How Is Breast Cancer Treated
Breast cancer is treated in several ways. It depends on the kind of breast cancer and how far it has spread.
Breast cancer is treated in several ways. It depends on the kind of breast cancer and how far it has spread. People with breast cancer often get more than one kind of treatment.
- Surgery. An operation where doctors cut out cancer tissue.
- Chemotherapy. Using special medicines to shrink or kill the cancer cells. The drugs can be pills you take or medicines given in your veins, or sometimes both.
- Hormonal therapy. Blocks cancer cells from getting the hormones they need to grow.
- Biological therapy. Works with your bodys immune system to help it fight cancer cells or to control side effects from other cancer treatments.
- Radiation therapy. Using high-energy rays to kill the cancer cells.
Doctors from different specialties often work together to treat breast cancer. Surgeons are doctors who perform operations. Medical oncologists are doctors who treat cancer with medicine. Radiation oncologists are doctors who treat cancer with radiation.
For more information, visit the National Cancer Institutes Breast Cancer Treatment Option Overview.external icon This site can also help you find health care services.external icon
Is There Anything I Can Do To Increase My Blood Counts
Your blood counts will increase again over time. Your doctor may prescribe medication to maintain or raise your white blood cell count. These are usually shots given between treatments. Sometimes your treatment will be delayed to allow time for your blood counts to recover.
Theres no evidence that vitamins or a special diet will speed the recovery of your blood counts. But if youre told you have anemia and your iron levels are low, you may need to take iron supplements. Your doctor will discuss this with you.
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, scientists reported 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.
Talk With Your Doctor
Make sure you talk with your doctor before you begin any of these alternative treatments. Your doctor can tell you if complementary or alternative therapies will be effective for the stage of your breast cancer, and steer you away from fraudulent products.
They can also tell you what research is available on different CAM treatments, what is and isnt known about them, and whether theyre safe. Your doctor can also write you a referral or a recommendation for an appropriate CAM treatment. Once you have all the information, you can make a truly informed decision.
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Highlights And Future Directions
Another direction for progress will come from ongoing development of more effective strategies for de-escalation of therapy, particularly through measurement of pCR and MRI biomarkers in NAC. For example, improvements in HER2-targeted therapy may result in improved responses, measured by reduction of functional tumor volume and biopsy, such that anthracyclines may be deleted from neoadjuvant platform trial regimens that currently contain anthracyclines. Further progress will likely come from the use of functional biomarkers such as the mPEPI and PEPI score, and genomic assays, in NET. The process of answering these questions, through well designed trials will continue to add to the growing body of information on neoadjuvant strategies in breast cancer, where quantitatively measuring the effects of targeted drug therapy has added so much to what we can offer our patients.
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What Can I Eat Before And After Chemotherapy Are There Any Foods To Avoid
Its best to eat small meals 4 to 5 times a day before chemotherapy to prevent feeling too full during your treatment. Food safety is also important during treatment. Avoid raw or undercooked meat, fish, and poultry and unpasteurized products. Ask your nurse if you should read the resource Food Safety During Cancer Treatment.
Drink lots of non-caffeinated liquids before and after your chemotherapy appointment to stay well hydrated.
Why Wasnt I Able To Get My Chemotherapy Treatment When It Was Scheduled
Chemotherapy works on both cancer cells and normal cells. Youre supposed to get your chemotherapy treatments on a set schedule so that your body has time to recover between treatments. This allows your normal cells to be replaced. Your body may need more time to reverse the effects of therapy .
Your doctor will decide if your chemotherapy should be rescheduled and they will discuss the reasons with you.
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Sensation Changes In Your Hands Or Feet
Some types of chemotherapy can affect the nerves in your hands and feet. You may develop some numbness or tingling in your fingers, toes, or both. This is known as neuropathy. This may not last or might be permanent depending on how long youre taking the chemotherapy. Your doctor may be able to help your neuropathy by using medications or changing the dose of your chemotherapy. For more information on neuropathy, read Neuropathic Pain.
What you can do:
- Talk with your doctor about putting ice on your hands and feet during your treatment, which may help prevent neuropathy. For more information, read Nail Cooling During Treatment with Taxane-based Chemotherapy.
- Be extra careful to avoid burning yourself when using the stove, oven, or iron. You may not be able to feel heat as much as you used to.
What to avoid:
- Using heating pads or hot packs because you could burn yourself.
Contact your doctor or nurse if you have:
- Problems holding a pencil or pen or closing buttons.
- Pain, burning, or tingling in your fingers or toes.
- Trouble walking or feeling the ground when you walk.
- Trouble balancing resulting in falls.
How Effective Is Chemotherapy For Breast Cancer Treatment
Chemotherapy treatment utilizes special drugs that are administered either orally or intravenously to destroy cancerous cells. These drugs generally travel to all parts of the body through the bloodstream. Normally, chemotherapy is used for treating early-stage invasive breast cancers. It is designed to eliminate any remaining cancerous cells following surgery & for reducing risk of recurrence of breast cancer. Chemotherapy is also utilized for destroying advanced-stage breast cancer or for the purpose of damaging cancerous cells. Moreover, in some patients, chemotherapy is also given prior to operation in order to shrink the size of cancerous tumors before surgical intervention.
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Adjuvant Chemotherapy: First Second And Third Generation Regimens
Adjuvant! is a web-based decision aid commonly used in clinical practice that allows clinicians and patients to better understand the potential benefits of adjuvant therapy, especially chemotherapy . Estimates provided by Adjuvant! have been shown to correlate closely with actual clinical outcomes in population- and hospital-based cohorts . Adjuvant! classifies adjuvant chemotherapy regimens as first, second, and third-generation, as exemplified in Table . A modification of this classification will be used here to categorize the numerous chemotherapy regimens discussed in this review, and to describe the clinical trials summarized in Table . The regimens used in these studies generally included anthracyclines and/or taxanes , which are the two most active classes of cytotoxic agents for both early and advanced stage breast cancer.
Table 2 Classification of adjuvant chemotherapy regimens
How Does Chemotherapy Work
Chemotherapy works by attacking fast-growing cells in your body, including cancer cells. There are many different types of chemotherapy your medical oncologist will talk to you about whats most suitable for you. Sometimes more than one type of treatment may be effective for you, and you may be asked to decide which one to have. Your medical oncologist can tell you about the pros and cons of each.
Some questions you might like to ask include:
- What are the possible side effects of each treatment?
- How long is the course of each treatment?
- How will the treatment fit in with my lifestyle and personal circumstances?
Some chemotherapy drugs are given in tablet form, however, most are administered intravenously . As a result, it is useful to drink plenty of fluids, relax and keep your hands and arms warm, as this can help the nurse or doctor find your veins.
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Lancet Study Suggests 10 Years Of Tamoxifen Not Just 5
A recent study published in the prestigious journal, Lancet, finds that taking Tamoxifen over 10 years can be more effective by This was accompanied with a slight rise in the risk of endometrial cancer. For women in their childbearing age, they might as well say goodbye to their chances of having children if they want them.
Rationale For Neoadjuvant Endocrine Therapy For Er
The PEPI score was also tested in the ACOSOG Z1031 trial to determine whether it could be used to assist decisions for neoadjuvant endocrine therapy vs. chemotherapy and identify patients with low risk of recurrence. The Z1031 trial tested 16 to 18 weeks of aromatase inhibitor in postmenopausal stage II or III ER-positive patients. Patients with a Ki67 of > 10% at 4 weeks of AI were declared endocrine therapy resistant and went on to neoadjuvant chemotherapy. Patients with a PEPI score of 0 exhibited a 5-year risk of relapse of 3.6% without chemotherapy, and confirmation is being sought in the ALTERNATE trial .
Prospective validation of the PEPI 0 and mPEPI 0 biomarker as a surrogate for 5-year RFS in the ALTERNATE trial would allow comparison of different NET strategies and agents and identify patients who do not need chemotherapy- a de-escalation strategy. Thus, neoadjuvant hormonal therapy is also a pathway to de-escalation because although higher-risk patients in the ALTERNATE trial were offered postoperative chemotherapy, many of these patients who received neoadjuvant hormonal therapy were able to avoid postoperative adjuvant chemotherapy. Therefore, in the ALTERNATE trial, postoperative chemotherapy served as a backstop for those patients who were candidates for it, whereas lower-risk patients avoided it.
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Prime Suspects In Promoting Metastasis
Death from breast cancer is mainly due to distant metastasis, when cancer cells from the primary tumor form tumors elsewhere in the body.
Previous research by the Einstein team, led by the other senior author of the new study, John Condeelis, Ph.D., has provided insights into how breast cancer spreads, including the role of TMEMs.
Each TMEM is made up of three different types of cells that are in close contact with each other on a blood vessel wall: an endothelial cell an immune cell called a macrophage and a tumor cell that produces high levels of a specific form of Mena, a protein that enhances the tumor cells ability to invade blood vessels and spread.
A 2015 study led by Dr. Condeelis monitored TMEM in living mice in real time. It showed that the macrophages in a TMEM loosen the normally tight connection that exists between endothelial cells, creating a temporary opening in the wall of a blood vessel for the tumor cell to squeeze through and enter the bloodstream, facilitating its spread to other parts of the body.
In several other studies, the Einstein researchers and their colleagues showed a correlation between the number of TMEM sites in patient tumor samples and an increased risk of metastasis in estrogen receptor positive, HER2-negative breast cancer, which is the most common type of breast cancer.
Given the findings from these studies, the researchers decided to investigate whether chemotherapy increases TMEM formation in breast tumors.
When It Is Used
How soon chemotherapy is recommended for treatment depends on the particular type of breast cancer you have, whether or not your tumor is estrogen receptor or HER 2 receptor-positive, and whether or not hormonal therapies are effective for your tumor.
Chemotherapy is usually recommended as the first-line metastatic cancer treatment for:
- People who have estrogen-receptor-positive tumors that have become resistant to hormonal medications such as tamoxifen or aromatase inhibitors
- People who have HER2 positive tumors that are estrogen receptor-negative
- People who have tumors that are both estrogen receptor and HER2 negative
- Cases in which hormonal therapies are effective against estrogen receptor-positive tumors and a rapid reduction in the tumor is needed
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Eye And Vision Changes
Some chemotherapy medications may cause you to have dry eyes or watery eyes . If this happens, you can use wetting drops or allergy eye drops. If you have blurry vision during your treatment, see your eye doctor. It may be because your eyes are dry or tearing.
Some chemotherapy medications may cause your eyelashes and eyebrows to fall out. If this happens, it wont last. They will grow back in after your chemotherapy treatment with that medication is over.
How Effective Is Chemotherapy For Colon And Rectal Cancer
As for mine and yours, chemotherapy was shown to be 1.8% effective toward 5-year survival for colon cancer and 5.4% effective for rectal cancer.
As bad as all this sounds, the reality is actually worse.
Nowhere in the study does it say that the 3,306 patients who made it to the five year mark were actually cancer free.
The only thing we know is that they were still alive at the five year mark.
It is safe to assume that some of them still had cancer and may have died of cancer later.
I would love to see a follow up on how many of the 5-year survivors actually lived to the 10 year mark. I imagine the results would be even more brutal.
As far as I know that study hasnt happened.
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Increased Risk Of Leukemia
Very rarely, certain chemo drugs can cause diseases of the bone marrow, such as myelodysplastic syndromes or even acute myeloid leukemia, a cancer of white blood cells. If this happens, it is usually within 10 years after treatment. For most women, the benefits of chemo in helping prevent breast cancer from coming back or in extending life are far likely to exceed the risk of this rare but serious complication.
An Abbreviated History Of Adjuvant Systemic Therapy
The initial approach to therapy for breast cancer was based on the premise that the disease metastasized via locoregional spread in an orderly fashion, and thus could be cured with aggressive surgery. The radical mastectomy was thus the standard surgical procedure for breast cancer in the early 20th century . Randomized trials subsequently showed no benefit from radical mastectomy compared with less aggressive surgical procedures, and demonstrated that distant recurrence remained a major clinical problem irrespective of the primary surgical therapy .
Table 1 Systemic adjuvant therapy options for operable breast cancer
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Changes To Taste And Appetite
Chemotherapy may cause changes in the taste of food, and even alterations to the taste of coffee and water.
Often women describe food as having a metallic taste. These changes to taste are called dysgeusia. This problem may be difficult to counteract. Changes in taste, combined with nausea or uneasiness in the stomach, may cause cravings for unusual foods, rather like the symptoms of pregnancy. Care must be taken to avoid high calorie snacks as weight gain often occurs during chemotherapy.
It is important to keep your strength up by eating frequent small meals and trying different foods. Talking to a dietician or an experienced chemotherapy or breast nurse can be very helpful.
I Havent Lost My Hair Yet And My Counts Havent Dropped Does This Mean That The Chemotherapy Isnt Working
Not having side effects such as hair loss, lowered blood counts, or nausea doesnt mean that the chemotherapy isnt working. Different therapies cause different side effects. Different people also have different reactions to the same treatment. Your doctor and nurse will monitor your progress and response to treatment.
How Can A Genomic Oncotype Dx Test Be Helpful
Patients who have a small, estrogen receptor positive, HER2 receptor negative tumor and no evidence of cancer in their lymph nodes may benefit from an Oncotype DX genomic assay. This cutting-edge test looks deeper into breast cancer cells to better identify people who may benefit from chemotherapy with ER+, HER2 breast cancers. The results of this test can also confirm that only hormonal therapy will be needed. Our video lesson on Genomic Assays provides much more detail about these advances in breast cancer care.
- You will find well-organized guides on breast cancer treatment by stage. Follow the prompts to breast cancer and then stage in the dropdown menus. The NCCN is a consortium of organizations and governmental agencies to promote quality breast cancer care.
- Their section on Chemotherapy is comprehensive and has great detail . The American Society of Clinical Oncologists is a leading organization of clinicians who care for people with cancer.
An outline of Chemotherapy for Breast Cancer is provided . The American Cancer Society is an organization that supports patients with cancer and funds research for cancer of all types.
Teaching everyone to be an expert in their own breast cancer care.
All information is designed to help patients engage their physicians in discussions about treatment options. No professional services or specific care recommendations are intended or offered.