Endocrine Therapy In Premenopausal Women
Recommended treatment is ovarian suppression plus endocrine therapy with tamoxifen or an AI. Gonadotropin-releasing hormone analogues may be used to suppress ovarian estrogen production :
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Goserelin 3.6 mg SC depot every 4 wk or
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Leuprolide 7.5 mg IM depot every 4 wk or 22.5 mg IM every 3 mo or 30 mg IM every 4 mo
Treatment considerations are as follows:
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Exercise caution when using GRH analogues in combination with AIs because of inconsistent inhibition of estrogen production.
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Oophorectomy is preferred because it induces permanent menopause and obviates repeated injections.
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Tamoxifen or AIs are used in the same doses and schedules commonly employed for adjuvant therapy.
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Selected patients who have had prolonged response or periods of stability on AIs may be switched to one of the following: progestational agents or androgens or estradiol .
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In patients whose menopausal status is uncertain , confirmation of menopausal status may require documentation of an elevated serum follicle-stimulating hormone level and a low estradiol level.
Treatment Of Locally Advanced Or Inflammatory Breast Cancer
For information about the treatments listed below, see the Treatment Option Overview section.
- Targeted therapy .
- Clinical trials testing new anticancer drugs, new drug combinations, and new ways of giving treatment.
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 For Early
Oncologists recommend radiation therapy after breast cancer surgery because it lowers the likelihood that cancer will return by killing the remaining cancer cells.
External radiation therapy is a common way to treat breast cancer. The patient comes into the office 5 days a week for 6-8 weeks for a short treatment with the linear accelerator. It doesn’t hurt but is very time-consuming. There are also some side effects like fatigue, redness, and sensitivity of the skin where the radiation is aimed.
For patients with early-stage breast cancer, another type of radiation therapy may be an option called High Dose Rate Brachytherapy. For this type of internal radiation treatment, a tube is inserted in the breast and left there. Over the course of 5 days , a radioactive pellet is inserted into the tube to treat the area inside the breast where the cancer was located. The pellet is removed and then replaced again a few times each day. Once the five days are over, the tube is removed and the treatment is complete. This comes with fewer side effects compared to external radiation and it shortens the overall treatment time.
Your radiation oncologist, who works closely with your breast surgeon and medical oncologist, will determine if HDR internal radiation therapy is an option for you.
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Find The Right Breast Cancer Specialist For You In Colorado
At Rocky Mountain Cancer Centers, we treat patients with breast cancer of all stages throughout Colorado. Our breast cancer specialists are up-to-date on the latest treatments for various types of cancer. We’re also actively participating in clinical research to help find new and better ways to care for breast cancer patients. Our dedicated team is available to help you if you need it.
If you would like to schedule an initial consultation or would like a second opinion about breast cancer treatment options, request an appointment at the location most convenient for you.
What Is Invasive Breast Cancer
Breast cancer most often begins in the milk producing glands or the milk ducts. When cancer cells spread outside of these areas and into healthy breast tissue, its called invasive breast cancer.
Most breast cancers are invasive. In fact, according to the American Cancer Society, of breast cancers are an invasive type.
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Checking The Lymph Nodes
Before your treatment you have an ultrasound scan to check the lymph nodes in the armpit close to the breast. This is to see if they contain cancer cells. If breast cancer spreads, it usually first spreads to the lymph nodes close to the breast.
Depending on the results of your scan you might have:
- a sentinel lymph node biopsy during your breast cancer operation
- surgery to remove your lymph nodes
How Is It Diagnosed
There are a variety of tests to diagnose invasive breast cancer. These include:
- Breast exam: During a breast exam, a healthcare professional will carefully feel your breasts for signs of lumps or other changes.
- Mammogram: During a mammogram, a device presses your breasts between two plates. X-ray images of the breast tissue are then taken and evaluated for signs of cancer.
- Imaging tests: A healthcare professional may order additional imaging tests to help them better visualize breast tissue. Some examples include ultrasound or magnetic resonance imaging .
- Biopsy: During a biopsy, a sample of breast tissue is carefully removed and checked under a microscope for signs of cancer.
- Blood tests: Blood tests use a sample your blood to check for various markers of disease or illness.
If cancer is detected, additional tests can be used to help characterize the cancer and determine its stage. These tests can include things like:
- Receptor testing: Various tests can check for estrogen receptors, progesterone receptors, and HER2 status.
- Lymph node biopsy: A lymph node biopsy can determine if the cancer has spread to the nearby lymph nodes.
- Imaging tests: Imaging tests can look to see if cancer has spread to other areas. Some that may be used include bone scans, X-rays, CT scans, and positron emission tomography scans.
CE MM 4/8/2021: resolved
Treatment for invasive breast cancer depends on the stage of the cancer as well as other factors. Lets examine the most common treatment options.
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Checking For Cancer Recurrence And Growth
The Surveillance, Epidemiology, and End Results database classifies breast cancer into three stages:
- Localized: This means that the cancer does not appear to have spread outside of the breast.
- Regional: This means that the cancer has spread from the breast to nearby lymph nodes or structures.
- Distant: The means that the cancer has spread from the breast to distant parts of the body, such as the bones, liver, or lungs.
Most cases of localized and regional breast cancer are curable with treatment. In some cases, however, breast cancer returns after initial treatment. This is known as breast cancer recurrence.
If breast cancer spreads to distant organs, it is not curable. That said, treatment can help slow the growth of tumors and sometimes shrink them. Tumors may start to grow again if the treatment stops working.
Doctors may prescribe long-term medication and recommend lifestyle changes to help reduce the risk of cancer recurrence or growth.
If someone experiences cancer recurrence or tumors start to grow again, their doctor can help them understand their treatment options. Early diagnosis and treatment are important.
Chemo Drugs For Breast Cancer That Has Spread
- Taxanes: Paclitaxel , docetaxel , and albumin-bound paclitaxel
- Ixabepilone
- Gemcitabine
- 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.
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What Is Metastatic Breast Cancer
Metastasis is the process by which cancer cells spread. In the case of metastatic breast cancer, the cancer originated in breast tissue, then spread to other parts of the body.
Metastatic cancer is further described as local, regional or distant, depending on the location of the cancer cells in relation to the original tumor.
- Localized metastatic breast cancer often means the breast cancer has spread to nearby lymph nodes.
- The more distant locations include the bones, lungs, skin, liver and brain, although its possible for other parts of the body to be affected.
Its important to remember that every cancer is unique and that your experience may not necessarily be the same as that of another breast cancer patient. With a personalized treatment plan, metastatic breast cancer is typically treatable. A recent National Cancer Institute study found that the number of U.S. women living longer with distant metastatic breast cancer is growing, thanks to advances in treatments.
Its also important to prepare yourself with information about the disease, its symptoms and how its detected and treated.
Menstrual Changes And Fertility Issues
For younger women, changes in menstrual periods are a common side effect of chemo. Premature menopause and infertility may occur and could be permanent. If this happens, there is an increased risk of heart disease, bone loss, and osteoporosis. There are medicines that can treat or help prevent bone loss.
Even if your periods stop while you are on chemo, you may still be able to get pregnant. Getting pregnant while on chemo could lead to birth defects and interfere with treatment. If you have not gone through menopause before treatment and are sexually active, its important to discuss using birth control with your doctor. It is not a good idea for women with hormone receptor-positive breast cancer to take hormonal birth control , so its important to talk with both your oncologist and your gynecologist about what options would be best for you. When women have finished treatment , they can safely go on to have children, but it’s not safe to get pregnant while being treated.
If you think you might want to have children after being treated for breast cancer, talk with your doctor soon after being diagnosed and before you start treatment. For some women, adding medicines, like monthly injections with a luteinizing hormone-releasing hormone analog, along with chemo, can help them have a successful pregnancy after cancer treatment. To learn more, see Female Fertility and Cancer.
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Tnm System For Breast Cancer
Doctors also group cancers by the letters T, N, or M. Each of those letters tells you something about your cancer.
âTâ stands for tumor, or the lump of cancer found in the breast itself. The higher the number assigned after it, the bigger or wider the mass.
âNâ stands for nodes, as in lymph nodes. These small filters are found throughout the body, and they’re especially dense in and around the breast. They’re meant to catch cancer cells before they travel to other parts of the body. Here, too, a number tells you whether the cancer has spread to lymph nodes near the breast and, if so, how many.
âMâ stands for metastasis. The cancer has spread beyond the breast and lymph nodes.
During The Breast Biopsy
You have the excision biopsy under a general anaesthetic, this means you will be asleep.
Your nurse takes you to the operating theatre. The anaesthetist gives the anaesthetic through a small needle in a vein in the back of your hand.
When you are asleep your surgeon makes a small cut in your breast. They then remove the abnormal area of breast tissue. The wire guides the surgeon to the right place. They take out the guide wire when they have finished the biopsy.
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Stage 1b Breast Cancer Means One Of The Following Descriptions Applies:
Lymph nodes have cancer evidence with small clusters of cells between the approximate size of a pinprick to the approximate width of a grain of rice .
AND EITHER No actual tumor is found in the breast.
OR The tumor is smaller than the approximate size of a peanut .
Similar to stage 0, breast cancer at this stage is very treatable and survivable. When breast cancer is detected early, and is in the localized stage , the 5-year relative survival rate is 100%.
How Can I Protect Myself From Breast Cancer
Follow these three steps for early detection:
- Get a mammogram. The American Cancer Society recommends having a baseline mammogram at age 35, and a screening mammogram every year after age 40. Mammograms are an important part of your health history. Recently, the US Preventive Services Task Force came out with new recommendations regarding when and how often one should have mammograms. These include starting at age 50 and having them every two years. We do not agree with this, but we are in agreement with the American Cancer Society and have not changed our guidelines, which recommend yearly mammograms starting at age 40.
- Examine your breasts each month after age 20. You will become familiar with the contours and feel of your breasts and will be more alert to changes.
- Have your breast examined by a healthcare provider at least once every three years after age 20, and every year after age 40. Clinical breast exams can detect lumps that may not be detected by mammogram.
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What Stage Is My Breast Cancer Currently At
Determining the stage of a breast cancer is determined by the combination of the following:
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TNM system: This gives information about the size of the cancer and where the cancer has spread. T describes the size of the tumor, N describes spread to lymph nodes, and M describes metastasis to other sites in the body.
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Receptor status: This describes ER, PR, and HER2 status.
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Grade: Grade describes what the cancer cells look like when compared to normal cells.
Thats a lot of information to take in. But knowing this level of detail about breast cancers will help your cancer care team determine the best treatment for your unique situation.
What Is Stage 0 Lcis
Lobular carcinoma in situ at Stage 0 generally is not considered cancer. Although it has carcinoma in the name, it really describes a growth of abnormal but non-invasive cells forming in the lobules. Some experts prefer the name lobular neoplasia for this reason because it accurately refers to the abnormal cells without naming them as cancer. LCIS, however, may indicate a woman has an increased risk of developing breast cancer.
If you have been diagnosed with LCIS, your doctor may recommend regular clinical breast exams and mammograms. He or she may also prescribe Tamoxifen, a hormone therapy medication that helps prevent cancer cells from growing.
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Mortality Rates Versus Number Of Breast Cancer Deaths
Sometimes its useful to have an estimate of the number of people expected to die from breast cancer in a year. This numbers helps show the burden of breast cancer in a group of people.
Numbers, however, can be hard to compare to each other. To compare mortality rates in different populations, we need to look at mortality rates rather than the number of breast cancer deaths.
What Are The Stages Of Breast Cancer
There are two different staging systems for breast cancer. One is called anatomic staging while the other is prognostic staging. The anatomic staging is defined by the areas of the body where the breast cancer is found and helps to define appropriate treatment. The prognostic staging helps medical professionals communicate how likely a patient is to be cured of the cancer assuming that all appropriate treatment is given.
The anatomic staging system is as follows:
Stage 0 breast disease is when the disease is localized to the milk ducts .
Stage I breast cancer is smaller than 2 cm across and hasn’t spread anywhere including no involvement in the lymph nodes.
Stage II breast cancer is one of the following:
- The tumor is less than 2 cm across but has spread to the underarm lymph nodes .
- The tumor is between 2 and 5 cm .
- The tumor is larger than 5 cm and has not spread to the lymph nodes under the arm .
Stage III breast cancer is also called “locally advanced breast cancer.” The tumor is any size with cancerous lymph nodes that adhere to one another or to surrounding tissue . Stage IIIB breast cancer is a tumor of any size that has spread to the skin, chest wall, or internal mammary lymph nodes .
Stage IV breast cancer is defined as a tumor, regardless of size, that has spread to areas away from the breast, such as bones, lungs, liver or brain.
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What Is The Most Aggressive Type Of Breast Cancer
Any breast cancer that is metastatic, or stage IV, is aggressive because it has already spread beyond the breast. Some other breast cancer types are considered more aggressive than others, including inflammatory breast cancer and triple-negative breast cancer. These may be more likely to spread, less responsive to treatment, or at higher risk of returning after treatment.
Survival Rates For Breast Cancer
Survival rates can give you an idea of what percentage of people with the same type and stage of cancer are still alive a certain amount of time after they were diagnosed. They cant tell you how long you will live, but they may help give you a better understanding of how likely it is that your treatment will be successful.
Keep in mind that survival rates are estimates and are often based on previous outcomes of large numbers of people who had a specific cancer, but they cant predict what will happen in any particular persons case. These statistics can be confusing and may lead you to have more questions. Talk with your doctor about how these numbers may apply to you, as he or she is familiar with your situation.
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