Breast Cancer Treatment
Breast cancer treatment methods and procedures vary in a wide range and are personalized depending on the stage of disease, biological subtypes of the tumor and overall health status of the patient. Breast cancer treatment is managed by a multidisciplinary team consisting of a specialized breast surgeon, medical oncologist, radiation oncologist, breast radiologist and breast pathologist.
Although the priority in the treatment is to treat the cancer while preserving healthy breast tissue, sometimes complete removal of the breast may be mandatory. Radiotherapy and chemotherapy, hormonal therapy, targeted therapy and even biological treatment (immunotherapy) can be necessary following the surgery.
Local treatment is treatment of the area where cancer is present.
Surgical treatment and radiotherapy are means of local treatment. These methods are administered only to cancerous zone and its surrounding in the breast without affecting entire body. Local treatment can also be administered when cancer is found in areas outside breast (lung, liver, bones, etc.).
Systemic treatment affects the entire body. Those are namely chemotherapy, hormonal treatment, and biological treatment. Systemic treatments can be used to downsize tumors in the breast before local treatment administration in some patients. It is also used to treat relapses or widespread cancer in some patients.
Surgical treatment
Surgery is the primary treatment method for breast cancer. Several surgical procedures can be used for breast. Breast surgeon must comprehensively explain advantages, risks, suitability of those surgical procedures to the patient.
Breast conserving surgery is the removal of cancerous tissue together with a certain amount of peripheral healthy breast tissue, and conserving the remaining healthy breast tissue.
Partial mastectomy, segmental mastectomy, lumpectomy are sub-topics of breast conserving surgery, classified by amount and size of the removed breast tissue. Patient’s breast is maintained in all these methods, and radiotherapy is administered to remaining breast tissue to prevent relapses.
Modified radical mastectomy is removal of the entire breast along with lymphatic nodes in the armpit. It is the modified and restricted version of former radical mastectomy in which muscular tissues under the breast are also removed. Radical mastectomy is not administered unless the cancerous lump is extending to muscular layer under the breast tissues.
Axillary dissection is the procedure of removing armpit lymph nodes when cancerous cells have affected the lymphatic system in the armpit. Until recently, it was a mandatory component of breast cancer surgeries.
Axillary sentinel lymph node biopsy is a procedure in which a blue dye material or a radioactive material is administered around the cancerous tumor lump in the breast or under the areola to identify which armpit lymph node (s) uptake these materials, and removal of the involved lymph node only. Thus, most patients do not experience the negative side effects (numbness, swelling in the arm) resulting from removal of the entire armpit tissues. Today, armpit lymph node removal is not required for most patients thanks to axillary sentinel lymph node biopsy.
Objective of all these surgical procedures should be treating the cancer, and then maintain the breast to the possible extent, or otherwise offer breast reconstruction (breast implant, autologuous flaps) as an option to the patient.
Radiotherapy
Radiation treatment is one of the local treatment methods just like surgery, which can be used complementary to surgery as well as alone. Common procedure is external radiation where the desired area is externally irradiated. Radiation disrupts the cancerous cells present in the area of application, and the procedure is performed by a radiation oncologist.
Chemotherapy
It is a chemical treatment used for elimination of cancerous cells. As for breast cancer, usually a combination of a few different chemicals are used. Some of them are administered by injection, while others are taken orally, and the chemicals are delivered to entire body through blood system. It can be administered at hospital, clinic or at home on daily basis or once in every few weeks. The procedure is administered by a medical oncologist.
Hormonal treatment
These are the drugs used against the hormones causing cancer cell growth. They are effective on tumors with receptors susceptible to hormones. It is a systemic treatment similar to chemotherapy.
Targeted treatment
In few subtypes of breast cancer, specific receptors (target proteins) (Her 2) which contribute to uncontrolled growth of the tumor, are expressed. The drugs used in targeted treatment bind to these receptors, thus inhibiting the cell growth and causing their destruction.
Immunotherapy
These are the drugs that strengthens the patient’s own immune system against cancer cells. Immunotherapy is administered only in selected patients.
Recurrent Breast Cancer
Breast cancers reoccurring after treatment is referred as ‘relapsed cancer’, and develops from the initial tumor cells. Objective of the treatment is to completely eliminate the disease but aggressive tumors may not be completely eliminated even by adjuvant treatment. Cancer may relapse in the initial location or may appear in remote organs. However, advances in adjuvant treatment and radiotherapy (RT) procedures have significantly decreased the risk of relapse for breast cancer.
Relapsed breast cancer may occur after mastectomy or breast conserving surgery, or may occur locally or regionally months, years after the initial treatment.
Recurrent breast cancer treatment is defined in detail per surgical guidelines, and managed by a multidisciplinary team depending on the area and time of recurrence.
