Breast cancer is one of the common cancers of women and predominantly affects nulliparous women after their menopause. Depending on the onset, severity, and degree of malignancy of the carcinoma, the oncologist will decide on a combination of treatment options for the patients. The four common treatment options to treat or cure cancer of the mammary glands are as follows.
The word ‘Chemo” refers to chemicals. Chemotherapy is the treatment module where medicines and chemical drugs are used to kill the cancerous cells. Though chemotherapy brings about a lot of side effects, it is also proven to be beneficial in killing cancer cells. The benefits of chemotherapy are threefold.
- As adjuvant therapy: Chemo drugs are given to prevent the recurrence of cancer from radiation therapy and surgery.
- Non-Adjuvant therapy: chemo drugs are used to shrink the size of the tumor prior to removing it surgically.
- Chemotherapy drugs used to kill cancer cells that have spread to other parts of the body.
The common chemotherapy drugs that are used for breast cancer are,
- Anthracyclines: The class of drugs include epirubicin and Adriamycin
- Taxanes: Drugs that are included in the class of taxanes are Taxol and Taxotere
- These drugs are used in combination with cyclophosphamides, fluorouracil, and carboplatin.
Depending on the severity of the malignancy, the doctor will decide on combining different chemo drugs for optimal effects. Generally, fluorouracil will be administered in combination with Cytoxan and Adriamycin. Cytoxan can be given in combination with fluorouracil and adriamycin. Cytoxan can also be given in combination with fluorouracil and methotrexate.
Chemotherapy drugs are either given in the form of a tablet or in a vein daily, weekly or every 15 days or four weeks. Sometimes, a large central catheter can be placed on the internal jugular vein for repeated chemo cycles. This helps in reducing the hassles of repeated venipunctures.
Radiation therapy makes use of the high level of radioactive rays to kill cancer cells and to restrict them from dividing, growing, spreading and invading other body parts. Radiation therapy targets predominantly the cancer cells and causes little or no damage to the surrounding healthy cells. There are three main types of radiation therapy.
- External beam radiation therapy: This is the most common type of radiation therapy to treat breast cancer. Radioactive beams are emitted from a machine and are targeted on a specific area of the mammary glands that are affected by the disease.
- Brachytherapy: Radioactive patches are implanted under the skin in specific areas of the body. This patch emits radiations at frequent intervals to shrink the cancer cells.
- Proton therapy: This is also an external beam radiation therapy where the energy from the protons or positively charged ions are dispersed to damage the DNA of the cancer cells so that they no longer grow and multiply.
Not everyone with a cancer diagnosis is subjected to radiation therapy. It is recommended for those who are posted for mastectomy or breast removal surgery to decrease or shrink the size of the tumor. It is also given for those who have undergone mastectomy and lumpectomy surgeries, to lower the risk of cancer spreading to the surrounding normal breast tissue. Radiation therapy is also used to treat advanced breast cancer, where surgery is not possible owing to metastasis.
Except for mild skin damage, there are not many side effects of radiation therapy. Though the technician places marks on the skin to focus the beams on specific body parts, the radiations can also affect the surrounding healthy tissue. But the procedure is painless and is highly effective in shrinking the tumor.
Some types of breast cancer grow and multiply in the presence of excess female reproductive hormones, estrogen and progesterone. Hormone therapy is also known as endocrine therapy and it acts by removing, adding or blocking the hormones to treat the disease. This therapy can be mediated by using drugs that limit the scope of estrogen and progesterone that helps in the growth of cancerous cells in the breast. Or by using drugs and/or surgery to prevent the ovaries from making these two hormones.
Patients who will undergo hormone therapy will be selected by the doctor based on the availability of receptors for estrogen and progesterone on the surface of their tumor cells. If the receptors are present, then it means that the tumor cells require hormones to grow. In such instances, hormone therapy is the treatment of choice in attacking the tumor. Women who had their tumor removes surgically are also subjected to hormone therapy to prevent relapse.
Those women who don’t have the diagnosis of breast carcinoma but carry genes that raise the risk of cancer, from a strong family history are also subjected to hormone therapy to lower the chances of the disease. Some common drugs that are used for hormone therapy are, Fulvestrant, Letrozole, Goserelin, Anastrozole, Exemestane, Leuprorelin, Megestrol, etc.
Removing the breast partially or completely is the final choice of treatment for those with advanced cancers. Different types of procedures are available when it comes it partial or total mastectomy and it is up to the oncologist to decide on the best option for their clients.
- Simple or total mastectomy:
The doctor removes the complete mammary gland along with the nipple in this procedure. The lymph nodes are not removed from the axilla. This procedure is performed with simple tumors that have not spread to the adjacent lymph nodes and organs.
- Modified or radical mastectomy:
The surgeon removes the entire breast tissue along with the nipple and the lymph nodes in the axilla or armpit. This is the treatment of choice for cancers that have spread to the adjacent lymph nodes.
- Radical mastectomy:
When cancer has affected the underlying chest muscles, then the client will have her breasts, lymph nodes, nipple, and the underlying chest muscles removed. This is the last treatment of choice, as it is disfiguring and takes a long recovery time for the women.
The doctor removes only the tumor along with some of the breast tissue that surrounds it. This procedure is carried out in the early stages of cancer when the lump is small and localized. After the procedure, the client is subjected to radiation treatment to avoid the spread of cancer cells.