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All about breast cancer types of breast cancer risk factors for breast cancer breast cancer symptoms breast cancer diagnosis stages of breast cancer causes of breast cancer breast cancer treatment side effects of breast cancer treatment breast cancer surgery chemotherapy for breast cancer radiation therapy for breast cancer hormone therapy for breast cancer breast cancer medications breast cancer prevention

What treatments are available to cure breast cancer?

Treatment for breast cancer almost always begins with a decision about the type of surgery. Apart from removal of the tumor itself, operations may be performed to improve the appearance of the chest after breast surgery, to discover whether or not cancer has spread to the lymph nodes, or to relieve some of the symptoms of late-stage disease.

The most recent trend in breast cancer surgery is the use of breast-saving lumpectomy (removal of the tumor and its margins) plus radiation therapy for the treatment of early breast cancer. This method has been found to be as effective as mastectomy (complete removal of the breast), while sparing the breast.

In addition, sentinel lymph node biopsy - a more exacting, less invasive form of lymph node biopsy - is becoming an acceptable alternative to axillary (armpit) dissection during surgical staging. Lumpectomy removes the cancer, a surrounding border of cancer-free tissue (roughly 3/4 in), and the nearby lymph nodes. Lumpectomy is, by definition, a form of breast-conserving surgery (BCS). Partial mastectomy is a non-specific term for surgery in which part of the breast is removed. If the tumor is located in the upper breast, the incision often is made in a curved line, close to the areola (dark, circular area around the nipple). If the tumor is located in the outer breast near the armpit, the tumor and nearby lymph nodes may be taken out through the same incision. If the tumor is located in the lower breast, the surgeon usually makes a radial incision (one that extends from the center of the breast outward towards the edges). The axillary (underarm) lymph nodes are removed through the original incision or via a separate incision in the armpit itself. In general, between 10 and 15 lymph nodes are removed during partial mastectomy.

Radiation therapy, sometimes called radiotherapy, almost always is recommended after lumpectomy to destroy any cancer cells left behind and to prevent the cancer from returning. Without radiation therapy, the odds of the cancer returning increase by about 25 percent. Radiation therapy is used as a local adjuvant treatment in patients having a lumpectomy. It is also used, sometimes, after a mastectomy for women with large cancer tumors or with four or more positive lymph nodes; or when the margins of resection are involved with cancer. Such treatment can help destroy breast cancer cells that may have been left behind in the area where the breast had been (this area is called the "chest wall"). Such treatment helps to eliminate any cancer cells that may remain in the breast. Radiotherapy is used to prevent local recurrence (regrowth of breast cancer at the original site) and to avoid the need for mastectomy. Recent follow-up studies indicate that women who undergo lumpectomy with radiotherapy survive as long as women who undergo mastectomy. Unfortunately, women who develop a local recurrence usually require mastectomy, because a cancerous breast cannot be irradiated twice without damaging side effects (for example, death of normal breast tissue, skin ulceration, or radiation-induced cancer).

The need for chemotherapy depends on how much the cancer has spread. In some cases, chemotherapy will be recommended before surgery to shrink a large tumor so that it can be removed more easily. Chemotherapy involves a combination of anticancer drugs. These drugs are powerful and can have many side effects. Anticancer drugs are given by mouth or by injection into a blood vessel. Either way, the drugs enter the bloodstream and travel throughout the body. Chemotherapy is given in cycles: a treatment period followed by a recovery period, then another treatment period, and so on. Most patients receive treatment in an outpatient part of the hospital or at the doctor's office. Adjuvant chemotherapy usually lasts for three to six months. Chemotherapy is almost always necessary if cancer recurs. A form of chemotherapy called hormonal chemotherapy usually is recommended when the pathology report shows that the cancer is estrogen-receptor positive. In hormonal chemotherapy, the drug tamoxifen (Nolvadex) is taken daily, by mouth, for two to five years. Tamoxifen locks estrogen out of breast cancer cells that are estrogen-receptor positive, which may reduce the cancer recurrence rate by up to 30 percent.

In the past, precancerous DCIS was treated as if it were breast cancer, but now it appears that less aggressive treatments may be equally effective. Though mastectomy sometimes still is done for DCIS, lumpectomy with radiation also is commonly done. In some women, lumpectomy without radiation also may be effective. Because LCIS itself doesn't lead to cancer, no treatment is required, but women with this condition should have regular mammograms and breast exams by a physician.

Hormone therapy deprives cancer cells of the female hormone estrogen, which some breast cancer cells need to grow. For many women, hormone therapy is treatment with the drug tamoxifen, or, for postmenopausal women, an aromatase inhibitor, such as anastrozole (Arimidex) and letrozole (Femara). Some premenopausal patients may have surgery to remove their ovaries, which are a woman's main source of estrogen. Or they may be treated with a medication to reduce ovarian function. Like anticancer drugs, tamoxifen and the aromatase inhibitors are taken once a day by pill and are absorbed into the bloodstream. Most women take hormone therapy for five years. Two studies confirmed benefits for breast cancer patients taking adjuvant tamoxifen for five years, but saw no added benefit and noted potentially negative effects for patients taking tamoxifen longer than five years.

Breast implants (artificial cushions that are filled with a soft, breast-like substance - usually saline [salt water] or gel) have been used extensively for breast reconstruction. Breast implants are not placed under the skin, but rather are inserted under the pectoral (chest) muscle in a surgically-made pouch. Sometimes the chest muscle must be pre-stretched by a temporary device before placement of the permanent implant.

The major advantage of using an implant is that it can be inserted easily and quickly. The disadvantages are the continual risk of implant failure in the form of infection, rupture, breakdown, capsular contraction (tissue hardening around an implant), and the need for tissue pre-stretching. The lifespan of implants beyond 10 to 20 years is still unknown, as is the relationship - if any - to autoimmune disease. For these reasons, the use of the woman's own tissue has become the method of choice for breast reconstruction. Specifically, surgeons have begun to use skin and fat from elsewhere in the woman's body (e.g., the abdomen) to create a more natural-looking breast.

More information on breast cancer

What is breast cancer? - Breast cancer is cancer of breast tissue. Breast cancer starts in the cells of the breast. Breast tissue covers a larger area than just the breast.
What types of breast cancer are there? - Breast cancer is a type of uncontrolled growth of abnormal cells that can develop in one of several different areas of the breast.
What're the risk factors for breast cancer? - Risk factors for breast cancer include age, geographical variation, reproductive factors, inherited risk, previous breast disease.
What're the symptoms of breast cancer? - Symptoms of breast cancer include breast lump, breast discharge, nipple inversion, or changes in the skin overlying the breast.
How is breast cancer diagnosed? - The mainstay of breast cancer diagnosis is the triad of clinical history, physical examination and imaging (mammography or ultrasound).
What're the stages of breast cancer? - The stages of breast cancer depends on its size and the extent to which it has spread to other parts of the body.
What causes breast cancer? - The exact cause or causes of breast cancer remain unknown. Hormonal influences play a role in the development of breast cancer.
What're the treatments for breast cancer? - Treatment for breast cancer begins with a decision about the type of surgery. Breast implants is used for breast reconstruction.
What're the side effects of breast cancer treatment? - The type and extent of breast cancer treatment side effects vary depending on the particular treatment involved, its duration, and its dose.
How is breast cancer treated with surgery? - Surgery is the mainstay of therapy for breast cancer. A breast biopsy is the removal of breast tissue for examination by a pathologist.
What's the chemotherapy for breast care? - Chemotherapy is the use of anti-cancer drugs to treat cancerous cells. Chemotherapy involves being given a combination of anti-cancer medicines.
What's the radiation therapy for breast cancer? - Radiation therapy is often used to destroy any remaining breast cancer cells in the breast, chest wall, or axilla (underarm) area after surgery.
What's the hormone therapy for breast cancer? - Most breast cancer is sensitive to the female hormone oestrogen. Megestrol acetate is used for hormone treatment of advanced breast cancer.
What breast cancer medications are available? - Medications to treat breast cancer include selective estrogen-receptor modulators, aromatase inhibitors, biologic response modifiers.
Can breast cancer be prevented? - There is no known way to prevent breast cancer. But several preventive measures can be take to reduce risk of breast cancer.
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