
1. 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 depends 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
The procedure involves removing the entire breast and level I, II and II axillary lymph nodes, as well as the underlying muscles of the chest wall. 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 recurring. 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.
How radiotherapy is given depends on the type and stage of cancer being treated. Radiotherapy is commonly used to destroy any breast cancer cells left in the breast or breast tissue after surgery. Treatment is usually given over 5-6 weeks. Radiotherapy can also be used to reduce the size of the cancer before surgery and to relieve pain or other symptoms.
Radiation Therapy Side Effects
The most common side effects of radiation therapy include:
- Loss of appetite
- Nausea and vomiting
- Skin reactions, such as redness, permanent pigmentation, and scarring, in the treated area
- Swelling of the breast
Chemotherapy is a type of cancer treatment that uses drugs known as cytotoxics to kill cancer cells or to prevent them from growing further. These medications are given either by intravenous injection or by mouth.
It is usually used to destroy any cancer cells that haven’t been removed after surgery. This is called adjuvant chemotherapy. In some cases, it may be used to shrink a large tumour before surgery. This is called neoadjuvant chemotherapy.
There are many different types of chemotherapy drugs used to treat early breast cancer. Common drugs include doxorubicin, cyclophosphamide, fluorouracil, docetaxel and paclitaxel. The drug combination you are given will depend on the type of cancer, how far it has spread and what other treatments you are receiving.
Most people will have chemotherapy for 3–6 months. Some drugs are given once every three weeks, some are given each week, and some are given on an accelerated schedule. The number of chemotherapy sessions varies depending on the combination of drugs prescribed by your oncologist.
Chemotherapy Side Effects
The most common possible side effects of chemotherapy include:
- Hair loss
- Mouth sores
- Loss of appetite
- Nausea and vomiting
- Loss of fertility
Most of these side effects usually go away after treatment is finished. If side effects are affecting your daily life, it’s important to discuss them 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.
Chemotherapy drugs all work differently and have different side effects. Not all women will suffer side effects from chemotherapy. If you don’t experience side effects, it does not mean that the drugs aren’t working.
Some breast cancers are stimulated to grow by the hormones estrogen, which are found naturally in the body. These types of cancer are known as hormone receptor-positive cancers. Hormone therapy works by lowering the amount of estrogen or stop the growth of hormone receptor positive cancer cells.
There are different types of hormone therapies to treat early breast cancer. The type of hormone therapy you’ll have will depend on the type of breast cancer, your age, and whether you have experienced the menopause.
Some of the different hormone therapies available include:
- Anti-estrogens – stop estrogen in the body from attaching to cancer cells. One of the most well known is tamoxifen. Tamoxifen can be used in women who are pre-menopausal and women who are post-menopausal. Some common side effects of tamoxifen include fatigue, hot flushes, vaginal dryness or discharge, mood swings, nausea and vomiting.
- Aromatase Inhibitors (AIs) – block estrogen production, but only work for post-menopausal women. Examples are anastrozole (Arimidex), exemestane (Aromasin), and letrozole (Femara). Side effects include tiredness, headaches, hot flushes, vaginal dryness, muscle or joint pain, and skin rashes.
- Ovarian ablation or suppression – stops the ovaries from producing estrogen. This is often recommended for women who haven’t been through menopause. It may involve removing the ovaries surgically, a short course of radiotherapy or a monthly injection. All of these methods can cause menopausal side effects like hot flushes, nigh sweats, trouble sleeping, and mood swing.
Targeted therapy, or also called biological therapy, is a cancer treatment that uses specific drugs to target specific proteins called human epidermal growth factor receptor 2 (HER2) that play a role in the growth of cancer cells. These cancers are called HER2-positive.
Targeted therapy works by stopping the effects of HER2 and helping your immune system to fight off cancer cells. This treatment is generally less likely to harm normal, healthy cells than chemotherapy.
The best known targeted therapy used to treat HER2-positive breast cancer is Herceptin (Trastuzumab). It works by attaching itself to HER2-positive breast cancer cells, destroying the cells or reducing their ability to divide and grow. Herceptin also encourages the body’s own immune cells to help destroy the cancer cells.
Some people receive Herceptin as an injection, but most are given via an infusion into a vein. 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 Kadcyla (T-DM1), Perjeta (pertuzumab), and Tykerb (lapatinib).
Targeted Therapy Side Effects
Some common side effects of targeted therapies include fever, headache, diarrhea, and a rash. Your medical team will monitor you for side effects.
In some people, Herceptin can affect the way the heart works. This is more common in older people and people with pre-existing heart problems. You will have tests to check your heart function before starting Herceptin, and at regular intervals during treatment.