The month of October is dedicated to Breast Cancer, the most frequently diagnosed cancer among women in 140 of 184 countries worldwide. Most women with breast cancer seek surgical treatment as part of their recovery. Surgery is done to remove cancerous tumors, look at whether or not cancer has spread to the lymph nodes (located under your arms), restore the shape of the breast after removal of cancer, and relieve symptoms of advanced cancer. Depending on the case, you will either have a choice of which treatment to receive or your doctor may recommend a treatment to you.
There are several surgical options that you can choose to undergo. Breast-conserving surgery is when only part of the breast containing the cancer is removed. The severity of cancer along with several other factors determine how much of the breast tissue is removed, but the ultimate goal is to excise the cancer with some surrounding healthy tissue. This option, however, generally needs to be coupled with radiation therapy.
Mastectomy is another surgery option, where the entire breast is surgically removed including all of the tissue and nearby tissues. Women can choose between several kinds of mastectomy. Mastectomy can be a preferable option depending on the type of breast cancer, the size of the tumor, prior treatment with radiation, etc. It’s important to note that studies have shown that the survival rate between mastectomy and breast-conserving surgery treatments is the same for early-stage cancer.
A third surgery option is lymph-node removal surgeries. Two types of lymph-node removal surgeries include sentinel lymph node biopsy, where only one or a few lymph nodes under the arm are removed, and axillary lymph node dissection, where several underarm lymph nodes are removed.
For advanced cancers, surgery can be used to alleviate symptoms when a breast tumor is causing an open wound, has metastasized (the cancer has spread to different parts of the body), when a metastatic tumor is pressing on the spinal cord, to treat a liver blockage, and to relieve pain.
Chemotherapy is often used after surgery to kill cancer cells that weren’t removed or have spread, before surgery to shrink the tumor, and also for advanced breast cancer. Drugs used for chemotherapy include anthracyclines (epirubicin and doxorubicin are examples), Taxanes (paclitaxel and docetaxel), 5-fluorouracil/capecitabine, Cyclophosphamide, and Carboplatin, and a combination of 2-3 drugs is typically used. For advanced breast cancer, Taxanes, anthracyclines, platinum agents, vinorelbine, capecitabine, gemcitabine, ixabepilone, and eribulin are typically used. Chemotherapeutic drugs are usually given intravenously as an infusion or an injection, and it is given in cycles followed by a rest period to allow you to recover. Side effects include hair loss, nail changes, mouth sores, loss of appetite, changes in weight, nausea, vomiting, diarrhea, easy bruising/bleeding (low platelet count), fatigue (low RBC count), increased chance of infections (low WBC count), premature menopause and infertility, and changes in menstruation. Chemo can also result in heart damage, nerve damage, decreased mental functioning (known as chemo brain), and an increased risk of leukemia.
Hormone therapy is also often used after surgery to reduce the risk of the cancer returning, generally taken for 5-10 years. Two-thirds of breast cancers have receptors for estrogen and/or progesterone, and the binding of these hormones to the receptor can cause cancer to grow and spread. Tamoxifen blocks estrogen receptors on breast cancer cells. Side-effects include hot flashes, vaginal dryness, increased risk of developing uterine cancer, blood clots, and strokes in post-menopausal women. Fulvestrant is a drug that degrades the estrogen receptors; it is only approved for use in postmenopausal women and combined with a luteinizing-hormone releasing hormone to inactivate the ovaries. Side-effects include hot flashes, night sweats, headache, nausea, bone pain, and injection site pain. Aromatase inhibitors halt estrogen production in postmenopausal women ( a small amount of estrogen is produced by fat tissues with an enzyme called aromatase).
Radiation is another non-surgical treatment option where high-energy rays and particles are used to kill cancerous cells. This can reduce the chance of cancer returning and treat metastasizing cancer. Radiation can be localized depending on the location of the cancer. If it has not spread to the lymph nodes, radiation will be focused on the chest wall and the surgical scar. If however, it has spread to the lymph nodes, the underarms, chest, and collarbones will be given treatment. The standard schedule for radiation is 5 days a week for 6-7 weeks. An alternative option is hypofractionated radiation therapy, where the whole breast receives larger doses of radiation with fewer treatments (3-4 weeks). Accelerated partial breast irradiation gives large doses of radiation in a short time frame to only one part of the breast. Some side-effects are swelling in the breast, skin changes, and fatigue, and you may be advised to avoid exposure of treated skin to the sun.
Targeted Therapy is used in HER2 positive cancers (HER2, a growth protein, is found on the surface of these cells). Monoclonal (manmade) antibodies are designed in this case to attach to HER2, halting the growth of the cancer cells. The monoclonal antibodies available for clinical use are: trastuzumab, pertuzumab, and hyaluronidase, and a combination of the 3 are generally used for treatment.
Immunotherapy uses medicine to stimulate one’s immune system to recognize and destroy cancer cells effectively and is only used to treat certain cancers. Breast cancer cells often use immune checkpoints to avoid attack by immune cells, immune checkpoint inhibitors allow the immune cells to attack these. PD-L1 inhibitors are often used since PD-L1 is often found on tumor cells, however, they can result in fatigue, cough, nausea, appetite loss, constipation, and diarrhea
Our team sends love to all the breast cancer fighters and survivors this October. Fight, Hope, Believe!
Written by Lily Sun
Researched by Natasha Koneru