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Is Chemo Necessary For Breast Cancer

Doctors Have Provided Women With Chemo Treatment After Mastectomy Surgery And Lumpectomy Surgery For Years To Prevent The Spread And Recurrence Of Cancer What Has Changed

Is Chemotherapy Necessary Before or After Breast Surgery?

It may seem both enticing and scary go without Chemotherapy. The side effects are physically demanding, yet its proven for years to kill cancer in the body and keep it from spreading.

However, according to the recent New York Times article based on a clinical study, TAILORx, published in the New England Journal of Medicine, about 96% of women with an early-stage diagnosis are over treated with Chemotherapy.

The medical study tested more than 10,000 women with 70% in the testing range that foregoes chemotherapy treatments. These women were then divided into two groups. Half received chemotherapy after surgery and radiation the other half did not.

Seven years of follow-up on these patients proved that Chemo has no advantage to Endocrine Therapy, a treatment with less harsh side effects.

Tucatinib Neratinib And Lapatinib

The tyrosine-kinase inhibitors FDA-approved for metastatic breast cancer treatment are:

  • Tucatinib
  • Neratinib
  • Lapatinib

Tyrosine-kinase inhibitors are a class of drugs that target enzymes important for cell functions . These drugs can block tyrosine-kinase enzymes at many points along the cancer growth pathway.

A tyrosine-kinase inhibitor in combination with trastuzumab and chemotherapy can be used to treat HER2-positive metastatic breast cancer. This combination may give women with HER2-positive metastatic breast cancer more time before the cancer spreads compared to treatment with trastuzumab and chemotherapy alone .

Adding the tyrosine-kinase inhibitor tucatinib to treatment with trastuzumab and chemotherapy may also increase overall survival in women with HER2-positive metastatic breast cancer who were treated with trastuzumab in the past .

Neratinib is also used to treat HER2-positive early breast cancer.

Tucatinib, neratinib and lapatinib are pills.

Learn about neratinib and treatment of early breast cancer.

Tucatinib, neratinib and lapatinib and brain metastases

Many drug therapies cannot pass through the blood to the brain . So, they cant treat breast cancer that has spread to the brain.

However, tucatinib, neratinib and lapatinib can pass through the blood-brain barrier and may be used to treat some metastatic breast cancers that have spread to the brain.

Its Not Like The Movies

Lets just debunk this myth right now. Sitting in the chemo chair is not like the movies. At least not the ones that I have seen, where youre sitting right next to someone else getting chemo. Its also not like the newest episode of New Amsterdam where Max gets chemo and is sitting there playing cards with his chemo friends. I was like, Oh cool, maybe Ill make friends like he did.

But honestly yall, Im glad it isnt like the movies. I wasnt sure if I was going to feel up to entertaining or making friends with others. This is completely new to me and I wanted to tackle this by myself, no social strings attached! My sister, husband, and one close family friend are the only people who come with me to my treatments.

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 youll 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 youre taking it, although they should start again once your treatment is complete.

If youre 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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Do My Receptors Suggest I Need Chemotherapy

Once a breast biopsy is found to be cancerous, the pathologists will automatically run more tests on the same tissue to determine what receptors are expressed. This information is critical in guiding what further therapies may be needed before or after surgery, such as chemotherapy or hormonal therapy. Learn more about My Tumor Receptors with our video lesson on the subject. You should be engaged with this aspect of your cancer care from the outset.

The Tnm System The Grading System And Biomarker Status Are Combined To Find Out The Breast Cancer Stage

70% of Women with Common Breast Cancer Are Better Off ...

Here are 3 examples that combine the TNM system, the grading system, and the biomarker status to find out the Pathological Prognostic breast cancer stage for a woman whose first treatment was surgery:

If the tumor size is 30 millimeters , has not spread to nearby lymph nodes , has not spread to distant parts of the body , and is:

  • Grade 1
  • PR-

The cancer is stage IV .

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Treatment Of Locally Advanced Or Inflammatory Breast Cancer

For information about the treatments listed below, see the Treatment Option Overview section.

Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.

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.

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What Are My Mastectomy Breast Cancer Treatment Options

Some surgeons believe that using chemotherapy to shrink the tumor before surgery is the most effective method. This approach is known as Neoadjuvant Therapy.

Experts suggest that neoadjuvant therapy can not only improve surgical options for breast cancer patients, but it can also allow for a better assessment of the patientâs overall response to chemotherapy. This process can provide the doctors and specialists with more information and help them decide which is the best option for follow-up treatment for the patient after the mastectomy. While the approach may not work for all patients, it is worth discussing neoadjuvant therapy with your doctor to determine if you are a good candidate.

What Are The Side Effects

Chemotherapy for Breast Cancer

Chemotherapy is sometimes referred to as a systemic treatment, because it affects all parts of your body. Unfortunately, it can attack fast-growing healthy cells, such as hair follicles, as well as cancer cells. This causes unwanted side effects such as fatigue, nausea and hair loss. Your medical oncologist or oncology nurse can give you information on ways to manage these side effects.

If side effects are affecting your daily life, its important to discuss them with a member of your medical team. In some instances, your oncologist may be able to change your chemotherapy drug to one that has fewer side effects.

Chemotherapy drugs all work differently and have different side effects. Not all women will suffer side effects from chemotherapy. If you dont experience side effects, it does not mean that the drugs aren’t working.

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What Are Some Common Chemotherapy Combinations Used In Breast Cancer

Chemotherapy regimens usually have acronyms to help simplify what theyre called. They can also include other medications like HER2 target therapy, discussed below. A few examples of some common breast cancer chemotherapy regimens are:

  • AC T: Doxorubicin and cyclophosphamide followed by paclitaxel

  • AC T: Doxorubicin and cyclophosphamide followed by docetaxel

  • AC THP: Doxorubicin and cyclophosphamide followed by paclitaxel, trastuzumab, and pertuzumab

  • TC: Docetaxel and cyclophosphamide

  • TAC: Docetaxel, doxorubicin, and cyclophosphamide

  • CMF: Cyclophosphamide, methotrexate, and fluorouracil

  • TCHP: Docetaxel, carboplatin, trastuzumab, and pertuzumab

These acronyms consist of the first letter of each medications name in the regimen, but it varies if the first letter refers to the medications brand or generic name. For example in the TC regimen the letter T refers to Taxotere, which is the brand name of docetaxel. The C refers to cyclophosphamide.

These medications are discussed individually below.

Are There Ways To Prevent Hair Loss With Chemotherapy

Not everyone loses hair when receiving chemotherapy, but many people do. Some peoples hair only thins. Others lose the majority or all of their hair.

Using a cold cap can reduce hair loss. Cold caps cool your scalp before, during and after chemotherapy treatment. Cooling tightens the blood vessels in your scalp, potentially reducing how much chemotherapy goes to your hair follicles.

People may choose to wear a wig as a result of hair loss. Some private insurance companies may help cover wig costs if your doctor prescribes a cranial prosthesis or hair prosthesis. Medicare Parts A and B do not cover wigs, but the costs may be tax-deductible.

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What Happens Before Chemotherapy For Breast Cancer

A few days before your chemotherapy treatment, youll have blood tests. The blood tests tell your oncologist and pharmacist how to tailor your treatment based on your laboratory values and body mass index .

You may receive chemotherapy through a large, sturdy tube called a central venous catheter . If your healthcare provider recommends a CVC, it will be surgically implanted before treatment. It stays in place until you finish chemotherapy. Types of CVCs include:

  • Central line: Long, plastic tube inserted near your heart or in a neck vein.
  • Peripherally inserted central catheter : A central line that goes in through an arm vein.
  • Port-a-cath : A small, implantable chamber where your nurse gives drug injections.

Many With Early Breast Cancer May Not Need Chemo

My Breast Cancer Journey, Part 2

HealthDay Reporter

SUNDAY, June 3, 2018 A majority of women with an early form of a common breast cancer may be able to skipchemotherapy, depending on the results of a comprehensive gene test.

The new study of nearly 7,000 women found that use of the already available Oncotype DX gene test could pinpoint those women who needed chemotherapy, and those who did not.

The women had a specific type of breast tumor known as hormone receptor-positive, HER2-negative, and axillary node-negative.

The findings could be a game-changer in breast cancer care, researchers and experts said.

Half of all breast cancers are hormone receptor-positive, HER2-negative, and axillary node-negative, noted study author Dr. Joseph Sparano, who helps direct clinical research at the Albert Einstein Cancer Center in New York City.

Our study shows that chemotherapy may be avoided in about 70 percent of these women when its use is guided by the test, thus limiting chemotherapy to the 30 percent who we can predict will benefit from it, Sparano said in a news release from the American Society of Clinical Oncology .

His team is scheduled to present the study findings Sunday at the ASCO annual meeting, in Chicago, and the study is also being published simultaneously in the New England Journal of Medicine.

One oncologist agreed that the highly anticipated findings could transform care.

New England Journal of Medicine

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Treatment Of Early Localized Or Operable Breast Cancer

For information about the treatments listed below, see the Treatment Option Overview section.

  • A clinical trial of a new chemotherapy regimen.
  • A clinical trial of monoclonal antibody therapy.

For patients with triple-negative or HER2-positive disease, the response to preoperative therapy may be used as a guide in choosing the best treatment after surgery.

Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.

Radiation Therapy Side Effects

The side effects of radiation therapy depend on the type of radiation therapy youre having. In general, the side effects tend to develop as treatment goes on and may be more troubling toward the end of treatment. Overall, the most common side effects are redness, swelling, and skin peeling in the area being treated. Read more about radiation therapy side effects.

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Will I Need Chemotherapy After A Total Mastectomy

A total mastectomy is the surgical removal of the entire breast to treat breast cancer. A physician may recommend this treatment on its own or in combination with another therapy, such as chemotherapy. When chemotherapy is provided after surgery, it is called adjuvant chemotherapy. Whether or not chemotherapy is recommended following a total mastectomy will depend on many different factors, including the patients overall health, age and medical history as well as the type, stage and nature of the breast cancer.

What Are The Side Effects Of Chemo Versus Endocrine Therapy How Does Each Impact A Womans Health

Surgery Always Needed for Neoadjuvant Chemotherapy?

Side effects of Chemotherapy include hair loss, nausea, damage to the heart and nerves, and an increased risk of both infection and rare leukemia later in life.

Less severe, Endocrine Therapy increases menopausal-type symptoms such as hot flashes. Occasionally it also increases joint pain, muscle pain, and weight gain. One of the Endocrine Therapy drug options Tamoxifen rarely may increase the chances of cancer in the uterus. Most patients tolerate it very well.

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Breast Cancer Is A Disease In Which Malignant Cells Form In The Tissues Of The Breast

The breast is made up of lobes and ducts. Each breast has 15 to 20 sections called lobes. Each lobe has many smaller sections called lobules. Lobules end in dozens of tiny bulbs that can make milk. The lobes, lobules, and bulbs are linked by thin tubes called ducts.

Each breast also has blood vessels and lymph vessels. The lymph vessels carry an almost colorless, watery fluid called lymph. Lymph vessels carry lymph between lymph nodes. Lymph nodes are small, bean-shaped structures found throughout the body. They filter lymph and store white blood cells that help fightinfection and disease. Groups of lymph nodes are found near the breast in theaxilla , above thecollarbone, and in the chest.

The most common type of breast cancer is ductal carcinoma, which begins in the cells of the ducts. Cancer that begins in the lobes or lobules is called lobular carcinoma and is more often found in both breasts than are other types of breast cancer. Inflammatory breast cancer is an uncommon type of breast cancer in which the breast is warm, red, and swollen.

See the following PDQ summaries for more information about breast cancer:

For Metastatic Breast Cancer

Chemo can be used as the main treatment for women whose cancer has spread outside the breast and underarm area to distant organs like the liver or lungs. Chemo can be given either when breast cancer is diagnosed or after initial treatments. The length of treatment depends on how well the chemo is working and how well you tolerate it.

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What Is The Treatment For Triple

Chemotherapy.Chemotherapy is almost always called for, Sun says. Chemo can downstage tumors . While Sun says the chemotherapy for triple-negative breast cancer can be intense, she adds that regimen can be tailored to the individual and adjusted for older or frailer patients.

In those cases where we get complete response, we know we gave you the right medicine and your prognosis is good, Sun says.

Surgery can remove more of the tumor. Surgery for triple-negative breast cancer does not always have to be a mastectomy, Sun says. Effective chemotherapy done first opens up the possibility of less-invasive surgical options that are less of an ordeal for the patient. If the tumor is small enough after chemo, outpatient procedures or a lumpectomy may be possible.

Surgical samples of the cancerous tissues taken from surgery can provide more information on the cancer and how it is behaving so chemotherapy can be tailored accordingly.

Radiation therapy involves the use beams of radiation to destroy cancer cells, using various techniques to prevent damage to healthy surrounding tissue.

Medical treatments are being tested on triple-negative breast tumors in clinical trials.

Immunotherapy and PARP inhibitors are very exciting and theres lots of research going on, including here at Johns Hopkins, Sun says.

Five Ways To Prepare For A Mastectomyemotionally And Physically

More breast cancer patients can safely forego chemotherapy ...

In 2015, Beth W. was diagnosed with stage 3 breast cancer. After receiving her initial treatment at another facility, she sought out a second opinion at Cancer Treatment Centers of America® , where she eventually embarked on a nine-month treatment journey of chemotherapy, radiation and surgery. One question she gets the most from other patients is how to prepare for a mastectomy. Here are the five ways she says she prepared for the procedureemotionally and physically.

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