There are several modes of treatment for breast cancer including:
- Surgical management of breast cancer
- Reconstructive surgery
- Chemotherapy or endocrine therapy
- Diet management. Dietary phytoestrogens such as those found in soybeans have a chemical structure that is similar to that of 17b-estradiol and can bind to the estrogen receptor to compete with estrogen. Their consumption may have a weak protective effect against breast cancer and are good for preventive treatment.
Treating the invasive breast cancer
Surgery in treatment of breast cancer
- Treatment with surgery involves removal of the lump in the breast. For patients with tumors smaller than 5 cm are best managed with lump removal (lumpectomy) followed by irradiation treatment to the affected breast.
- In larger tumors a process called mastectomy (removal of the breasts) is preferred. In this procedure, there an additional use of drugs for treating cancer. In estrogen-receptor positive tumors, endocrine treatment is added to the mastectomy to shrink the tumors before surgery
- A process of axillary node (lymph nodes in the armpits) evaluation should be performed on most women who are suitable candidates for preventive (adjuvant) treatment. In this process, the sentinel node (the first lymph node where metastatic spread of cancer goes to) is taken for biopsy. Some oncologists will inject a dye, isosulfan blue dye, a radioactive isotope compound around the primary tumor or areolar area of the breasts to help identify the first node (or nodes) draining the primary lesion. Majority of patients have the sentinel node in the same side of the arm pit as the breast. In a study, about 60% of patients with positive tests for the sentinel node, there have been results of only the sentinel node having the tumor.
Breast reconstruction surgery
This type of procedure is performed at the same time with breast mastectomy. With this, women have a chance to overcome the psychological effects of loosing their breasts. A woman will feel complete and better with both breasts intact and the psychological effect of restoring to the original shape the lost breast is paramount.
The choice of breast implants to be used is also important to the patients. Several types are in the market including saline or silicone implants and are less costly and generally easy to implant.
Other types of reconstruction include the use flaps or grafts from other parts of the body. It is recommended to go for the implants in cases of loosing large amounts of tissue during surgery of the breasts.
Loosing a breast to a woman is a tragedy. She will not feel complete and this affects her body image and to some extent her sexual sense too. There is a greater need to have psychological support and counseling before and after the procedure. The good thing is that most implants and types of reconstructive surgeries in the market help in restoring theta lost confidence.
There is need to offer psychosocial support shortly after diagnosis is made, especially to the most vulnerable or the most distressed, to cope better.
Preventive (adjuvant) therapy is defined as the use of chemotherapy, hormonal drugs, radiation or a combination of these before, during, or after definitive treatment of the primary breast cancer.
- The objective of adjuvant therapy is to destroy small, hidden (occult) distant tumor spreads( micrometastases)
- In addition, adjuvant therapy helps to delay cancer recurrence for a median of 2 to 3 years in the majority of treated women.
- Those who require this type of treatment are those in menopause, have large tumor size, poor tumor grade, tumor spread to lymph nodes, positive HER2 status and positive estrogen and progesterone status.
Adjuvant Endocrine Treatment
- Tamoxifen is used to treat patients who are in postmenopausal stage and are estrogen or progesterone receptor positive. Its estrogen-agonist effects on bone and liver help to maintain bone density and to lower cholesterol levels in postmenopausal women. The risk is that it may cause bone loss in premenopausal women, risk of endometrial cancer, increase the risk in developing deep venous thrombosis and exacerbate hot flashes in 10 to 30% of postmenopausal women.
- The use of aromatase inhibitors such as anastrozole, exemestane and letrozole are used in endocrine management of breast cancer too. Unlike tamoxifen, aromatase inhibitors are not associated with an increased risk of vein thrombosis or endometrial cancer. There common risks are joint pins, muscle aches and bone loss with fractures.
- There are various drugs in the market for treating breast cancer. Most treatments involve the use of combination therapy to achieve the best results. These are also superior in the management of breast cancer
- The commonest drugs used in management include: Anthracyclines such as epirubicin or doxorubicin, taxanes, humanized monoclonal antibodies such as trastuzumab against a protein encoded by the HER-2 gene.
Radiation treatment of breast cancer
- Studies have proven that breast irradiation following removal of the affected breast lumps ( lumpectomy)reduces the risk of breast tumor recurrence
- This kind of treatment involves the streaming of radiation beams to the chest wall following mastectomy. There is a significant decrease I rates of recurrence besides killing of the tumor in early stage cancer
- The treatment is offered to women who have lumps ranging is sizes of > 5cm in diameter and those with extensive lymph node involvement.
- There is a risk of developing Lymphedema in the upper limbs and on the side of the mastectomy in radiation treated patients.