How Is Breast Cancer Treated
If the tests find cancer, you and your doctor will develop a treatment plan to eradicate the breast cancer, to reduce the chance of cancer returning in the breast, as well as to reduce the chance of the cancer traveling to a location outside of the breast. Treatment generally follows within a few weeks after the diagnosis.
The type of treatment recommended will depend on the size and location of the tumor in the breast, the results of lab tests done on the cancer cells, and the stage, or extent, of the disease. Your doctor will usually consider your age and general health as well as your feelings about the treatment options.
Breast cancer treatments are local or systemic. Local treatments are used to remove, destroy, or control the cancer cells in a specific area, such as the breast. Surgery and radiation treatment are local treatments. Systemic treatments are used to destroy or control cancer cells all over the body. Chemotherapy and hormone therapy are systemic treatments. A patient may have just one form of treatment or a combination, depending on her individual diagnosis.
Myth #: Metastatic Breast Cancer Is A Single Type Of Cancer That Will Be Treated The Same Way For Every Person
The label metastatic contributes to the myth that it is one kind of breast cancer. But like earlier-stage breast cancers, stage IV cancers can have different characteristics that will guide treatment choices. They can test positive or negative for hormone receptors and/or an abnormal HER2 gene the gene that causes the cells to make too many copies of HER2 proteins that can fuel cancer growth. These test results guide treatment choices.
For triple-negative stage IV cancers meaning they test negative for hormone receptors and an abnormal HER2 gene testing for PD-L1 is becoming more common. PD-L1 is a checkpoint protein found on the surface of healthy cells that prevents the bodys immune system T-cells from attacking them. Some breast cancer cells also have large amounts of PD-L1 on their surfaces, which helps shield them from the bodys immune response. Newer immunotherapies are being used to treat PD-L1-positive MBC.
Furthermore, treatment choices can depend on a persons age, overall health, and whether there are other medical conditions present.
The bottom line? Treatments vary. DivineMrsM of Ohio says it well: There is the misconception that there is one standardized treatment for every case of MBC, like a one size fits all. But there are different approaches and it cant always be said that one approach is better than another. Most people dont realize different subcategories of this disease.
Survival After Breast Conservation Vs Mastectomy Adjusted For Comorbidity And Socioeconomic Status: A Swedish National 6
JAMA Surg. Published online May 05, 2021. doi:10.1001/jamasurg.2021.1438.
Breast conserving surgery is a surgery where the cancer of the breast is removed while as much of the normal breast is left behind as possible. The amount of breast tissue removed at the time of surgery depends on the size of the tumor, location of the mass and a patients breast size. Most women after BCS will need radiation therapy . On the contrary mastectomy is removal of the entire breast however, no muscles are removed from beneath the breast tissue. There are different types of mastectomy, such as skin-sparing mastectomy and nipple-sparing mastectomy, which are different cosmetic options. Depending on the size and location of the tumor, your breast surgeon will discuss whether or not both BCS and mastectomy are options for you.
Early trials showed that cancer outcomes were the same for women who underwent BCS followed by RT as women who underwent mastectomy. However, some more recent population-based trials showed that there was improved overall survival for patients who undergo BCS with RT compared to patients who had mastectomy with or without RT, which are both standard of care for small breast cancers. These more recent studies put into question mastectomy as an equally effective alternative to BCS for small breast cancers.
It is interesting to see that BCS and mastectomy may not provide equivalent long-term results as we had once believed for women who are candidates for both options.
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Breast Examination After Treatment For Breast Cancer
After surgery
The incision line may be thick, raised, red and possibly tender for several months after surgery. Remember to examine the entire incision line.
If there is redness in areas away from the scar, contact your physician. It is not unusual to experience brief discomforts and sensations in the breast or nipple area .
At first, you may not know how to interpret what you feel, but soon you will become familiar with what is now normal for you.
After breast reconstruction
Following breast reconstruction, breast examination for the reconstructed breast is done exactly the same way as for the natural breast. If an implant was used for the reconstruction, press firmly inward at the edges of the implant to feel the ribs beneath. If your own tissue was used for the reconstruction, understand that you may feel some numbness and tightness in your breast. In time, some feeling in your breasts may return.
After radiation therapy
After radiation therapy, you may notice some changes in the breast tissue. The breast may look red or sunburned and may become irritated or inflamed. Once therapy is stopped, the redness will disappear and the breast will become less inflamed or irritated. At times, the skin can become more inflamed for a few days after treatment and then gradually improve after a few weeks. The pores in the skin over the breast also may become larger than usual.
What to do
T Categories For Breast Cancer
T followed by a number from 0 to 4 describes the main tumor’s size and if it has spread to the skin or to the chest wall under the breast. Higher T numbers mean a larger tumor and/or wider spread to tissues near the breast.
TX: Primary tumor cannot be assessed.
T0: No evidence of primary tumor.
Tis: Carcinoma in situ
T1 : Tumor is 2 cm or less across.
T2: Tumor is more than 2 cm but not more than 5 cm across.
T3: Tumor is more than 5 cm across.
T4 : Tumor of any size growing into the chest wall or skin. This includes inflammatory breast cancer.
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The Myth And Stigma Of The 5
Many people still believe that breast cancer, even hormone-positive disease, is essentially cured after five years this can lead to misunderstandings in families. Loved ones who don’t understand late recurrence may downplay your feelings, or criticize you when you think “brain tumor” each time you get a headache.
Until information on late recurrence becomes more widely known, and even though it’s frustrating, you may need to educate loved ones about the risk, and why you should be concerned when you develop new or unexplained symptoms.
Multifocal Staging: Increased Risk Of Axillary Metastasis
The discovery of multifocal and multicentric breast cancer presents new challenges in terms of staging, follow-up procedures, and treatments. Of the approximately 11% of patients who have developed multifocal and multicentric tumors, approximately 52% of these will also present with axillary lymph node involvement. By contrast, axillary node involvement is discovered with unifocal breast cancers only about 38% of the time. This suggests that women with multifocal breast carcinomas have an increased tumor load, or a more serious and aggressive kind of breast cancer. Multifocal and multicentric tumors have tended to be understaged, often leading to a false sense of assurance and denying the patient the opportunity to aggressively pursue adjuvant therapies.
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How Do Tamoxifen Raloxifene Anastrozole And Exemestane Reduce The Risk Of Breast Cancer
If you are at increased risk for developing breast cancer, four medications tamoxifen , raloxifene , anastrozole , and exemestane may help reduce your risk of developing this disease. These medications act only to reduce the risk of a specific type of breast cancer called estrogen receptor-positive breast cancer. This type of breast cancer accounts for about two-thirds of all breast cancers.
Tamoxifen and raloxifene are in a class of drugs called selective estrogen receptor modulators . These drugs work by blocking the effects of estrogen in breast tissue by attaching to estrogen receptors in breast cells. Because SERMs bind to receptors, estrogen is blocked from binding. Estrogen is the fuel that makes most breast cancer cells grow. Blocking estrogen prevents estrogen from triggering the development of estrogen-receptor-positive breast cancer.
Anastrozole and exemestane are in a class of drugs called aromatase inhibitors . These drugs work by blocking the production of estrogen. Aromatase inhibitors do this by blocking the activity of an enzyme called aromatase, which is needed to make estrogen.
Breast Lump While Nursing
If a person notices their breast is lumpy, tender, and warm while nursing they likely have mastitis.
Mastitis an infection that develops from a blocked milk duct. A doctor will treat the infection with antibiotics. To prevent mastitis from recurring, a person may need to try different nursing techniques.
If more lumps develop in the breast after the person takes antibiotics, they should speak to their doctor again. While only
According to the National Breast Cancer Foundation, people should perform breast self-exams at least once a month. The best time for females to do this is immediately after the end of a menstrual period.
A person can perform the following steps to perform a breast self-exam:
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Lisa Fought Breast Cancer For 8 Years Heres Her Story
In contrast to the common belief that surviving for five years after cancer treatment is equivalent to a cure, with hormone-sensitive breast tumors there is a steady rate of recurrence risk for at least 20 years after the original diagnosis, even with very small node-negative tumors.
Overall, the chance that an estrogen receptor-positive tumor will recur between five years and 20 years after diagnosis ranges from 10% to over 41%, and people with these tumors remain at risk for the remainder of their lives.
An awareness of the risk of late recurrence is important for a number of reasons. People are often shocked to learn that their breast cancer has come back after say, 15 years, and loved ones who don’t understand this risk are often less likely to be supportive as you cope with the fear of recurrence.
While chemotherapy has little effect on the risk of late recurrence hormonal therapy does, and estimating this risk may help determine who should receive extended hormonal therapy . Finally, late recurrences can differ from early relapse with regard to sites of metastases and survival.
Factors such as initial tumor size, number of nodes involved, and receptor status play into the risk of late recurrence, but tumor biology appears to have the greatest effect, and research is actively looking for ways to look at gene expression and copy number to predict risk.
Circulating Tumor Cells At 5 Years Post
In addition, liquid biopsy for the presence of circulating tumor cells at five years post-diagnosis may also help predict late recurrence.
In a 2018 study published in the Journal of the American Medical Association , women who had cancer cells in their blood five years after diagnosis were roughly 13 times more likely to experience a recurrence as those who did not. The finding was significant only for women who had estrogen receptor-positive tumors, and none of the women who had circulating tumor cells in their blood but estrogen receptor-negative tumors experienced a recurrence.
Using liquid biopsies to predict recurrence is still in the investigational stage and not currently used when making decisions on whether or not hormonal therapy should be continued beyond five years.
That said, these findings, along with molecular subtyping offers hopes that doctors will be better able to predict who should receive extended hormonal therapy in the future.
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Myth #: People With Metastatic Breast Cancer Have A Short Amount Of Time Left
While some people mistakenly think MBC is curable, at the other extreme are those who assume its an immediate death sentence. But there is a big difference between stage IV incurable cancer, which MBC is, and terminal cancer, which can no longer be treated. A person isnt automatically terminal when she or he gets a metastatic diagnosis. Although MBC almost certainly will shorten someones life, it often can be managed for years at a time.
As Illimae of Houston points out: Stage IV is not an immediate death sentence. It feels that way at first but many have months/years of reasonably decent condition. Brain mets are not necessarily the end either. When found early and treated, especially with minimal disease in the body, life can resume to a fairly normal state.
Mermaid007 adds: hen I was diagnosed with bone mets I felt I needed to go home and get my affairs in order when here I am 4 and half years later.
What Is Breast Cancer
Cells in the body normally divide only when new cells are needed. Sometimes, cells in a part of the body grow and divide out of control, which creates a mass of tissue called a tumor. If the cells that are growing out of control are normal cells, the tumor is called benign. If, however, the cells that are growing out of control are abnormal and don’t function like the body’s normal cells, the tumor is called malignant .
Cancers are named after the part of the body from which they originate. Breast cancer originates in the breast tissue. Like other cancers, breast cancer can invade and grow into the tissue surrounding the breast. It can also travel to other parts of the body and form new tumors, a process called metastasis.
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Early Recurrence Vs Late Recurrence
A recurrence of breast cancer at any time can be devastating. While 6% to 10% of breast tumors are diagnosed when the disease is already metastatic , 90% to 94% of metastatic breast cancers represent a distant recurrence of previous early-stage breast cancer .
Since distant metastases are responsible for around 90% of breast cancer deaths, finding ways to reduce the risk of recurrence is critical in improving the survival rate from the disease. Overall, it’s estimated that around 30% of breast cancers will recur at distant sites.
Can Cancer Form In Other Parts Of The Breast
Cancers can also form in other parts of the breast, but these types of cancer are less common. These can include:
- Angiosarcomas. This type of cancer begins in the cells that make up the lining of blood or lymph vessels. These cancers can start in breast tissue or breast skin. They are rare.
- Inflammatory breast cancer. This type of cancer is rare and different from other types of breast cancer. It is caused by obstructive cancer cells in the skins lymph vessels.
- Paget disease of the breast, also known as Paget disease of the nipple. This cancer affects the skin of the nipple and areola .
- Phyllodes tumors. These are rare, and most of these masses are not cancer. However, some are cancerous. These tumors begin in the breasts connective tissue, which is called the stroma.
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More Information About The Tnm Staging System
The T category describes the original tumor:
- TX means the tumor can’t be assessed.
- T0 means there isn’t any evidence of the primary tumor.
- Tis means the cancer is “in situ” .
- T1, T2, T3, T4: These numbers are based on the size of the tumor and the extent to which it has grown into neighboring breast tissue. The higher the T number, the larger the tumor and/or the more it may have grown into the breast tissue.
The N category describes whether or not the cancer has reached nearby lymph nodes:
- NX means the nearby lymph nodes can’t be assessed, for example, if they were previously removed.
- N0 means nearby lymph nodes do not contain cancer.
- N1, N2, N3: These numbers are based on the number of lymph nodes involved and how much cancer is found in them. The higher the N number, the greater the extent of the lymph node involvement.
The M category tells whether or not there is evidence that the cancer has traveled to other parts of the body:
- MX means metastasis can’t be assessed.
- M0 means there is no distant metastasis.
- M1 means that distant metastasis is present.
Risk Of Late Recurrence Is Underestimated
A survey led by the Canadian Breast Cancer Network found that women often underestimate their risk of late recurrence. In the survey, only 10% were aware of the risk of recurrence after five years of tamoxifen therapy, and 40% felt that they were cured after hitting the five-year mark.
Many breast cancer survivors underestimate their risk of late recurrence.
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Coping With The Fear Of Recurrence
Coping with the fear of recurrence can be challenging, especially when the risk of recurrence persists as with estrogen receptor-positive breast cancers. In the past, many people sensed that if they hit the five-year mark, the chances they were home free were high. Longer-term research has, unfortunately, dispelled this belief.
Some degree of fear can be a good thing. An awareness that breast cancer can come back often prompts people to be careful with follow-up appointments and to pursue healthy lifestyle changes to reduce risk. Yet, too much fear can be paralyzing.
If you’re struggling with this fear, seeking professional help can be wise. And in fact, there have even been studies linking psychological support with survival.