Monday 9 June 2014

Breast Cancer Treatment

TREATMENT
Cancer treatment is either local therapy or systemic therapy:
Local therapy: Surgery and radiation therapy are local treatments. They remove or destroy cancer in the breast. When breast cancer has spread to other parts of the body, local therapy may be used to control the disease in those specific areas.

Systemic therapy: Chemotherapy, hormone therapy, and biological therapy are systemic treatments. They enter the bloodstream and destroy or control cancer throughout the body. Some women with breast cancer have systemic therapy to shrink the tumor before surgery or radiation. Others have systemic therapy after surgery and/or radiation to prevent the cancer from coming back. Systemic treatments also are used for cancer that has spread.

Because cancer treatments often damage healthy cells and tissues, side effects are common. Side effects depend mainly on the type and extent of the treatment. Side effects may not be the same for each woman, and they may change from one treatment session to the next.
Before treatment starts, your health care team will explain possible side effects and suggest ways to help you manage them. Your doctor can describe your treatment choices and the expected results. You may want to know how treatment may change your normal activities. You may want to know how you will look during and after treatment. You and your doctor can work together to develop a treatment plan that reflects your medical needs and personal values. At any stage of disease, supportive care is available to control pain and other symptoms, to relieve the side effects of treatment, and to ease emotional concerns.

SURGERY
Modified Radical Mastectomy- The entire breast is removed, along with any axillary lymph nodes. Breast reconstruction or implant surgery is performed during the same procedure, after the breast is removed.

Breast Conserving Surgery is an attempt to save as much healthy breast tissue as possible and removes the lump with a wide margin. Radiation therapy is always used with this kind of treatment.
The choice between breast-sparing surgery (followed by radiation therapy) and mastectomy depends on many factors:
The size, location, and stage of the tumor
The size of the woman's breast
Certain features of the cancer
How the woman feels about saving her breast
Whether she has any contraindication for radiation therapy like active collagen vascular disease or pregnancy.

RADIATION THERAPY
Radiation therapy uses high-energy beams to destroy cancer cells. It is a painless form of treatment. There are two types of radiation treatment for breast cancer:
External beam radiation: the beams are aimed at the tumor from outside the body. Patients undergo radiation five days a week for a certain number of weeks usually 5 to 6 weeks. Usually the chest wall is treated for mastectomy patients and the intact breast for the  breast conserving surgery patients. The technique used is mainly two tangentials with beam modifying devices and use of bolus for the mastectomy patients. The choice of treatment of lymph node regions depends on many factors.
Internal radiation: small plastic tubes or catheters are implanted in the breast in operation theatre at the tumor site using special applicators. X rays or CT scan is done and the planning is done on computers using sophisticated software and then radioisotopes like Iridium is used to deliver the desired dose of radiation limited to the target volume.
Precautions with radiation therapy- You should wear loose-fitting cotton clothes during this time and avoid wearing bras as it will rub against irradiated skin and cause soreness.. You should check with your doctor before using any deodorants, lotions, or creams on the treated area. The area gradually heals once treatment is over. However, there may be a lasting change in the color of your skin.
You are likely to feel tired during radiation therapy, especially in the later weeks of treatment. Resting is important, but one should try to stay active and in a positive state of mind.

CHEMOTHERAPY
Chemotherapy is the use of drugs, either alone or in combination, to kill cancer cells. In breast cancer, chemotherapy is most often used either before or after surgery, or as a primary treatment for cancer that has spread outside the breast at the time of diagnosis.

Side effects depend mainly on the specific drugs and the dose. The drugs affect cancer cells and other cells that divide rapidly:

Blood cells: These cells fight infection, help your blood to clot, and carry oxygen to all parts of the body. When drugs affect your blood cells, you are more likely to get infections, bruise or bleed easily, and feel very weak and tired. Cells in hair roots: Chemotherapy can cause hair loss. Your hair will grow back, but it may be somewhat different in color and texture.
Cells that line the digestive tract: Chemotherapy can cause poor appetite, nausea and vomiting, diarrhea, or mouth and lip sores.
Your doctor can suggest ways to control many of these side effects.
Some drugs used for breast cancer can cause tingling or numbness in the hands or feet.
Some anticancer drugs can damage the ovaries. The ovaries may stop making hormones and one may have symptoms of menopause. These symptoms include hot flashes and vaginal dryness.

HORMONE THERAPY
Hormone therapy is used to prevent female hormones (estrogen, progesterone and estradiol) from fueling the growth of breast tumors in some patients. Hormone therapy can involve taking drugs, either by mouth or through an IV. Tamoxifen is an example of a hormone therapy drug. Surgery to remove the ovaries in women who have not yet reached menopause is another type of hormone therapy. Some breast tumors need hormones to grow. Hormone therapy keeps cancer cells from getting or using the natural hormones they need. These hormones are estrogen and progesterone. Lab tests can show if a breast tumor has hormone receptors. If you have this kind of tumor, you may have hormone therapy
This treatment uses drugs or surgery:

Drugs: Your doctor may suggest a drug that can block the natural hormone. One such drug is tamoxifen, which blocks estrogen. Another category of useful drugs are  aromatase inhibitor including anastrozole, letrozole etc but are useful only in postmenopausal female. The testing of serum FSH, Estradiol levels may be required before starting the hormonal treatment.

Surgery: If you have not gone through menopause, you may have surgery to remove your ovaries. The ovaries are the main source of the body's estrogen. A woman who has gone through menopause does not need surgery. (The ovaries produce less estrogen after menopause.)

The side effects of hormone therapy depend largely on the specific drug or type of treatment. Tamoxifen is the most common hormone treatment. In general, the side effects of tamoxifen are similar to some of the symptoms of menopause. The most common are hot flashes and vaginal discharge. Other side effects are irregular menstrual periods, headaches, fatigue, nausea, vomiting, vaginal dryness or itching, irritation of the skin around the vagina, and skin rash. Not all women who take tamoxifen have side effects.

Serious side effects of tamoxifen are rare. However, it can cause blood clots in the veins. Blood clots form most often in the legs and in the lungs. Women have a slight increase in their risk of stroke.
Tamoxifen can cause cancer of the uterus and therapy should be monitored with regular pelvic ultrasounds measuring the endometrial thickness. You should tell your doctor about any unusual vaginal bleeding between exams.

BIOLOGIC THERAPY
Biologic therapy is a drug treatment that helps the body’s immune system fight cancer. Herceptin® is a type of biologic therapy that targets cells which produce excessive amounts of a protein called HER2. This protein is present in some breast cancer patients and can be tested by Immunohistochemistry, the confirmation can be done with a FISH test.

Some women have chemotherapy before surgery. This is neoadjuvant therapy (treatment before the main treatment). Chemotherapy before surgery may shrink a large tumor so that breast-sparing surgery is possible. Women with large Stage II or IIIA breast tumors often choose this treatment.
After surgery, many women receive adjuvant therapy. Adjuvant therapy is treatment given after the main treatment to increase the chances of a cure. Radiation treatment can kill cancer cells in and near the breast. Women also may have systemic treatment such as chemotherapy, hormone therapy, or both. This treatment can destroy cancer cells that remain anywhere in the body. It can prevent the cancer from coming back in the breast or elsewhere.

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