Why Do Chemo Before Surgery Breast Cancer

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.

Who Is A Good Candidate For Neoadjuvant Therapy

Patients should meet a few requirements to be a candidate for neoadjuvant therapy. The size of the tumor, the type of breast cancer they have, and whether lymph nodes are involved are all things a doctor will consider before suggesting this form of treatment. Some forms of breast cancer are more likely to respond well to neoadjuvant therapy.

Unless a tumor is small and there is no lymph node involvement, most patients who have eitherHER2-positive breast cancer or triple-negative are good candidates for using chemotherapy either before or after their mastectomy.

With the best outcomes, this therapy can eliminate all visible tumors from the breast and produce what is known as a pathologic complete response to the treatment. That means the doctor will find no trace of the invasive tumor in the breast or the lymph nodes after the patient has received treatment.

Women who have estrogen receptor-positive breast cancer, which is the most common type, may not be good candidates for neoadjuvant therapy. Instead, these patients may benefit from anti-estrogen treatment to help shrink their tumor before surgery.

How You Have Chemotherapy

You usually have treatment into your bloodstream .

You might have treatment through a long plastic tube that goes into a large vein in your chest. The tube stays in place throughout the course of treatment. This can be a:

• central line
• PICC line
• portacath

If you don’t have a central line you might have treatment through a thin short tube . The cannula goes into a vein in your arm each time you have treatment.

• About chemotherapy into your vein

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Treatment For Stage 1 Breast Cancer

Doctors can offer a variety of for stage 1 breast cancer, although surgery is the primary treatment.

Surgery

A lumpectomy or mastectomy are both viable surgical options for people with stage 1 breast cancer. A doctor will decide what surgery is most appropriate depending on the location of the primary tumor, how large it is, the size of the breast, family history, genetics, and the persons preference.

The doctor may also carry out a biopsy on one or more lymph nodes.

After removing the tissue, they will send it to a laboratory for further tests. The results will help inform decisions on the next stage of treatment.

Radiation therapy

Radiation therapy is a standard treatment for stage 1 breast cancer. However, the decision will depend on factors such the age of the person, the type of cancer, the size of the tumor, and whether there are cancer cells in the lymph nodes.

Hormone therapy

If the breast cancer is ER+ or PR+, hormone therapy may be effective. Hormone therapy works by preventing the growth of estrogen, which helps cancer grow, by blocking estrogen from attaching to tissue and fuelling cancer growth, or both.

Hormone therapy can reach cancer cells in the breast, as well as other areas of the body, and it can reduce the risk of cancer returning.

Chemotherapy

However, the

also has subcategories known as 2A and 2B.

Stage 2A breast cancer is invasive cancer:

How Is Chemotherapy For Breast Cancer 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 breast cancer. If a woman has breast cancer in both breasts, the central line will most likely be placed on the side that had fewer lymph nodes removed or involved with cancer.

Chemo is given in cycles, followed by a rest period to give you time to recover from the effects of the drugs. Chemo cycles are most often 2 or 3 weeks long. The schedule varies depending on the drugs used. For example, with some drugs, chemo is given only on the first day of the cycle. With others, it is given one day a week for a few weeks or every other week. Then, at the end of the cycle, the chemo schedule repeats to start the next cycle.

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Is There A Breast Cancer Cure

There is currently no cure for metastatic breast cancer, or breast cancer that has spread to distant parts of the body. However, early stages of breast cancer that remain localized are highly treatable 99 percent of people who receive treatment in the earliest stages of breast cancer live for 5 years or longer after diagnosis, according to the

How Long Do Chemo Treatments Last

Most chemotherapy treatments are given in repeating cycles. The length of a cycle depends on the treatment being given. Most cycles range from 2 to 6 weeks. The number of treatment doses scheduled within each cycle also varies depending on the drugs being given.

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Treatment For Stage 3 Breast Cancer

for stage 3 breast cancer may include the following, depending on the type of cancer and other factors:

• chemotherapy

stage 4 breast cancer , also called metastatic breast cancer, has cancer that has spread to nearby lymph nodes and also more distant lymph nodes and other organs in the body.

Stage 4 breast cancer is the most advanced stage. Stage 4 breast cancer also may be breast cancer that returned to affect other parts of the body. Cancer that has returned in other parts of the body is called recurrent metastatic breast cancer

What Did This Study Do

This systematic review included 14 studies assessing how waiting time between breast cancer surgery and the start of chemotherapy affected survival. Five were randomised controlled trials and nine were observational cohorts, either hospital-based or general population samples.

Five randomised controlled trials and three cohorts including 26,265 participants were pooled in meta-analysis looking at the link between a four-week delay in start of chemotherapy and overall survival. These studies were categorized as high validity, meaning they included information on patients age, cancer stage, hormone receptor status, and made it clear that chemotherapy was to aid treatment, not as palliative care after surgery had failed.

Results were pooled using a fixed effect and a random effects model, which allows for the fact that the effect varied between the individual studies. Researchers analysed the randomised studies separately from the observational studies.

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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

What Is A Mastectomy

A mastectomy is a surgical procedure that removes the entire breast. The procedure includes a total mastectomy, where all the breast tissue is removed, but the nipple is left. This procedure is performed to help remove cancerous tissue. The type of mastectomy a patient has depends on the severity of the cancer diagnosis.

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Timing Of Chemotherapy Matters

The next study, Chavez-MacGregor et al, asked basically the same question, except that the authors looked at time to adjuvant chemotherapy after definitive surgery. Adjuvant chemotherapy is chemotherapy given after surgery with the intent of decreasing the chance of tumor recurrence. It is standard of care for many kinds of breast cancer. For instance, in two of the kinds of breast cancer with poorer prognosis, triple negative breast cancer and HER2 breast cancer, except in the case of very small node-negative tumors, nearly every patient who is healthy enough to handle it will be recommended adjuvant chemotherapy.

Their rationale:

Not surprisingly, the authors found a correlation between prolonged time to chemotherapy and Hispanic ethnicity, non-Hispanic black race, lower socioeconomic status, and nonprivate insurance. This is similar to what Bleicher et al found with respect to time-to-surgery, namely that the proportion of patients with black race or Hispanic ethnicity increased with each interval delay. This is by no means a new finding disparities in health care of this sort have been documented in many previous studies. Indeed, these sorts of disparities are likely one reason why minorities and people of lower socioeconomic status experience worse outcomes in many cancers. Indeed, there are a lot of potential confounders, many of which couldnt be accounted for in either study, as Chavez-MacGregor et al note:

What Did It Find

• A four-week increase in time from surgery to start of chemotherapy was linked to a 4% to 8% increase in chances of death depending on the choice of analytical model. In the fixed effect model of high quality studies, the overall survival was increased by 4% for those people not delayed by more than 4 weeks and in the random effects model by 8% . The authors concluded that the 5% estimate of the increased risk was reasonable.
• This finding was mainly dependent on the results of three cohort studies . None of the five individual randomised controlled trials showed a statistically significant effect of time to start of chemotherapy upon overall survival. This reduces our confidence in the accuracy of the results.
• Seven studies also reported effect of chemotherapy delay on the outcome of survival before cancer recurrence. These studies found suggestion that four-week delay also slightly increased risk of cancer recurrence , but this fell short of statistical significance when only the five high validity studies were pooled .

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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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One reason to question the findings, however, is that if pre-op chemo promotes metastasis in some patients, that might be expected to have shown up in studies of the therapy. Overall, in fact, those studies show that neoadjuvant chemotherapy does not seem to improve overall survival, as the authors of an editorial in the Journal of Clinical Oncology wrote.

Thats not as bad as decreasing survival, of course. But Einsteins Dr. Maja Oktay, a co-author of the new research, cautioned that the typical length of the studies six or so years is too short to assess the risk of metastasis, which can take more than 20 years to appear, she said. Such patients might never be flagged as having metastatic cancer, let alone having it linked to pre-op chemo decades earlier, said Aguirre-Ghiso.

On a brighter note, not all breast cancer patients have the kind of tumor microenvironment in which pre-op chemo can promote metastasis. Whether they do or not can be determined by a simple lab test, but one that is not routinely done, Condeelis said.

Serendipitously, an experimental compound called rebastinib, being developed by Deciphera Pharmaceuticals, seems to be able to block the on-ramp to the metastasis highway. In a study currently recruiting patient volunteers, the Einstein scientists are studying whether rebastinib can improve outcomes in metastatic breast cancer.

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Learning Breathing And Leg Exercises

Breathing exercises help to stop you from getting a chest infection. If you smoke, it helps if you can stop at least a few weeks before your operation.

Leg exercises help to stop blood clots forming in your legs. You might also have medicines to stop the blood from clotting. You have them as small injections under the skin.

You start the injections before your operation. You might also wear compression stockings and pumps on your calves or feet to help the circulation.

Your nurse and physiotherapist will get you up out of bed quite quickly after your surgery. This is to help prevent chest infections and blood clots forming.

This 3-minute video shows you how to do the breathing and leg exercises.

Ovarian Ablation Or Suppression

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 you’ll 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 you’re taking it, although they should start again once your treatment is complete.

If you’re 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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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.

When To Consider Joining A Clinical Trial

If youre newly diagnosed with early or locally advanced breast cancer, consider joining a clinical trial before starting treatment. For most people, treatment doesnt usually start right after diagnosis. So, theres time to look for a clinical trial that youre eligible for and fits your needs.

Once youve begun standard treatment for early or locally advanced breast cancer, it can be hard to join a clinical trial.

Learn more about clinical trials.

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Playing An Active Role

You play an active role in making treatment decisions by understanding your breast cancer diagnosis, your treatment options and possible side effects.

Together, you and your health care provider can choose treatments that fit your values and lifestyle.

Chemo Before Breast Cancer Surgery Ok

Patients With Early-Stage Breast Cancer Should Discuss Options, Researchers Say

April 18, 2007 — Getting chemotherapy before breast cancer surgery may help some patients avoid mastectomy, according to a new research review.

Patients with early-stage breast cancer should talk to their doctors about the risks and benefits of getting chemotherapy before breast cancer surgery, note the researchers.

They included J.S.D. “Sven” Mieog of the surgery department at Leiden University Medical Center in Leiden, Netherlands.

The reviewed studies included a combined total of 5,500 women with early-stage breast cancer in the U.S., Europe, Canada, Japan, U.K., Russia, and Lithuania.

The researchers randomly assigned the patients to get chemotherapy before or after breast cancer surgery. The follow-up time varied among the studies, ranging from 1.5 years to about 10 years.

Survival rates were similar for the presurgery and postsurgery chemotherapy groups. That includes overall survival and survival without breastcancer‘s return.

However, the women who got chemotherapy before breast cancer surgery were less likely to get mastectomy than those who had chemotherapy after breast cancer surgery.

The review shows no increase in side effects with presurgery chemotherapy. In fact, the presurgery chemotherapy patients were slightly less likely to have serious infections during the studies.

The review appears online in The Cochrane Library.

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