Why Are People Offered Chemotherapy
Chemotherapy is given to reduce the risk of breast cancer coming back in the future. It uses anti-cancer drugs to destroy cancer cells.
It is most commonly given after surgery.
Some people wonder why they need chemotherapy if theyve already had surgery to remove their cancer. Whether someone is offered chemotherapy depends on a number of features of their cancer. These include the size and grade of the cancer; whether it has spread to any of the lymph nodes under the arm; and whether the cancer is hormone receptor and HER2 positive or negative.
For some people the benefit is clear, but for others its less certain. This is why cancer specialists may use a test, like the one described above, to help estimate the benefit.;
Because it affects cells throughout the body, chemotherapy can cause side effects including sickness, hair loss and an increased risk of infection.
Possible Side Effects Of Chemo For Breast Cancer
Chemo drugs can cause side effects. These depend on the type and dose of drugs given, and the length of treatment. Some of the most common possible side effects include:
- Hair loss
Chemo can also affect the blood-forming cells of the bone marrow, which can lead to:
- Increased chance of infections
- Easy bruising or bleeding
These side effects usually go away after treatment is finished. There are often ways to lessen these side effects. For example, drugs can be given to help prevent or reduce nausea and vomiting.
Other side effects are also possible. Some of these are more common with certain chemo drugs. Ask your cancer care team about the possible side effects of the specific drugs you are getting.
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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What Is External Beam Radiation Therapy
During external beam radiation therapy, a beam of radiation is directed through the skin to the cancer and the immediate surrounding area in order to destroy the main tumor and any nearby cancer cells. To minimize side effects, the treatments are typically given five days a week, Monday through Friday, for a number of weeks. This allows doctors to get enough radiation into the body to kill the cancer while giving healthy cells time each day to recover.
The radiation beam is usually generated by a machine called a linear accelerator. The linear accelerator, or linac, is capable of producing high-energy X-rays and electrons for the treatment of your cancer. Using high-tech treatment planning software, your treatment team controls the size and shape of the beam, as well as how it is directed at your body, to effectively treat your tumor while sparing the surrounding normal tissue. Several special types of external beam therapy are discussed in the next sections. These are used for specific types of cancer, and your radiation oncologist will recommend one of these treatments if he or she believes it will help you.
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.
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Accelerated Partial Breast Irradiation
In select women, some doctors are using accelerated partial breast irradiation to give larger doses over a shorter time to only one part of the breast compared to the entire breast. Since more research is needed to know if these newer methods will have the same long-term results as standard radiation, not all doctors use them. There are several different types of accelerated partial breast irradiation:
- Intraoperative radiation therapy : In this approach, a single large dose of radiation is given to the area where the tumor was removed ;in the operating room right after BCS . IORT requires special equipment and is not widely available.
- 3D-conformal radiotherapy : In this technique, the radiation is given with special machines so that it is better aimed at the tumor bed. This spares more of the healthy breast. Treatments are given twice a day for 5 days.
- Intensity-modulated radiotherapy : IMRT is like 3D-CRT, but it also changes the strength of some of the beams in certain areas. This gets stronger doses to certain parts of the tumor bed and helps lessen damage to nearby normal body tissues.
- Brachytherapy: See brachytherapy below.
Women who are interested in these approaches may want to ask their doctor about taking part in clinical trials of accelerated partial breast irradiation.
Radiation After Mastectomy Offers Benefits If Breast Cancer Has Spread To One To Three Lymph Nodes
- Tags:Planning/Considering Radiation, After Surgery, Planning/Considering Surgery, Early-stage: Stage 0 — DCIS , Early-stage: Stage IA, Early-stage: Stage IB, Early-stage: Stage IIA, Early-stage: Stage IIB, Early-stage: Stage IIIA, Lymph Nodes Removed, 1-9 Involved, Radiation to the Breast, Radiation After Surgery , Whole-Breast External Radiation, Mastectomy, Ductal Carcinoma In Situ, Invasive or Infiltrating Ductal Carcinoma, and Invasive or Infiltrating Lobular Carcinoma
Almost all women get radiation therapy after lumpectomy to reduce the risk of the cancer coming back .
Lumpectomy plus radiation has been shown to be as effective as mastectomy without radiation for most women diagnosed with early-stage breast cancer.
Early-stage breast cancer is stage 0, I, and II.
Radiation isnt given routinely after mastectomy, but some women benefit from it. Research has shown that women diagnosed with breast cancers that:
- are larger than 5 cm
- have spread to four or more lymph nodes
- have positive margins
- have spread to the skin
benefit from radiation after mastectomy.
But it hasnt been clear if radiation after mastectomy to remove breast cancer with just one to three positive lymph nodes offers benefits. Some studies found that radiation improved survival. Other studies showed no benefits.
The women were put into three categories:
- no cancer in the lymph nodes
- breast cancer in one, two, or three lymph nodes
- breast cancer in four or more lymph nodes
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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, sometimes 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 done, it is usually delayed until after radiation is complete. In some cases, 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, trastuzumab may be changed to a different drug, called ado-trastuzumab emtansine, which is given every 3 weeks for 14 doses. For people with hormone receptor-positive cancer in the lymph nodes who have completed a year of trastuzumab, the doctor might also recommend additional treatment with an oral drug called neratinib for a year.
What Type Of Drug Treatment Might I Get
Most women with breast cancer in stages I to III will get some kind of drug therapy as part of their treatment. This may include:
- Hormone therapy
- HER2 targeted drugs, such as trastuzumab and pertuzumab
- Some combination of these
The types of drugs that might work best depend on the tumors hormone receptor status, HER2 status, and other factors.
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Are There Any Side Effects
Radiation therapy is usually well tolerated and many patients are able to continue their normal routines. However, some patients may eventually develop painful side effects. Be sure to talk to a member of your radiation oncology treatment team about any problems or discomfort you may have. Many of the side effects of radiation therapy are only in the area being treated. For example, a breast cancer patient may notice skin irritation, like a mild to moderate sunburn, while a patient with cancer in the mouth may have soreness when swallowing. Some patients who are having their midsection treated may report feeling sick to their stomach. These side effects are usually temporary and can be treated by your doctor or other members of the treatment team.
Side effects usually begin by the second or third week of treatment, and they may last for several weeks after the final radiation treatment. In rare instances, serious side effects develop after radiation therapy is finished. Your radiation oncologist and radiation oncology nurse are the best people to advise you about the side effects you may experience. Talk with them about any side effects you are having. They can give you information about how to manage them and may prescribe medicines or changes in your eating habits to help relieve your discomfort.
Study: More Breast Cancer Patients Can Safely Skip Chemotherapy
A federally funded study has found that many women with the most common type of early stage breast cancer likely do not need chemotherapy after surgery. The study was presented June 3, 2018 at the American Society of Clinical Oncology meeting in Chicago, and simultaneously published in the New England Journal of Medicine. It is likely to change the way many newly diagnosed breast cancer patients are treated.
“With results of this groundbreaking study, we now can safely avoid chemotherapy in about 70% of patients who are diagnosed with the most common form of breast cancer,” said Kathy Albain, MD, a co-author of the study. “For countless women and their doctors, the days of uncertainty are over.”
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Is Chemotherapy Necessary Before Or After Breast Cancer Surgery Or At All
A recent study found that breast cancer has been highly over treated with chemotherapy and doctors can now confidently provide an alternative treatment known as Endocrine Therapy.
However, each patient is different with a unique set of circumstances. Chemotherapy is necessary in advanced stages, as well as early stages when specific characteristics are present, such as spreading to the lymph nodes or other body parts.
What Are The Cosmetic Results Of Breast Conservation Therapy
Eighty percent to 90 percent of women treated with modern surgery and radiotherapy techniques have excellent or good cosmetic results; that is, little or no change in the treated breast in size, shape, texture or appearance compared with what it was like before treatment.
Patients with large breasts seem to have greater shrinkage of the breast after radiation therapy than do patients with smaller breasts. However, this problem usually can be overcome with the use of higher x-ray energies or with IMRT. Partial breast radiation using brachytherapy can also be considered if the patient has a small early-stage tumor. This treatment is still undergoing clinical investigation. Certain single institution studies on brachytherapy and intraoperative radiation have shown some promising results. You would need to discuss this with your doctor before or shortly after surgery to determine if you qualify for partial breast radiation.
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Thousands Could Avoid Chemo
You may have read the news that a ‘test means fewer women will need chemotherapy’.
The news reports follow a study, called TAILORx, of a test widely used on the NHS.
The test;;Oncotype DX;;predicts whether someone would benefit from chemotherapy.
The test is suitable for women whose breast cancer:
- is;HER2 negative
- hasnt spread to the lymph nodes under the arm
However, there’s a significant grey area of women for whom the benefit is unclear. The researchers looked at this intermediate group. They concluded that for most women in this group over the age of 50, chemotherapy didn’t have any benefit, and hormone therapy alone led to similar survival rates. For some women under 50 in this group, chemotherapy could also be spared. ;;
This means that several thousand women a year could avoid having chemotherapy, which can cause a range of often unpleasant side effects.
You can read a;more detailed analysis of the study on the NHS Choices website.
Rationale For Neoadjuvant Therapy: The Nsabp B
The NSABP B-18 trial was designed to determine whether preoperative treatment with four cycles of doxorubicin/cyclophosphamide would improve overall survival and DFS when compared with the same treatment given postoperatively. At 9 years of follow-up, there was no difference in survival or DFS between the two groups,. A critical observation during this follow-up was that pCR correlated with OS, and this finding became stronger with longer follow up. Primary tumor response graded as pCR, pINV , clinical partial response , or clinical non-responder and was associated with outcome measures of OS , DFS , and RFS . The B-18 trial established that chemotherapy can be given before surgery with no loss of efficacy, opening the way to measuring chemotherapy effect and the testing of novel agents, as in the B-27 trial.
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Brachytherapy Delivered Via Implantable Device
The doctor places a device inside the breast at the time of the surgery or shortly thereafter which carries targeted radiation to the tissue where the cancer originally grew . This type of radiation may take only one treatment delivered in the operating room or may take 5-7 days given on an outpatient basis in the radiation therapy department.In nearly all cases, the appropriate method is determined by the radiation oncologist based on the location and size of the tumor.
What Are Clinical Trials
Cancer specialists regularly conduct studies to test new treatments. These studies are called clinical trials. Clinical trials are available through cancer doctors everywhere- not just in major cities or in large hospitals.
Some clinical studies try to determine if a therapeutic approach is safe and potentially effective. Many large clinical trials compare the more commonly used treatment with a treatment that cancer experts think might be better. Patients who participate in clinical trials help doctors and future cancer patients find out whether a promising treatment is safe and effective. All patients who participate in clinical trials are carefully monitored to make sure they are getting quality care. It is important to remember that clinical trials are completely voluntary. Patients can leave a trial at any time. Clinical trials testing new treatments are carried out in phases:
Only you can make the decision about whether or not to participate in a clinical trial. Before making your decision, it is important to learn as much as possible about your cancer and the clinical trials that may be available to you. Your radiation oncologist can answer many of your questions if you are considering taking part in a trial or contact the National Cancer Institute at 1-800-4-CANCER or www.cancer.gov.
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