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One reason to question the findings, however, is that if pre-op chemo promotes metastasis in some patients, that might be expected to have shown up in studies of the therapy. Overall, in fact, those studies show;that neoadjuvant chemotherapy does not seem to improve overall survival, as the authors of an editorial in the Journal of Clinical Oncology wrote.
Thats not as bad as decreasing survival, of course. But Einsteins Dr. Maja Oktay, a co-author of the new research, cautioned that the typical length of the studies six or so years is too short to assess the risk of metastasis, which can take more than 20 years to appear, she said. Such patients might never be flagged as having metastatic cancer, let alone having it linked to pre-op chemo decades earlier, said Aguirre-Ghiso.
On a brighter note, not all breast cancer patients have the kind of tumor microenvironment in which pre-op chemo can promote metastasis. Whether they do or not can be determined by a simple lab test, but one that is not routinely done, Condeelis said.
Serendipitously, an experimental compound called rebastinib, being developed by Deciphera Pharmaceuticals, seems to be able to block the on-ramp to the metastasis highway. In a study currently recruiting patient volunteers, the Einstein scientists are studying whether rebastinib can improve outcomes in metastatic breast cancer.
Stage 4 Breast Cancer
A person with stage 4 breast cancer has cancer that has spread not only to the nearby lymph nodes but also to more distant lymph nodes and other organs in the body.
Stage 4 breast cancer is the most advanced stage. It is also known as secondary or metastatic breast cancer. Stage 4 breast cancer may be recurrent breast cancer that has now spread to other parts of a persons body.
How Is Chemotherapy Given
Chemo drugs for breast cancer are typically given into a vein , either as an injection over a few minutes or as an infusion over a longer period of time. This can be done in a doctors office, infusion center, or in a hospital setting.
Often, a slightly larger and sturdier IV is required in the vein system to administer chemo. These are known as central venous catheters , central venous access devices , or central lines. They are used to put medicines, blood products, nutrients, or fluids right into your blood. They can also be used to take out blood for testing.
There are many different kinds of CVCs. The most common types are the port and the PICC line. For breast cancer patients, the central line is typically placed on the side opposite of the underarm that had lymph nodes removed for the breast cancer surgery.
Chemo is given in cycles, followed by a rest period to give you time to recover from the effects of the drugs. Cycles are most often 2 or 3 weeks long. The schedule varies depending on the drugs used. For example, with some drugs, the chemo is given only on the first day of the cycle. With others, it is given for a few days in a row, or once a week. Then, at the end of the cycle, the chemo schedule repeats to start the next cycle.
Adjuvant and neoadjuvant chemo is often given for a total of 3 to 6 months, depending on the drugs used. The length of treatment for advanced breast cancer depends on how well it is working and what side effects you have.
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Wire Localization To Guide Surgery
Sometimes, if the cancer in your breast cant be felt, is hard to find, and/or is difficult to get to, the surgeon might use a mammogram or ultrasound to guide a wire to the right spot. This is called wire localization or needle localization. If a mammogramis used you may hear the term stereotactic wire localization. Rarely, MRI might be used if the mammogram or ultrasound are not successful. ;
After your breast is numbed, a mammogram or ultrasound is used to guide a thin hollow needle to the abnormal area. Once the tip of the needle is in the right spot, a thin wire is put in through the center of the needle. A small hook at the end of the wire keeps it in place. The needle is then taken out. The surgeon uses the wire as a guide to find the part of the breast to be removed.
The surgery done as part of the wire localization may be enough to count as breast-conserving surgery if all of the cancer is taken out and the margins are negative. If cancer cells are found at the edge of the removed tissue , more surgery may be needed.;;
It should be noted that a wire-localization procedure is sometimes used to perform a surgical biopsy of a suspicious area in the breast to find out if it is cancer or not.;
There are other ways a surgeon can be guided to the tumor, but these techniques are newer and not used in every facility.
Treatment For Stage 2 Breast Cancer
The most common type of treatment for stage 2 breast cancer is surgery.
In most cases, treatment involves removing the cancer.
A person with stage 2A or 2B breast cancer may undergo a lumpectomy or mastectomy. The doctors and the individual can decide based on the size and location of the tumor.
A doctor may recommend a combination of radiation therapy, chemotherapy, and hormone therapy to people with stage 2A or 2B breast cancer.
The subcategories for stage 3 breast cancer are 3A, 3B, and 3C.
3A breast cancer is an invasive breast cancer where:
- There is no tumor in the breast, or a tumor of any size is growing alongside cancer found in four to nine axillary lymph nodes or the lymph nodes by the breastbone.
- A person has a tumor greater than 5 cm, as well as clusters of breast cancer cells in the lymph nodes that are between 0.22 mm in diameter.
- The tumor is larger than 5 cm, and cancer has also spread to one to three axillary lymph nodes or the lymph nodes near the breastbone.
Stage 3B breast cancer is invasive breast cancer where:
- A tumor of any size has spread into the chest wall or skin of the breast, causing swelling or an ulcer to develop. It could also have spread to up to nine axillary lymph nodes or may have spread to lymph nodes by the breastbone.
If cancer spreads to the skin of the breast, a person may have inflammatory cancer.
Symptoms of inflammatory breast cancer include:
Stage 3C breast cancer is an invasive breast cancer where:
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Surgery For Breast Cancer
Most women with breast cancer have some type of surgery as part of their treatment. There are different types of breast surgery, and it may be done for different reasons, depending on the situation. For example, surgery may be done to:
- Remove as much of the cancer as possible
- Find out whether the cancer has spread to the lymph nodes under the arm
- Restore the breasts shape after the cancer is removed
- Relieve symptoms of advanced cancer
Your doctor may recommend a certain operation based on your breast cancer features and your medical history, or you may have a choice about which type to have. Its important to know your options so you can talk about them with your doctor and make the choice that is right for you.
Ovarian Ablation Or Suppression
In women who have not;yet experienced the menopause, oestrogen is produced by the ovaries.
Ovarian ablation or suppression stops the ovaries working and producing oestrogen.
Ablation can be done using surgery or radiotherapy. It;permanently stops the ovaries from working and means you’ll experience the menopause early.
Ovarian suppression involves using a medicine called goserelin, which is a luteinising hormone-releasing hormone agonist .
Your periods will stop while you’re taking it, although they should start again once your treatment is complete.
If you’re;approaching the menopause , your periods may not start again after you stop taking goserelin.
Goserelin comes as an injection you have once a month.
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What Is Radioactive Seed Localization
Radioactive seed localization is a technique used to locate and remove small breast cancers that are detected on a mammogram or ultrasound but cannot be felt by your surgeon during a breast exam.
The procedure can take place up to a week before your lumpectomy. A radiologist places a tiny radioactive seed, about the size of a grain of rice, in your breast to mark the exact location of the cancer. The implanted seed contains a small amount of radiation, which helps your surgeon find the cancer at the time of your surgery using a handheld radiation-detection device.
The seed is removed by your surgeon during your lumpectomy.
How Long Will I Be In Hospital
The length of your hospital stay will depend on what type of surgery you have, how you recover and the support available at home.
Some people who’ve had breast surgery without reconstruction are discharged from hospital within 23 hours. This means you may have your surgery as a day case or stay overnight, being discharged within 23 hours of admission.
In such cases some people might still have;wound drains;in place. Your treatment team will talk to you about how long youll be in hospital.
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Who Cannot Have Radiation Therapy
Sometimes a woman may be eligible for a lumpectomy, but not for radiation, thus requiring a mastectomy. Not everyone can have radiation therapy. Being pregnant or having certain health conditions can make radiation therapy harmful.
- Pregnancy.;Radiation can harm the foetus, so is not given during pregnancy. Depending however on the timing of the pregnancy and the breast cancer diagnosis, a woman may be able to have a lumpectomy and put off radiation therapy until after delivery.
- Scleroderma or systemic lupus.; Certain serious connective tissue diseases such as scleroderma or lupus, may make you especially sensitive to the side effects of radiation therapy
- Past radiation therapy to the same breast or to the same side of the chest. In general, radiation therapy to the breast can only be given once.
If you have a choice, take time to study your options. In the vast majority of cases there is absolutely no rush to come to a decision, and it is more important that you take your time to come to a decision with which you are comfortable, than to rush into a decision that you may later regret. A short delay before surgery will have no adverse impact on prognosis, and if you feel that your breast surgeon is unduly pressuring you into making a hasty decision, particularly if they indicate that a short delay may influence your prognosis, you may wish to consider a second opinion. See Delay between Diagnosis and Surgery
Reproduced from breastadvocateapp.com
Checking The Lymph Nodes Before Surgery
You have an ultrasound scan of the lymph nodes under your arm at the same time as having other tests to diagnose breast cancer.
You usually have a biopsy of any lymph nodes that look abnormal. The biopsy is sent to the laboratory to check for cancer cells. If this shows that the cancer has spread to the nodes in the armpit, you will have surgery to remove all or most of them. You have this at the same time as your breast surgery. This is called an axillary lymph node dissection or clearance.
If the lymph nodes look normal during the ultrasound scan, you dont have a biopsy. But you will have a sentinel lymph node biopsy during your surgery.
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What Are Some Of The Possible Risks Or Complications
Minor complications include:
- Slight swelling of the breast during radiotherapy. This usually goes away within six to 12 months.
- The skin becomes darker during the course of radiotherapy, similar to tanning from the sun. In most cases, this also fades gradually over six to 12 months.
- Most women will have aches or pains from time to time in the treated breast or the muscles surrounding the breast, even years after treatment. The reason why this happens is not clear; however, these pains are harmless, although annoying. They are NOT a sign that the cancer is reappearing.
- Rarely, patients may develop a rib fracture years following treatment. This occurs in less than one percent of patients treated by modern approaches. These heal slowly by themselves.
More serious complications include:
Risks And Benefits Of Mastectomy Versus Lumpectomy Plus Radiation Therapy
The main benefit of lumpectomy plus radiation therapy is the breast is preserved as much as possible.
A potential benefit of mastectomy is radiation therapy may be avoided. Although some women will need radiation therapy after mastectomy, many will not.
Radiation therapy has some side effects and requires daily trips to a treatment facility. If you live far away from a radiation treatment centre, or if you cannot have radiation therapy, mastectomy may sometimes be a better option for you than lumpectomy.
The table below outlines some things to consider when choosing between mastectomy and lumpectomy plus radiation therapy.
Total mastectomy versus lumpectomy plus radiation therapy
|Chance of recurrence in the breast||Very low for early stages of breast cancer||Low for early stages of breast cancer (but slightly higher than with mastectomy|
|Chance of distant metastatic recurrence outside the breast and/or axilla||Same as with lumpectomy plus radiation therapy||Same as with mastectomy|
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Making Your Own Decision
Your breasts may be such an important part of your identity your sense of who you are that youll go to great lengths to preserve them. Thats a completely acceptable approach to take, no matter what your age or figure as long as it doesnt endanger your overall health and chances for a full recovery.
Over the past decade, women with early-stage breast cancer are increasingly opting for mastectomy or double mastectomy removal of both breasts. The increased availability of advanced breast reconstruction techniques has contributed to the trend.
Things to consider
There are no right or wrong answers when you are making a decision between treatments. Women each feel very differently. You need to decide what feels best for you.
Some women want to keep their breast if at all possible, so they choose a lumpectomy and radiotherapy.
Other women feel that once they have breast cancer they would rather have the whole breast removed because it makes them feel it is more likely to remove all of the cancer. They can then choose to have a new breast made .
Some women feel strongly that they dont want radiotherapy. Others welcome it if it means keeping their breast.
Factors affecting which surgery might be best for you:
- the size of your cancer;
- where the cancer is in your breast
- whether there is more than one area of cancer;
- the size of your breasts;
- your general health;
What to take into account
To help you decide, you might want to think about:
How Can I Make A Decision Between Mastectomy And Breast Conservation Therapy
Breast conservation therapy is often used for patients with early-stage invasive breast cancers . It is also used for patients with DCIS . Some of the reasons to not have breast conservation therapy include: personal preference; increased risk of complications from radiation therapy in individuals with certain rare medical conditions such as certain autoimmune disorders; surgery that would require removing a large amount of diseased breast tissue that would lead to a poor cosmetic result; and tumors that are more likely than average to have a relapse in the breast with breast conservation therapy.
Most patients may choose a treatment based on other factors, such as convenience or personal preference . Most women prefer to keep their breast if this is possible to do safely, but there is no right answer that is best for everyone. This decision is one that is ideally made in partnership between a patient and her physician. In some cases a pre-surgical consultation with a radiation oncologist may be helpful in answering questions about breast-conserving therapy.
Nearly all physicians will recommend patients be treated with mastectomy instead of breast conservation therapy when the risk of recurrence in the breast is more than 20 percent. This is the case if the tumor is large or multifocal . This situation occurs for only a small number of women, however.
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Breast Cancer: Types Of Treatment
Have questions about breast cancer? Ask here.
ON THIS PAGE: You will learn about the different types of treatments doctors use for people with breast cancer. Use the menu to see other pages.
This section explains the types of treatments that are the standard of care for early-stage and locally advanced breast cancer. Standard of care means the best treatments known. When making treatment plan decisions, you are strongly encouraged to consider clinical trials as an option. A clinical trial is a research study that tests a new approach to treatment. Doctors want to learn whether the new treatment is safe, effective, and possibly better than the standard treatment. Clinical trials can test a new drug and how often it should be given, a new combination of standard treatments, or new doses of standard drugs or other treatments. Some clinical trials also test giving less treatment than what is usually done as the standard of care. Clinical trials are an option to consider for treatment and care for all stages of cancer. Your doctor can help you consider all your treatment options. Learn more about clinical trials in the About Clinical Trials and Latest Research sections of this guide.