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.
What Is Breast Cancer
Breast cancer is a type of cancer that starts in the breast. It starts when cells in the breast begin to grow out of control.
Breast;cancer cells usually form a tumor that can often be seen on an x-ray or felt as a lump. Breast cancer is most common in women, but;men can get breast cancer, too.
Breast cancer cells can spread to other parts of the body and grow there, too. When cancer cells do this, its called metastasis.
Cancer is always named based on the place where it starts. So even if breast cancer spreads to the bones , its still called breast cancer. Its not called bone cancer unless it starts from cells in the bone.
Delay In Surgery And Tumor Growth: Her2 And Triple Negative Tumors
The optimal time between diagnosis and surgery can also be looked at from the standpoint of tumor growth, although the doubling rate varies between different tumors.
A 2016 study, though it didn’t look at survival, did evaluate the growth rate of breast cancers during wait time for surgery by ultrasound measurements. In this study, the average wait time between diagnosis and surgery was 31 days .
The average diameter and volume of tumors at diagnosis was 14.7 millimeters and 1.3 centimeters vs. 15.6 millimeters and 1.6 centimeters.
The growth rate of different tumors based on receptor status, however, was very different:
- Triple-negative tumors: 1.003 percent growth each day
- HER2 positive tumors: 0.850 percent growth each day
- Luminal B/A tumors : 0.208/0.175 percent growth each day
As noted, tumors that were triple negative or HER2 positive grew much faster. This was also linked to an increase in stage based on size between diagnosis and surgery, with 18 percent of triple-negative tumors increasing versus only 2 to 3 percent of estrogen receptor positive tumors changing. Since stage is linked with survival rates, this study also supports earlier surgery, especially for people with triple negative or HER2 positive tumors.
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Ajcc Anatomic And Prognostic Stage Groups
There are three stage group tables for invasive cancer:
- Anatomic Stage Group. The Anatomic Stage Group table is used in regions of the world where tumor grading and/or biomarker testing for ER, PR, and HER2 are not routinely available.
- Clinical Prognostic Stage Group. The Clinical Prognostic Stage Group table is used for all patients in the United States. Patients who have neoadjuvant therapy as their initial treatment should have the clinical prognostic stage and the observed degree of response to treatment recorded, but these patients are not assigned a pathological prognostic stage.
- Pathological Prognostic Stage Group. The Pathological Prognostic Stage Group table is used for all patients in the United States who have surgery as initial treatment and have pathological T and N information reported.
In the United States, cancer registries and clinicians must use the Clinical and Pathological Prognostic Stage Group tables for reporting. It is expected that testing is performed for grade, HER2, ER, and PR status and that results are reported for all cases of invasive cancer in the United States.
AJCC Anatomic Stage Groups
AJCC Prognostic Stage Groups
The Clinical Prognostic Stage is used for clinical classification and staging of patients in the United States with invasive breast cancer. It uses TNM information based on the patients history, physical examination, imaging results , and biopsies.
Genetics And Family History
Treatment for breast cancer may depend partly on having a close relative with a history of breast cancer or testing positive for a gene that increases the risk of developing breast cancer.
Patients with these factors may choose a preventive surgical option, such as a bilateral mastectomy.
Clinical trials are studies in which patients volunteer to try new drugs, combinations of drugs, and methods of treatment under the careful supervision of doctors and researchers. Clinical trials are a crucial step in discovering new breast cancer treatment methods.
Emerging treatments for breast cancer being studied in clinical trials include:
- PARP inhibitors that block protein used to repair DNA damage that occurs during cell division are being used and tested for TNBC.
- Drugs that block androgen receptors or prevent androgen production are being used and tested for TNBC.
If youre interested, ask your oncologist for information about available trials.
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What Is Targeted Therapy For Her2
When a cancer is HER2-positive, it means that the cancer cells make too much HER2 protein, which can cause tumors to grow more rapidly than with other forms of breast cancer.
Drugs that target the HER2 proteins are the primary treatment for this type of breast cancer, given along with chemotherapy. Your oncology team may refer to these medications as targeted therapy or HER2-directed therapy.
Trastuzumab and pertuzumab are the most commonly used drugs used to treat HER2-positive breast cancer. Neratinib is another drug that is sometimes given after trastuzumab.
Some other targeted therapy drugs, such as lapatinib or ado-trastuzumab emtansine , are mainly used to treat more advanced HER2-positive breast cancers.
Herceptin and Perjeta are given at the same time as chemotherapy through an IV. HER2-directed therapy is usually given over a longer period of months than chemotherapy.
Herceptin alone is usually continued after chemotherapy has finished, every three weeks for a total of one year.
Side effects for HER2-targeted therapies may include:
- sleep problems
- redness at the IV site
Side Effects Of Breast Cancer Chemotherapy
Chemotherapy usually works by attacking rapidly dividing cells. This means that chemotherapy can harm not only cancer cells but also healthy cells that are dividing rapidly, like the ones that cause your hair to grow.
Whether you have side effects from breast cancer chemotherapy will depend on the details of your treatment plan. The care teams at MSK are committed to helping you feel your best during and after treatment. During treatment, well watch carefully for your reaction to the drugs and adjust the drugs or dose as necessary. Well also continue to monitor you for possible long-term effects after your treatment ends.
We offer a variety of other specialized services to support you during your treatment. Many MSK patients find that our Integrative Medicine Service can be a valuable part of their treatment plan. Programs include massage, acupuncture, hypnotherapy, meditation, visualization, music therapy, and nutritional counseling.
One side effect of chemotherapy can be hair loss. MSK offers scalp cooling to help minimize hair loss. Learn more about scalp cooling, or ask your care team for more information.
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Questions To Ask The Doctor
- Do you know the stage of the cancer?
- If not, how and when will you find out the stage of the cancer?
- Would you explain to me what the stage means in my case?
- Based on the stage of the cancer, how long do you think Ill live?
- Do you know if my cancer has any of these proteins: estrogen receptor, progesterone receptor, or the HER2 protein?
- What does it mean if my cancer has any of these proteins?
- What will happen next?
There are many ways to treat breast cancer.
Surgery and radiation are used to treat cancer in a specific part of the body . They do not affect the rest of the body.
Chemotherapy, hormone treatment,;targeted therapy, and immunotherapy drugs go through the whole body. They can reach cancer cells almost anywhere in the body.
Doctors often use more than one;treatment for breast cancer. The treatment plan thats best for you will depend on:
- The cancer’s stage and grade
- If the cancer has specific proteins, like the HER2 protein or hormone receptors
- The chance that a type of treatment will cure the cancer or help in some way
- Your age
- Other health problems you have
- Your feelings about the treatment and the side effects that come with it
Limited Arm And Shoulder Movement
You might also have limited movement in your arm and shoulder after surgery. This is more common after ALND than SLNB. Your doctor may advise exercises to help keep you from having permanent problems .
Some women notice a rope-like structure that begins under the arm and can extend down toward the elbow. This is sometimes called axillary web syndrome or lymphatic cording. It is more common after ALND than SLNB. Symptoms may not appear for weeks or even months after surgery. It can cause pain and limit movement of the arm and shoulder. This often goes away without treatment, although some women may find physical therapy helpful.
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Treatment For Breast Cancer May Cause Side Effects
For information about side effects that begin during treatment for cancer, see our Side Effects page.
Some treatments for breast cancer may cause side effects that continue or appear months or years after treatment has ended. These are called late effects.
Late effects of radiation therapy are not common, but may include:
- Inflammation of the lung after radiation therapy to the breast, especially when chemotherapy is given at the same time.
- Arm lymphedema, especially when radiation therapy is given after lymph node dissection.
- In women younger than 45 years who receive radiation therapy to the chest wall after mastectomy, there may be a higher risk of developing breast cancer in the other breast.
Late effects of chemotherapy depend on the drugs used, but may include:
Late effects of targeted therapy with trastuzumab, lapatinib, or pertuzumab may include:
- Heart problems such as heart failure.
What Are The Chances Of Breast Cancer Recurrence After Treatment For Stage 2 Breast Cancer
In women who have breast-conserving treatment, the chance of recurrence is about 3-15% in 10 years, depending on tumor characteristics and margins. Distant recurrence in those who had mastectomy is most influenced by axillary lymph node involvement. When axillary lymph nodes are not cancerous, the recurrence rate is 6% in 5 years. When axillary lymph nodes are cancerous, the recurrence rate is 23% in 5 years with mastectomy but no radiation.
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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.
Can I Still Work While Receiving Chemotherapy Treatments For Breast Cancer
Yes. Most people are able to continue working while they are being treated with chemotherapy. You may have to adjust your work schedule while receiving chemotherapy, especially if you have side effects. It may be possible to schedule your treatments later in the day or right before the weekend so they don’t interfere as much with your work schedule.
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How Can A Genomic Oncotype Dx Test Be Helpful
Patients who have a small, estrogen receptor positive, HER2 receptor negative tumor and no evidence of cancer in their lymph nodes may benefit from an Oncotype DX genomic assay. This cutting-edge test looks deeper into breast;cancer cells to better identify people who may benefit from chemotherapy with ER+, HER2 breast cancers. The results of this test can also confirm that only hormonal therapy will be needed. Our video lesson on Genomic Assays provides much more detail about these advances in breast cancer care.
- You will find well-organized guides on breast cancer treatment by stage. Follow the prompts to breast cancer and then stage in the dropdown menus. The NCCN is a consortium of organizations and governmental agencies to promote quality breast cancer care.
- Their section on Chemotherapy is comprehensive and has great detail . The American Society of Clinical Oncologists is a leading organization of clinicians who care for people with cancer.
An outline of Chemotherapy for Breast Cancer is provided . The American Cancer Society is an organization that supports patients with cancer and funds research for cancer of all types.
Teaching everyone to be an expert in their own breast cancer care.
All information is designed to help patients engage their physicians in discussions about treatment options. No professional services or specific care recommendations are intended or offered.
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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Certain Factors Affect Prognosis And Treatment Options
The prognosis and treatment options depend on the following:
- The stage of the cancer .
- The type of breast cancer.
- Estrogen receptor and progesterone receptor levels in the tumor tissue.
- Human epidermal growth factor type 2 receptor levels in the tumor tissue.
- Whether the tumor tissue is triple negative .
- How fast the tumor is growing.
- How likely the tumor is to recur .
- A womans age, general health, and menopausal status .
- Whether the cancer has just been diagnosed or has recurred .
Ajcc Pathological Prognostic Stage Groups
The Pathological Prognostic Stage applies to patients with invasive breast cancer initially treated with surgery. It includes all information used for clinical staging, surgical findings, and pathological findings following surgery to remove the tumor. Pathological Prognostic Stage is not used for patients treated with neoadjuvant therapy before surgery to remove the tumor.
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Time To Chemotherapy After Surgery
After surgery for early-stage breast cancer, many women also have adjuvant chemotherapy .
The period of time between surgery and chemotherapy depends somewhat on how well someone does with surgery since the surgical site needs to be relatively well-healed before chemotherapy begins. But once the incision are healed, what is the optimal time to begin this treatment?
Targeted Therapy For Breast Cancer
Targeted therapy refers to a variety of drugs that enter the bloodstream and treat cancer throughout the body. Targeted therapy drugs aim to attack cancer cells without harming healthy cells, and tend to have fewer side effects than chemotherapy drugs.
Targeted therapies are often used to treat HER2-positive breast cancers. These are cancers that have an excess of a protein called HER2 that promotes the growth of cancer cells.
Common targeted therapy drugs for HER2-positive breast cancers include:
- Monoclonal antibodies like trastuzumab are synthetic antibodies designed to attach to HER2 proteins and stop cells from growing.
- Antibody-drug conjugates like ado-trastuzumab emtansine attach to HER2 proteins on cancer cells and help chemotherapy reach them.
- Kinase inhibitors like Lapatinib block HER2 proteins.
Targeted therapies are also used to treat hormone receptor-positive breast cancer along with hormone therapy.
Common targeted therapy drugs for people with hormone receptor-positive cancers include:
- CDK4/6 inhibitors, which block CDK proteins in cancer cells to stop them from dividing and slow cancer growth.
- mTOR inhibitors, which block mTOR proteins in cancer cells to stop them from dividing and growing. This treatment is believed to help hormone therapy drugs work more efficiently.
- PI3K inhibitors, which block the PI3K proteins in cancer cells and helps prevent them from growing.
Common targeted therapy drugs for people with TNBC include:
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