Purpose Of Neoadjuvant Chemotherapy
All systemic therapy given for non-metastatic, invasive breast cancer is intended to reduce the risk of your cancer returning. But the purpose of administering it prior to surgery is to shrink your tumor or stop the spread of cancer to make surgery less invasive and more effective.
This process, called downstaging, may make it possible for you to have less extensive surgery on the breast and/or axilla , especially for those with large tumors. By having the size of the tumor reduced, you may become a candidate for surgical resection or breast-conserving surgery rather than mastectomy.
Neoadjuvant chemotherapy has also been shown to improve cosmetic outcomes and reduce postoperative complications such as lymphedema, particularly in those who undergo breast reconstruction surgery.
Up to half of the patients undergoing neoadjuvant treatment may become suitable candidates for breast conservation rather than mastectomy.
One systematic review of neoadjuvant chemotherapy for operable breast cancer found that those who received chemotherapy before surgery had a lower mastectomy rate than those undergoing some surgical procedure before being given chemotherapy.
Sex Contraception And Pregnancy
You can still have sex during treatment. Its thought that chemotherapy drugs cant pass into vaginal fluids or semen, but this cant be completely ruled out as chemotherapy drugs can pass into the blood and some other body fluids. Most treatment teams will advise using barrier methods of contraception, such as condoms during treatment, and for a few days after chemotherapy is given.;
If you havent been through the menopause, its important to use contraception because chemotherapy drugs can harm a developing baby in the first three months of pregnancy. Its still possible to become pregnant even if your periods become irregular or stop completely.
Your specialist will usually recommend barrier methods of contraception, such as condoms. The contraceptive pill is not usually recommended because it contains hormones. Emergency contraception such as the morning after pill can still be used.
An interuterine device can be used as long as its not the type that releases hormones. If you have a coil in place that does release hormones, such as the Mirena or Jaydess, when youre diagnosed, you may be advised to have this removed.
What Are The Side Effects Of Chemo Versus Endocrine Therapy How Does Each Impact A Womans Health
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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Do I Already Have Cancer In My Axillary Nodes
If you are found to have lymph node positive breast cancer before surgery, it is likely you will benefit from neoadjuvant chemotherapy. Your breast surgeons exam is not always successful at identifying breast cancer in the axillary lymph nodes under the arm. Request an axillary ultrasound from your breast surgeon while you are in the examination room. You want to know early on whether cancer is suspected to have spread to your lymph nodes. Take our video lesson on Axillary Ultrasound . You can have a minimally invasive needle biopsy to see if the abnormal node has cancer within it. If so, it opens the door for more sophisticated treatment options including neoadjuvant chemotherapy.
What Is Neoadjuvant Therapy
Neoadjuvant therapy is a treatment approach which focuses on this type of reverse order. The idea is to first shrink the tumor with chemotherapy before any next steps, specifically surgery.
This approach not only can improve surgical options, but also allows for a better assessment of the patients response to the chemotherapy, Dr. Moore says. It can also inform better recommendations for follow-up treatments after surgery. The approach doesnt work for everyone, but its certainly worth discussing with your doctor to find out if youre a candidate.
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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.
When You Might Have Chemotherapy
Whether you have chemotherapy as part of your treatment depends on what;type of cancer you have, how big it is;and whether it has spread or not.
Doctors use chemotherapy because it circulates throughout the body in the bloodstream. So it can treat cancer almost anywhere in the body. Chemotherapy is a systemic treatment.
Surgery only removes the cancer from the area it is in the body. And radiotherapy only treats the area of the body it is aimed at.;
You might have chemotherapy:
- to shrink a cancer before surgery or radiotherapy
- to try to stop cancer coming back after surgery or radiotherapy;
- as a treatment on its own, if your type of cancer is very sensitive to it;
- to treat cancer that has spread from where it first started;
Where Is Chemotherapy Given
Unless youre having chemotherapy as tablets, youll normally be given your treatment at hospital as an outpatient or day case. This means youll be able to go home on the same day.
You may be at the hospital for a short time only. However, because of tests, waiting times and how long it takes to prepare and give the chemotherapy drugs, some people are there for most of the day. You may be asked to have blood tests a few days before you have your chemotherapy.
You might find it helpful to take things to help pass the time as well as snacks and drinks. You may be able to take someone to go with you to keep you company. Talk to your chemotherapy nurse to find out if this is possible.
In some areas chemotherapy may be given in a mobile treatment centre or in your home.
With some types of chemotherapy you may be given your first treatment as an inpatient and may need to stay in hospital overnight.
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.
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How Long Will I Have Chemotherapy For
Chemotherapy is commonly given as a series of treatments with a break between each treatment to give your body time to recover from any short-term side effects. The treatment and period of time before the next one starts is called a cycle.
You may have treatment weekly or every two or three weeks.
You may have one drug or a combination of two or three drugs. The exact type and dose of chemotherapy will be tailored to your individual situation. The drugs used, the dose, how often theyre given and the number of cycles may be called your chemotherapy regime or regimen.
The length of time that you have chemotherapy will depend on your individual situation. Your treatment team will discuss this with you.
For Cancer That Has Spread
Your doctor might suggest chemotherapy if there;is a chance that your cancer might spread in the future. Or if it has already spread.;
Sometimes cancer cells break away from a tumour. They may travel to other parts of the;body through the;bloodstream or;lymphatic system.;
The cells may settle in other parts of the;body and develop into new tumours. These are called secondary cancers or;metastases. The drugs circulate in the bloodstream around the body to treat any cancer cells that have spread.;
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Complementary And Alternative Treatments
Some people with breast cancer might be interested in exploring complementary or alternative treatments like vitamins, herbs, acupuncture, and massage.
These treatments are used alongside traditional breast cancer therapies to treat cancer or relieve cancer symptoms and uncomfortable side effects of treatments like chemotherapy. You can explore these treatments at any stage of breast cancer.
Examples of alternative therapy include:
- using massage to relax
- using peppermint tea to reduce nausea
- using cannabis to relieve pain
While some alternative medicine treatments might help you feel more comfortable, its important to keep in mind that many are unproven and could be harmful to your health. To be safe, talk with your doctor about alternative treatments youre interested in pursuing.
Breast cancer that spreads to other parts of the body can cause pain, such as bone pain, muscle pain, headaches, and discomfort around the liver. Talk with your doctor about pain management.
Options for mild to moderate pain include acetaminophen and nonsteroidal anti-inflammatory drugs , such as ibuprofen.
For severe pain in a later stage, your doctor may recommend an opioid such as morphine, oxycodone, hydromorphone, or fentanyl. These opioids have the potential for addiction, so they are only recommended in certain cases.
While breast cancer stage has a lot to do with treatment options, other factors can impact your treatment options as well.
Feeling Unwell Or Tired
Many women do not feel as healthy after chemo as they did before. There is often a residual feeling of body pain or achiness and a mild loss of physical functioning. These changes may be very subtle and happen slowly over time.
Fatigue is another common problem for women who have received chemo. This may last a few months up to several years. It can often be helped, so its important to let your doctor or nurse know about it. Exercise, naps, and conserving energy may be recommended. If you have sleep problems, they can be treated. Sometimes fatigue can be a sign;of depression, which may be helped by counseling and/or medicines.
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Physical Emotional And Social Effects Of Cancer
In general, cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.
Palliative care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative care along with treatment for the cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.
Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments similar to those meant to get rid of the cancer, such as chemotherapy, surgery, or radiation therapy.
Music therapy, meditation, stress management, and yoga for reducing anxiety and stress.
Meditation, relaxation, yoga, massage, and music therapy for depression and to improve other mood problems.
Meditation and yoga to improve general quality of life.
Acupressure and acupuncture to help with nausea and vomiting from chemotherapy.
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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Neoadjuvant And Adjuvant Systemic Therapy
For women who have a hormone receptor-positive breast cancer, most doctors will recommend hormone therapy as an adjuvant treatment, no matter how small the tumor is. Women with tumors larger than 0.5 cm across may be more likely to benefit from it. Hormone therapy is typically given for at least 5 years.
If the tumor is larger than 1 cm across, chemo after surgery is sometimes recommended. A woman’s age when she is diagnosed;may help in deciding if chemo should be offered or not. Some doctors may suggest chemo for smaller tumors as well, especially if they have any unfavorable features .
After surgery, some women with HER2-positive cancers will be treated with trastuzumab for up to 1 year.
Many women with HER2-positive cancers will be treated with trastuzumab followed by surgery and more trastuzumab for up to 1 year. If after neoadjuvant therapy, residual cancer is found during surgery, trastuzumab may be changed to a different drug, called ado-trastuzumab emtansine, which is given every 3 weeks for 14 doses. If hormone receptor-positive cancer is found in the lymph nodes, your doctor might recommend one year of trastuzumab followed by additional treatment with an oral drug called neratinib for 1 year.
How Does Endocrine Therapy Help Reduce The Recurrence Of Breast Cancer
Hormone-receptor-positive breast cancer depends on estrogen and progesterone to grow and spread. When these hormones are decreased in the body, the cancer cells cannot thrive. Endocrine Therapy stops the body from producing estrogen, and/or blocks cells from using the hormone to grow.
Endocrine therapy includes a few options. Depending on your circumstances Dr. Gorman may choose one of the following:
- Aromatase Inhibitors AIs stop the bodys tissues and organs from producing estrogen while allowing the ovaries to produce their natural amount. It is important that premenopausal women not use this therapy, as the drugs may increase production of estrogen in women who have not gone through menopause.
- Tamoxifen works in women who are both pre and postmenopausal by inhibiting cells to use estrogen, therefore decreasing and stopping growth.
- Ovarian Suppression stops the ovaries from producing estrogen through prescribed drugs or a surgical procedure. This option is for premenopausal women.
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Cost And Health Insurance
The price of neoadjuvant therapy varies depending on the length of treatment needed and whether you have access to health insurance. For those with health insurance, the average cost is about $5,000.
Although NAT may cost thousands of dollars, most insurance companies cover these treatments. Also, successful neoadjuvant therapy will likely save you money in the long run by making more cost-effective treatment, like local removal of your breast cancer tumor, possible.
Survival And Time To Surgery
A 2016 study published in JAMA Oncology looked at data from over 115,000 people via the National Cancer Database . This study included people age 18 and older who were cared for at Commission on Cancer-accredited cancer centers across the United States.
All of the people had early stage breast cancer with surgery as their first treatment. They then looked at wait times to surgery and survival rates at five different intervals: a wait of less than 30 days, a wait time of 31 to 60 days, a wait time of 61 to 90 days, a wait time of 91 to 120 days, and a wait time of 121 to 180 days.
They found that for each 30-day interval of delay, survival rates decreased for people with stage I and stage II breast cancer. The conclusion was that although time is needed to discuss treatment options and prepare, earlier surgery is better.
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