Systemic Treatments For Stage Iv Breast Cancer
Treatment often continues until the cancer starts growing again or until side effects become unacceptable. If this happens, other drugs might be tried. The types of drugs used for stage IV breast cancer depend on the hormone receptor status, the HER2 status of the cancer, and sometimes gene mutations that might be found.
Starting With Neoadjuvant Therapy
Most often, these cancers are treated with neoadjuvant chemotherapy. For HER2-positive tumors, the targeted drug trastuzumab is given as well, often along with pertuzumab . This may shrink the tumor enough for a woman to have breast-conserving surgery . If the tumor doesnt shrink enough, a mastectomy is done. Nearby lymph nodes will also need to be checked. A sentinel lymph node biopsy is often not an option for stage III cancers, so an axillary lymph node dissection is usually done.
Often, radiation therapy is needed after surgery. If breast reconstruction is planned, it is usually delayed until after radiation therapy is done. For some, additional chemo is given after surgery as well.
After surgery, some women with HER2-positive cancers will be treated with trastuzumab for up to a year. Many women with HER2-positive cancers will be treated first with trastuzumab followed by surgery and then more trastuzumab for up to a year. If after neoadjuvant therapy, any residual cancer is found at the time of surgery, ado-trastuzumab emtansine may be used instead of trastuzumab. It is given every 3 weeks for 14 doses. For women with hormone receptor-positive cancer that is in the lymph nodes, who have completed a year of trastuzumab, the doctor might also recommend additional treatment with an oral targeted drug called neratinib for a year.
The Types Of Radiotherapy
The type of radiotherapy you have will depend on the type of breast cancer and the type of surgery you have. Some women may not need to have radiotherapy at all.
Types of radiotherapy include:
- breast radiotherapy after breast-conserving surgery, radiation is applied to the whole of the remaining breast tissue
- chest-wall radiotherapy after a mastectomy, radiotherapy is applied to the chest wall
- breast boost some women may be offered a boost of high-dose radiotherapy in the area where the cancer was removed however, this may affect the appearance of your breast, particularly if you have large breasts, and can sometimes have other side effects, including hardening of breast tissue
- radiotherapy to the lymph nodes where radiotherapy is aimed at the armpit and the surrounding area to kill any cancer that may be in the lymph nodes
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What You Need To Know About Breast Cancer Chemotherapy Pills
People commonly associate chemotherapy with intravenous cancer drugs in a hospital or doctors office. This has been the traditional nonsurgical method of treating cancer.
Due to recent advances in cancer treatments, oral chemotherapy pills have become more widely used for many types of cancer. There are a few that are approved for breast cancer, including capecitabine , which is often used to treat metastatic breast cancer.
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How Does Intravenous Delivery Work In Chemotherapy
Needle: Drugs may be sent through a thin needle in a vein on your hand or lower arm. Your nurse inserts the needle and removes it when treatment is done. Tell your doctor right away if you feel pain or burning during treatment.
Catheter: Itâs a soft, thin tube. Your doctor puts one end into a large vein, often in your chest area. The other end stays outside your body and is used to deliver chemotherapy or other drugs, or to draw blood. It usually stays in place until all your treatment cycles are finished. Watch for signs of infection around your catheter.
Port: Itâs a small disc that a surgeon places under your skin. Itâs linked to a tube that connects to a large vein, usually in your chest. A nurse may insert a needle into your port to give you chemotherapy drugs or draw blood. The needle can be left in place for treatments that last more than a day. Tell your doctor if you notice any signs of infection around your port.
Pump: Often attached to catheters or ports, it controls the amount of chemotherapy drugs, and how fast they get into your body. You may carry this pump with you, or a surgeon may place it under your skin.
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How Does Chemotherapy Treat Cancer
Doctors use chemotherapy in different ways at different times. These include:
Before surgery or radiation therapy to shrink tumors. This is called neoadjuvant chemotherapy.
After surgery or radiation therapy to destroy any remaining cancer cells. This is called adjuvant chemotherapy.
As the only treatment. For example, to treat cancers of the blood or lymphatic system, such as leukemia and lymphoma.
For cancer that comes back after treatment, called recurrent cancer.
For cancer that has spread to other parts of the body, called metastatic cancer.
Chemotherapy Before Breast Cancer Surgery Might Fuel Metastasis
When breast cancer patients get chemotherapy before surgery to remove their tumor, it can make remaining malignant cells spread to distant sites, resulting in incurable metastatic cancer, scientistsreported last week.
The main goal of pre-operative chemotherapy for breast cancer is to shrink tumors so women can have a lumpectomy rather than a more invasive mastectomy. It was therefore initially used only on large tumors after being introduced about 25 years ago. But as fewer and fewer women were diagnosed with large breast tumors, pre-op chemo began to be used in patients with smaller cancers, too, in the hope that it would extend survival.
But pre-op chemo can, instead, promote metastasis, scientists concluded from experiments in lab mice and human tissue, published in Science Translational Medicine.
The reason is that standard pre-op chemotherapies for breast cancer paclitaxel, doxorubicin, and cyclophosphamide affect the bodys on-ramps to the highways of metastasis, said biologist John Condeelis of Albert Einstein College of Medicine, senior author of the new study.
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How Can You Tell If Its Working
Your oncologist will watch your bodyâs response during and after treatment.
Oncologists look for signs that your tumor is shrinking or growing. They use tests like physical exams, blood tests, or imaging scans like X-rays.
If your treatment doesnât seem to be working, the oncologist might give you a different dose or a mix of other treatments.
The Abramson Cancer Center of the University of Pennsylvania: âChemotherapy Primer: Why? What? And How?â
American Cancer Society: âDeciding Which Chemotherapy Drugs to Use,â âDifferent Types of Chemotherapy Drugs,â âQuestions About Chemotherapy,â âTypes of Targeted Therapies Used to Treat Cancer.â
University of Texas M.D. Anderson Cancer Center: âChemotherapy.â
National Cancer Institute: âChemotherapy and You.â
How Is Chemotherapy Used In Cancer Treatment Today
How chemotherapy is used in treatment depends on the type and stage of the cancer and how aggressive it is. Some cancers, such as an indolent lymphoma or prostate cancer, may not need immediate treatment, but chemotherapy may eventually be recommended if the cancer progresses. Other cancers require immediate treatment.
An oncologist may recommend chemotherapy before and/or after another treatment. For example, in a patient with breast cancer, chemotherapy may be used before surgery, to try to shrink the tumor. The same patient may benefit from chemotherapy after surgery to try to destroy remaining cancer cells.
Chemotherapy may also be used to relieve symptoms caused by advanced cancer, which improves a patients quality of life. Some of these patients may be able to take occasional breaks from treatment.
The types of cancers where chemotherapy is very commonly used as primary treatment include:
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How Often And How Long Is Chemotherapy
It depends on the type of cancer you have, the way it responds to treatment and your ability to tolerate the treatment. Your doctor will talk to you about the time period planned for your course of treatment. You may have chemotherapy over 3 to 6 months but treatment may also be shorter or longer.
You will usually have several treatment cycles with periods of rest in between to allow normal cells to recover. These can be given over a few days, weeks or months, and some on a long-term basis.
Maintenance chemotherapy to prevent cancer coming back and palliative treatment to control the cancer, may continue for months or even years.
If you are worried about how long the treatment is taking or the impact of side effects, talk to your treatment team.
Chemo Drugs For Breast Cancer That Has Spread
- Taxanes: Paclitaxel , docetaxel , and albumin-bound paclitaxel
- Antibody drug conjugates
Although drug combinations are often used to treat early breast cancer, advanced breast cancer often is treated with single chemo drugs. Still, some combinations, such as paclitaxel plus gemcitabine, are commonly used to treat metastatic breast cancer.
For cancers that are HER2-positive, one or more drugs that target HER2 may be used with chemo.
What Is The Role Of Chemotherapy In Breast Cancer
Chemotherapy is typically used to shrink breast cancer tumors before surgical removal. This is especially necessary when:
- The tumor is so large that it cannot be removed via surgery. Once the tumor regresses with chemotherapy, it becomes easier for doctors to remove it without risking spread to adjacent organs.
- Doctors want to check how well a particular medication works on your breast cancer. This helps them decide whether to continue the same drug after surgery or switch to another medication if the previous one does not work.
Breast cancer varies from person to person, and the type of medications your oncology team prescribes will depend on the goals of treatment and the features of your particular cancer.
How Long Can Chemo Take To Work
A chemotherapy course usually lasts 36 months, although this can vary.
The timing depends on various factors, including the type and stage of cancer, the persons overall health, and the type of chemotherapy drug that the doctor uses.
Doctors do tests at intervals to assess the effectiveness of chemotherapy.
If tests show that chemotherapy is not having enough of an impact, other options are available. Some include:
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Is Chemotherapy The Only Treatment For Breast Cancer
No. Occasionally, chemotherapy is the only breast cancer treatment, but most often, healthcare providers use chemotherapy with other treatments, such as:
- Lumpectomy: Removing the tumor and a small amount of surrounding breast tissue.
- Mastectomy: Removing one or both breasts.
- Hormone therapy: Taking medicines that lower estrogen or block estrogens effects on cancer cells.
- Targeted therapy: Taking medicines that target the changes in cancer cells to destroy them or slow their growth.
- Radiation therapy: Using high-energy X-rays to destroy cancer cells.
Will A Biopsy Confirm A Diagnosis Of Breast Cancer
Yes it will. In fact a biopsy is the god standard in diagnosing most infective, inflammatory and malignant diseases.
A biopsy requires the extraction of a small number of cells to view their characteristics under a microscope. A high degree of specificity allows for a correct pathology confirmation of cancer in cases with a strong suspicion of malignancy .
As mentioned before, a breast ultrasound or an x-ray helps guide the extracting needle towards the area under suspicion, to increase the probability of finding abnormal cells.
Dr. Naoko says,
Before taking any further steps, any woman who receives a positive biopsy for breast cancer, should immediately consult with a breast cancer specialist to help categorise the type of cancer..since treatment depends on so many factors..such as size, grading, type of cancer and of course the womans health context.
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Cancer Researchers Worry Immunotherapy May Hasten Growth Of Tumors In Some Patients
Depending on characteristics such as how many tumor cells, blood vessel cells, and immune cells are touching each other, the tumor microenvironment can nearly triple the chance that a common type of breast cancer that has reached the lymph nodes will also metastasize, Condeelis and colleagues showed in a 2014 study of 3,760 patients. The discovery of how the tumor microenvironment can fuel metastasis by whisking cancer cells into blood vessels so impressed Dr. Francis Collins, director of the National Institutes of Health, that he featured it in his blog.
The new study took the next logical step: Can the tumor microenvironment be altered so that it promotes or thwarts metastasis?
To find out, Einsteins George Karagiannis spent nearly three years experimenting with lab mice whose genetic mutations make them spontaneously develop breast cancer, as well as mice given human breast tumors. In both cases, paclitaxel changed the tumor microenvironments in three ways, all more conducive to metastasis: The microenvironment had more of the immune cells that carry cancer cells into blood vessels, it developed blood vessels that were more permeable to cancer cells, and the tumor cells became more mobile, practically bounding into those molecular Lyfts.
Pre-op chemo may have unwanted long-term consequences in some breast cancer patients, the Einstein researchers wrote.
Longer Term Side Effects
Tiredness is commonly reported during treatment. This may be a direct effect of the drugs or may be due to other factors such as disrupted sleep patterns.
- Try to get adequate rest but also try to exercise regularly. Go for a walk outside each day as this can actually give you more energy.
- Find something that you actually enjoy doing and also try to incorporate exercise into your usual day, e.g. walk upstairs rather than taking the lift, park further away from where you want to go and walk the extra distance. Build this up gradually.
- Your GP, practice nurse or a physiotherapist can work with you to devise a specific exercise plan for you.
- Let others help when your energy levels are low.
If your fatigue doesnt allow you to exercise, discuss this with your GP.
Usually energy levels recover after treatment finishes but this commonly takes time. In some cases full recovery may take 12 months or more.
Some people notice they are having concentration and short-term memory problems following their chemotherapy. This is often referred to as chemo brain. The severity and duration of symptoms differ from person to person. For some people the symptoms are very mild and resolve soon after treatment stops, but others may find their daily life is noticeably affected for a much longer period, restricting their ability to return to work in their pre-treatment capacity.
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Questions To Ask Your Doctor About Chemotherapy
Patients are sometimes reluctant to ask questions, but I tell my patients that any question is an important question when it comes to their cancer care. Oncologists deal with cancer every day, but its all new to the patient. Getting your questions answered will help you make informed decisions about your care.
Think about your questions before your appointment. Write them down and bring them with you. I also recommend bringing a family member or friend to take notes during the appointment because its easy to get overwhelmed by information.
Here are some questions to consider asking your doctor about chemotherapy:
- What drug or drugs are you recommending?
- Whats the goal of this treatment?
- How long will I be on it?
- How do I receive it?
- How often do I have to come in? Can someone come in with me?
- If Im taking this drug at home, where do I store it? How often do I take it? What if I forget to take it?
- What are the potential side effects? Are you going to give me anything ahead of time to deal with them?
- Am I likely to have long-term side effects from this drug?
- Who do I call if Im at home and I have a question?
- What kind of support is there to help me through this treatment?
- Is there any support for my caregivers?
If you think of more questions after your appointment, call back and ask them.
If you start chemotherapy and your experience is different from what you expected, talk to your care team. They may be able to make changes that help you.
Can I Work During Chemotherapy
It depends on the work that you do and on how you feel. On days you donât feel well, you may want to see if you can work fewer hours or work from home. In some cases, employers are required by law to adjust your schedule when you have cancer treatment. A social worker may be able to help you learn about what the law allows.
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How Long Does Chemotherapy Take For Breast Cancer
Typically, you receive chemotherapy in cycles. You may receive chemo every week or every two, three or even four weeks. Cycles are usually two to three treatments long. Each cycle includes a rest period to allow your body to recover. For example, you may have the same treatment every Monday for three weeks. Then you have an extra week to recover before repeating the cycle. Many people have multiple treatment cycles in a row. Treatment may last three to six months.
Chemotherapy Regimens For Early
At some point, your medical oncologist will recommend a chemotherapy plan for you. Also called a chemotherapy regimen, the plan will have important details about your treatment, including:
- which drugs youre receiving
- the order in which you receive them
- the amount of each drug
- how often and how long you will need chemotherapy
Most women with early-stage breast cancer receive chemotherapy for approximately three to six months. Theres time in between treatments to allow your body to recover. If you are receiving targeted therapy for early HER2-positive breast cancer, treatment could last up to a year.
For some people, doctors may recommend a dose-dense chemotherapy regimen. Dose-dense chemotherapy means there is less time between treatments. You will not need to have a larger dose of chemotherapy.
Research has shown that dose-dense chemotherapy can improve survival and lower the risk of the breast cancer coming back compared to a traditional chemotherapy schedule. Dose-dense chemotherapy does not result in more side effects.
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