A diagnosis of breast cancer usually means plunging into the complex world of cancer treatment. Typically, it's an oncologist who plans a course of treatment, though this may be done in consultation with a surgeon and other specialists. Breast cancer treatment may consist of a single process, such as chemotherapy, or more likely it will be a combination of different treatment types, such as surgery followed immediately by radiation, followed later by a course of chemo. Within each of these treatment categories, there are myriad distinctions to understand and decisions to make, which can leave everyone involved feeling overwhelmed.
Here's a guide to the main types treatments for breast cancer and how they work:
Neoadjuvant therapy and adjuvant therapy for breast cancer treatment
Sometimes oncologists prescribe chemotherapy, radiation, or other drugs, such as hormones, to shrink a tumor prior to surgery. This is known as neoadjuvant therapy. Adjuvant therapy is the term for chemotherapy or radiation given after surgery.
Surgery for breast cancer treatment
If the doctor identifies a tumor that's safe for removal, surgery is going to be an important part of the treatment. The oldest form of cancer treatment, surgery is still considered the best way to remove cancerous tissue, particularly when it's localized in one area of the body, such as the breast. The goal in surgery is to remove the entire tumor, including the cancerous cells spreading around the edge, or "margin," of the tumor.
The doctor may discuss one or a number of different types of surgery:
- Diagnostic surgery. Some types of surgery are used to diagnose and "stage" cancer when the doctor can't see what's going on from outside the body.
- Lumpectomy or mastectomy. Small tumors can be removed through a lumpectomy or partial mastectomy; larger or more aggressive tumors require a mastectomy, or removal of the whole breast.
- Surgery on surrounding areas. Breast cancer is often treated with surgery to remove the tumor in the breast and additional surgery or biopsy to remove the lymph nodes under the arm. The surgeon may also decide to remove blood vessels close to the tumor to prevent the cancer from spreading.
- Prophylactic surgery. This type of surgery is a proactive treatment used to prevent cancer from developing in people who are likely to develop the disease. Women with a strong family history of breast cancer or whose genetic testing shows they carry the breast cancer gene BRCA may choose to have a prophylactic mastectomy to protect themselves.
Biopsies are the most common type of diagnostic surgery. Using a needle, the doctor draws a tissue sample from a tumor. Biopsies can also be done by cutting through the tissue with a knife or laser. An excisional biopsy is one that cuts out the entire tumor, while an incisional biopsy removes a small part of a larger tumor. Unlike regular surgery, biopsies are often outpatient procedures performed using local anesthesia.
Laparoscopies or endoscopies, often done in tandem with biopsies, use a flexible tube and scope to examine a potentially cancerous area. These procedures aren't typically used for breast cancer and would only be done to check if the cancer has spread to another part of the body.
Chemotherapy for breast cancer treatment
One of the most effective ways to kill off cancer cells is with toxic chemicals called chemotherapy agents, which are drugs developed to target fast-growing cells. There are many different chemotherapy drugs, and some attack a variety of types of cancer while others focus on particular cancers, such as breast cancer .
Chemotherapy drugs work by targeting all fast-growing cells, so they also affect rapidly dividing cells in other parts of the body, such as the hair, the mouth, and the digestive system, which is what leads to common side effects such as nausea , dry mouth and hair loss . Unlike radiation and surgery, which are site-specific, or "local," chemotherapy is considered a "systemic" treatment, since the medications travel throughout the body.
- Chemotherapy drugs. Some chemotherapy drugs, called "nonspecific," are capable of killing cancer cells during any phase of growth; others, called "specific," can kill cancer cells only during a specific phase and not while the cell is resting. Doctors often create a chemotherapy regimen by combining specific and nonspecific chemo agents for maximum effect.
When the doctor chooses a drug, she also makes decisions about dosage level, frequency of dosage, and length of treatment. These decisions can affect how easy or difficult it is to tolerate the chemo regimen. The more you can find out about exactly which drugs will be used, in what dosages, and for how long, the better prepared you'll be to manage side effects. Some chemotherapy drugs are given through an IV, while others can be taken orally or by injection.
- Chemotherapy schedules. Chemotherapy is most often performed on an outpatient basis, though if surgery is involved, the doctor may start chemo during the hospital stay.
Chemotherapy is usually given in cycles, with periods of treatment followed by periods of rest to allow the body to recover. Patients might receive three weeks of chemo followed by one week of rest, one week of chemo followed by three weeks of rest, or other combinations. Generally, though, a full four weeks makes up one cycle. Sometimes patients meet certain health criteria in order to go through the next round of chemotherapy. For example, the doctor may monitor blood cell counts, and if the white or red blood cell count drops too low, the doctor may have to postpone the next round of chemo until the count rises again.
Radiation therapy for breast cancer treatment
Radiation can be performed after a breast tumor is surgically removed to catch stray cancer cells, before surgery to shrink a tumor, or as a stand-alone therapy.
There are two general kinds of radiation therapy: internal and external. Doctors usually recommend internal radiation, also called brachytherapy, when they want to target the cancer with a high dose of radiation delivered internally to a small area, such as tumors located in the breast. The radiation is implanted or injected in wires, "seeds," or capsules, then left in place for a period of time, either until they're removed or until they decay and become inactive. Brachytherapy is usually performed as an outpatient procedure, though sometimes doctors choose to implant a radioactive "source" at the end of surgery.
When the radiation is beamed into the body from an outside source, most often from an X-ray machine or linear accelerator, it's called external radiation. External radiation is usually given in the form of a sequence of treatments, typically five days a week for six to eight weeks. (On weekends, patients get a break so their body can recover.)
Radiation therapy is a rapidly improving technology, and there are many different types available.
Hormone therapy for breast cancer treatment
Used most often to treat breast and prostate cancers, hormone therapy uses the body's own natural hormones to treat cancers that are affected by the hormones produced by the endocrine system. Because hormones fuel the growth of so me types of cancer, cutting off or blocking the action of those hormones can stop the cancer from growing. Estrogen blockers, for example, can be very effective in treating some types of breast cancer.