Treatment of Breast Cancer

Treatment decisions are made after considering the optimal treatment for the stage of cancer, the age of the patient and her preferences, along with the risks and benefits ascribed to each treatment protocol.

Most women with breast cancer will have to undergo some type of surgery. Surgery is often combined with other treatments such as radiation therapy, chemotherapy, hormone therapy and/or monoclonal antibody therapy.

Surgery

The basic purpose of breast cancer surgery is to remove the cancer from the breast and lymph nodes.

In a lumpectomy, only cancerous tissue plus a rim of normal tissue is removed. Lympectomy is almost always followed by six to seven weeks of radiation therapy which has the same expected long-term survival as in case of mastectomy.

Simple or total mastectomy includes removal of the entire breast.

Modified radical mastectomy includes removal of the entire breast and lymph nodes under the arm, but does not also include removal of the underlying chest wall muscle, as with a radical mastectomy.

Both lumpectomy and mastectomy are often accompanied by removal of regional (axillary) lymph nodes to determine if the disease has spread beyond the breast.

Radiation Therapy

Radiation may be used to destroy cancer cells remaining in the breast, chest wall, or underarm area after surgery, or to reduce the size of a tumor before surgery.

Systemic Therapy

Systemic therapy includes chemotherapy and hormone therapy. Adjuvant systemic therapy is used after all visible cancer has been surgically removed in order to kill any undetected tumor cells that may have migrated to other parts of the body.

adjuvant systemic therapy is administered depending upon the tumor size, histology, and the presence of cancer in axillary nodes.

Systemic therapy is also used in treating women with advanced breast cancer. In such conditions, removal of most of the cancer by surgery is not possible, and therefore systemic therapies become the main treatment modality.

Chemotherapy

Research has established that combinations of several drugs are more effective than just one drug alone. If the disease has become resistant to the first-line therapies, which include specific combinations of cyclophosphamide, methotrexate, fluorouracil, doxorubicin, epirubicin, and paclitaxel, about 20% to 30% of patients do respond to second-line drugs.

Chemotherapy medications for breast cancer include:

  • Paclitaxel
  • Doxorubicin
  • Paraplatin
  • Cyclophosphamide
  • Epirubicin
  • Gemcitabine
  • Vincristine

In many cases, chemotherapy medicines are given in combination.These combinations are known as chemotherapy regimens. In early stage breast cancer, standard chemotherapy regimens lower the risk of the cancer coming back. In advanced breast cancer, chemotherapy regimens make the cancer shrink or disappear in about 30-60% of people treated.
The Standard chemotherapy regimens include:
1. Doxorubicin and Docetaxel
2. Doxorubicin and Cyclophosphamide, with or without Paclitexel or Docetaxel
3. Cyclophosphamide, Methotrexate, and 5- fluorouracil
4. Cyclophosphamide, Epirubicin, and 5-fluorouracil
5. 5-fluorouracil, Doxorubicin, and Cyclophosphamide
6. Cyclophosphamide,Doxorubicin,and5-fluorouracil
7. Docetaxel, Doxorubicin and Cyclophosphamide.

Hormone Therapy:

Estrogen, a hormone produced by the ovaries, promotes growth of some breast cancers. Women whose breast cancers test positive for estrogen or progesterone receptors can be given hormone therapy to block the effects of estrogens on the growth of breast cancer cells.

Tamoxifen, the most commonly used antiestrogen drug, has been shown to provide a 26% annual reduction in recurrence and a 14% annual reduction in deaths. Hormone therapy is effective in both postmenopausal and premenopausal patients whose cancers are positive for steroid hormone receptors.

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