Before rushing into treatment, responsible breast cancer professionals urge their new patients to thoroughly assess their options. If you have breast cancer, you will almost certainly require a mix of treatments. These will vary depending on the tumor’s form and size, your age, and the extent to which the disease has spread. Take your time considering each choice, and consider bringing a spouse, a friend, or a relative with you to your doctor’s appointment to assist you in asking questions and remembering answers.
When is surgery advised?
Surgery is the first line of defense against most breast cancers. If your cancer is small and limited to one area of your breast, your surgeon may remove only the lump and a little amount of surrounding tissue. This procedure is known as a lumpectomy. If the cancer was discovered early, you’ll likely have a lumpectomy, potentially with the removal of some underarm lymph nodes, followed by radiation to destroy any undiagnosed cancer cells left in the area. (You may not need lymph node surgery if a sentinel node biopsy reveals no malignancy in the sentinel nodes.)
Women with early-stage breast cancer can also receive radiation treatment. The new treatment, called brachytherapy, takes around five days instead of the traditional six weeks of radiation after a lumpectomy. Radioactive “seeds” are briefly implanted into the location where the tumor was excised in this therapy. The radiation can be concentrated more precisely using this technique than with an external beam. Brachytherapy had previously been used to treat tumors such as prostate cancer, but it is a new treatment option for breast cancer patients. Although preliminary studies on its effectiveness have been encouraging, long-term findings are needed to compare this radiation treatment to regular external beam radiation.
If the cancer is more advanced, your surgeon may suggest a mastectomy, which involves removing the entire breast. Radical mastectomies, which involved the removal of the breast and the muscles of the chest wall, are no longer common. The most common mastectomy is a modified radical mastectomy, which involves the removal of the visible breast, all breast tissue, and lymph nodes in the armpit. After this procedure, you may choose to have your breasts reconstructed. If reconstruction is desired, it can be done at the same time as your mastectomy or at a later date. For women with smaller tumors, a novel treatment called skin-sparing mastectomy may be a possibility. This treatment leaves the majority of the skin over the breast untouched.
Will I have to get chemotherapy?
Women who have had breast cancer and had surgery are understandably concerned about the prospect of chemotherapy. Most people think about hair loss and nausea as side effects, while modern approaches have reduced some of these problems. It’s crucial to realize that not all women with breast cancer require chemotherapy. If your doctor suspects that cancer has spread to other parts of your body, he or she will likely prescribe chemotherapy, hormone therapy, or both. Chemotherapy is most successful in premenopausal women, while hormone treatment is more effective in postmenopausal women.
Chemotherapy employs chemicals that kill all fast-growing cells, including malignant cells as well as hair-producing cells and immune system cells. It may be prescribed before surgery to reduce a large tumor or destroy any leftover cancer cells if the tumor was invasive. Cytoxan is one of the most often used chemotherapy medicines. Another is Taxol, which is currently synthesized but was originally extracted from yew tree bark. Taxol is now approved for the treatment of early breast cancer. It was previously solely used to treat advanced breast and ovarian cancer. Adriamycin, Methotrexate, and 5-Fluorouracil are three more often utilized chemotherapeutic medicines.
Is it possible to just watch and wait?
Some doctors believe that treatment should begin regardless of the type of breast cancer, but others now believe that in the case of DCIS, a non-invasive breast cancer confined to the milk ducts, women should have the option of watchful waiting, which involves having mammograms alternated with MRIs twice a year to see if anything has changed.
Herceptin, a monoclonal antibody, slows tumor growth by attaching to a region crucial for cell growth regulation in breast cancer cells. A woman’s cancer cells must have an excess of a protein called HER2/neu on the cell surface for this treatment to work, which occurs in around 1 in 5 breast cancer patients. These malignancies spread more quickly, and Herceptin can help limit their progression and boost the immune system’s ability to fight them more effectively. Intravenously, the medication is normally given once a week or in a greater dose every three weeks.
In some women, Herceptin can cause major adverse effects such as heart muscle damage, breathing issues, and severe allergic responses. Indeed, in 2005, the federal Food and Drug Administration (FDA) issued a formal warning for Herceptin after it was related to serious cardiac problems in around 4% of women who took part in large government research. However, in the majority of cases, these side effects are only transient and disappear as therapy is stopped.
Hormone replacement treatment
Tamoxifen, the most often used hormone-related medication, suppresses tumor growth by interfering with estrogen’s impact on tumor cells. While the advantages of tamoxifen much exceed the hazards, it does increase a woman’s risk of two types of uterine cancer: endometrial cancer and uterine sarcoma, according to the National Cancer Institute. Toremifene is a drug comparable to tamoxifen that is used to treat advanced malignancies in postmenopausal women.
Aromatase inhibitors such as letrozole (Femara), anastrozole (Arimidex), and exemestane (Aromasin) are now commonly utilized in postmenopausal women with estrogen and/or progesterone receptor-positive malignancies, either after or instead of tamoxifen treatment. The best period of treatment and if one of these medications is superior to the others are still being researched. In a five-year study of 9,300 women, researchers discovered that anastrozole reduced tumor recurrence by 70%, compared to 50% for tamoxifen. In comparison to tamoxifen, it had a lower risk of strokes, blood clots, and uterine malignancies. Although women on anastrozole had a greater risk of osteoporosis, experts claimed medicines may be provided to lower that risk.
Letrozole was reported to reduce the risk of recurrent breast cancers by 40% in a study of over 5,000 women published in the New England Journal of Medicine. All of the women in the research had estrogen-sensitive breast cancer and had been on tamoxifen for five years. Half were given a placebo tablet, while the other half were given letrozole. Because the letrozole group received such great results from the medicine, the study was halted early so that the other women in the study might also benefit from it. Increased risk of osteoporosis, joint and bone discomfort, hot flashes, night sweats, and allergic responses are all documented adverse effects of letrozole, however, most people seem to have relatively mild issues.
Fulvestrant is another medicine that appears to operate after tamoxifen has lost its effectiveness (Faslodex). It is approved for the treatment of postmenopausal women with advanced breast cancer that has progressed and has not responded to tamoxifen or toremifene, as well as those with HER2-negative breast cancer that has spread.
Furthermore, when given to pre-and perimenopausal women with breast cancer, a class of medications known as LHRH agonists suppresses the ovaries. The goal is to protect fertility by maintaining the ovaries during chemotherapy. Goserelin (Zoladex), leuprolide (Lupron), and triptorelin are examples of this class of drugs (Trelstar).
With so many therapies available and more being researched, deciding which is best can be difficult. Your doctor can help you assess the benefits of treatment against any potential adverse effects and choose the best treatment for you by analyzing your medical history.
What other therapies are in the works?
The following are some promising studies:
- Clinical trials are underway for a vaccination that stimulates the immune system to fight breast cancer cells.
- Compounds that induce a tumor to kill its own cells, as well as others that cut off a tumor’s blood supply by preventing the formation of surrounding blood vessels.
- PARP is a therapy that aids in the battle against cancer caused by BCRA mutations.
- More tailored medicines that target cancer cells while sparing healthy cells
- Oncoplasty is a procedure that combines breast cancer surgery with breast rebuilding in one operation.
What benefits does alternative medicine provide?
Alternative medicines have not been proven to cure cancer, so consult your doctor before using them. Certain alternative remedies, on the other hand, may help you feel better and recover more quickly. Acupuncture has been shown to relieve cancer-related nausea and discomfort in several cases. According to the National Academy of Sciences’ Institute of Medicine, smoking marijuana lowers chemotherapy-induced nausea and vomiting; the substance may be beneficial for some individuals who aren’t assisted by anti-nausea drugs. Some states have legalized marijuana for medical use. Meditation and guided imagery can help you relax and cope with discomfort better. Furthermore, research has indicated that women who participate in weekly support groups have a higher quality of life than those who only receive traditional therapies.
There is no proof that eating a macrobiotic diet or any other diet would cure cancer; in fact, it may prevent you from getting the nourishment you require. A varied diet rich in fruits, vegetables, grains, and legumes, although low in saturated fat, can’t hurt. You might also try drinking green tea; one exploratory study found that consuming four cups of green tea per day reduced the risk of recurrence in breast cancer patients by half. The FDA, however, decided after analyzing scientific evidence that green tea did not lessen the incidence of breast cancer.
Cancer-curing herbal therapies should be avoided. Anything powerful enough to impact tumor cells is likely to cause significant adverse effects, thus it should only be used under the supervision of a specialist.
According to research published in the Journal of the American Medical Association, something as easy as going for a stroll a few times a week can help you survive breast cancer. Those in the research who walked for 3 to 5 hours per week at a speed of around 3 miles per hour had half the risk of dying from the disease as women who did not exercise. You don’t even need to break a sweat; the study found no evidence that increasing the intensity of the exercise resulted in a substantial increase in benefit.