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Cancer treatments

Over the recent years, the number of breast cancer treatments has dramatically increased, providing new hope for this common cancer.  In the past, people who were diagnosed with breast cancer only had a few treatments available to them. Today, there are so many treatments available that patients have options in determining the best method of treatment for them. 

Types of cancer treatment

There are three broad types of cancer treatments, all being available at each stage of breast cancer.  Local and regional breast cancer treatments concentrate therapy on the areas of the breasts and surrounding tissues, such as the lymph nodes.  This can include:

  • biopsy
  • lumpectomy
  • mastectomy

If the breast cancer has spread (metastasized), local cancer treatments may involve other parts of the body such as the bones, lungs, or other organs. 

The second broad category of cancer treatments include systemic treatments directed at the whole body, instead of just one targeted area.  Examples of systemic cancer treatments include:

  • radiation
  • chemotherapy
  • hormonal therapy

Because these cancer treatments affect the whole body, they can produce side effects including hair loss, and other symptoms.  In many cases, these side effects are resolved once treatment is completed.

The third area of cancer treatment is holistic and complementary therapy. These cancer treatments address the body, mind, and spirit, including:

  • acupuncture
  • herbal medicine
  • supplements
  • massage therapy
  • essential oils
  • other alternative therapies

While every patient has some degree of choice when it comes to cancer treatments, there is a standard course of treatment or common pathway that most treatments take.  Most cancer treatments begin with surgery to remove the cancerous tissues in the body.  The extent and type of surgical procedure used will depend on the stage of the breast cancer and the preference of the patient and her physician.

Chemotherapy

Chemotherapy is a cancer treatment using a combination of drugs in order to destroy certain cancer cells in tumors or ones that may have spread to other parts of the body. Chemotherapy is known as a systemic treatment because it is a type of treatment that affects the entire body. Chemotherapy is used when there is the possibility that cancer cells remain in the body even after other types of treatment have been performed.

Chemotherapy that is given in combination with surgeries or radiotherapy is known as adjuvant chemotherapy. Most adjuvant chemotherapy is given after surgery or radiotherapy a month or so after the patient has recovered.

Chemotherapy is often given when the cancer is seen to be unusually aggressive. Chemotherapy can be given when:

  • cancer is found in the lymph nodes
  • the tumor is particularly large
  • the cells are dividing at a high rate

Most breast cancer patients will also have the drug therapy if their cancer has a high risk of spreading to other parts of the body.

Chemotherapy for breast cancer is given as a treatment in three or four week intervals during a period of four to six months. Most chemotherapy that necessitates hospital visits consists of IV infusions that are given on an outpatient basis. Therapy is varied and depends on several factors including the severity of the cancer, the rate of division, or the patient's general health.

Most people experience some side effects from chemotherapy. Side effects occur because the attacking mechanisms in the chemotherapy drugs do not discriminate in the different cells that they affect. This means that many normal cells are affected as well. Common side effects include:

  • nausea
  • vomiting
  • diarrhea
  • sore mouth or ulcers  
  • hair loss or thinning

Other side effects may also occur. Most side effects can be controlled to a certain extent. Hair loss or thinning can usually come back after chemotherapy treatment is completed. All cases of chemotherapy are undergone because the treatment's beneficial results greatly outweigh side effects.

Herceptin

The U.S. Food and Drug Administration approved Herceptin for treating advanced or metastatic breast cancer in September 1998. Herceptin was fast tracked for admittance for use in early stage breast cancer in the European market in early October 2005. The drug is given intravenously and is primarily used in patients who have had little success with radiation therapy. Herceptin is also used as a first line cancer-fighting agent in patients with metastatic disease.

Herceptin is a bioengineered antibody made from antibodies found in mice. The antibody was shaped to be more in line with human antibodies. When used effectively, Herceptin can target cancer cells and inhibit the growth of tumors. The drug has recently been seen to be effective in blocking the protein HER-2 that is responsible for about one-third of all breast cancer cases.  The HER-2 protein block would then stop cancer cells from growing, and improves the immune system of women with the disease.

Herceptin's use in early stage breast cancer is seen to be highly effective. Preliminary studies have shown that its use can cut the growth of highly aggressive cancerous tumors by half if used in early stage breast cancer.

The use of Herceptin may result in some serious side effects. Women with heart related problems might not be eligible for Herceptin treatment because the drug can weaken the heart muscle, leading to congestive heart failure. This side effect was most often seen in patients who had Herceptin combined with chemotherapy and other drugs.

Hormonal therapy

Hormonal therapy for breast cancer works on a simple theory. Because breast cancer growth can expand and quicken with naturally occurring hormones in the body, stopping or reducing these hormones will decrease the incidence of breast cancer.

Similar to other methods of treating cancer like chemotherapy, hormonal therapy for breast cancer works by sending agents into the bloodstream in order to attack and kill cancer cells.  Reducing or ceasing hormone production results in a cessation of cancer cell growth in certain women.

In order to be a candidate for hormonal therapy the patient must have cancer that is estrogen-positive, meaning that estrogen causes it to grow and spread. Hormonal therapy can also be applied after other treatments take place.  Hormonal therapy can insure that the recurrence of breast cancer gets reduced and can help in preventing additional cancers in the future.

The most popular method of hormonal therapy has been tamoxifen. Tamoxifen is a medication that inhibits estrogen growth. The drug is taken daily usually for a five-year period. Newer studies show that tamoxifen may be even more effective when used in combination with other hormonal therapy drugs.

Lumpectomy

Lumpectomy is a conservative breast cancer treatment in which the tumor and a small amount of surrounding tissue are surgically removed. A lumpectomy is also called wide excision biopsy, or breast conserving therapy. It is called the latter because lumpectomy allows women to maintain most of their breast after surgery. Mastectomy, on the other hand, is the surgical removal of the entire breast and, often, surrounding structures.

Lumpectomy is often performed on women with localized breast cancer and may be suitable for women with breast cancer in situ, and stages I, II, and III breast cancers. Studies have found that for a majority of these women, lumpectomy followed by radiation therapy provides an equal breast cancer survival rate as mastectomy.

During a lumpectomy, the surgeon will remove the abnormal tissues and a small margin of surrounding tissue. After the lumpectomy, a pathologist will test the excised tissues to ensure that all of the cancerous tissues were removed. This is done by checking to see if the edges of the tissue are all "clear" or free of anomalies.

A preliminary test can be done during a lumpectomy procedure to determine if all the abnormal tissues have been removed. Only a later pathological test can confirm that all the tissues were removed. If the outer tissues contain abnormal cells, additional surgery may be required to remove these tissues.

Some patients with breast cancer may not be good candidates for lumpectomy cancer treatment.  The followings may be poor candidates for lumpectomy:

  • those who have previously underwent radiation therapy for breast or chest
  • those who had a lumpectomy that did not remove the entire tumor
  • those with more than one tumor in the breast
  • patients with connective tissue disease
  • women who would be pregnant at the time of radiation therapy
  • patients with a tumor larger than two inches in circumference
  • women with a large tumor in respect to breast size

Mastectomy

A mastectomy is the complete removal of one or both breasts, usually in order to combat the spread of breast cancer. Prophylactic mastectomies, those done without evidence of breast cancer, have a success rate of stopping the cancer in 90% of cases.  Most mastectomies are successful in some degree, especially when the breast cancer is detected before the carcinoma carrying cells spread to other body parts.

The process for mastectomy possibility includes having a biopsy done to determine the extent of the spread of the cancer. The tumor and surrounding tissue is taken out and the surrounding tissue is tested for cancer cells. If the cancer is detected and has spread then mastectomy becomes a possible treatment option. Recent advancements in breast cancer procedures have resulted in a decrease in mastectomy operations. However the success rate of the mastectomy is still a draw for many patients.

A bilateral prophylactic mastectomy is a double breast mastectomy, which is done even without evidence of cancer.  This type of surgery is usually performed in women who are at a very high risk of developing breast cancer, but signs of the disease have not appeared yet.  Mastectomies may also be performed if a patient has already had breast cancer and it had been taken out. Women with past histories of breast cancer have a higher rate of developing the disease again.

Another type of mastectomy is known as "simple" or "total." In this type of mastectomy the removal of the breast does not include removal of the lymph nodes. Lymph nodes are located in the underarm area. Breast cancer that has spread to other parts of the body usually is detected first in the lymph nodes. Total mastectomies occur when the evidence of cancer in the breast tissue is apparent, or may also occur for prophylactic reasons.

A radical mastectomy involves the removal of the breast and the lymph nodes. Certain muscles under the breast are also removed in radical mastectomies.  Radical mastectomy is a severe surgery, because it involves so much tissue removal. This type of mastectomy is performed only in rare cases where the cancer has spread to the lymph nodes and other nearby areas.

Radiation Therapy

Radiation therapy is a type of surgical procedure that uses high-powered rays in order to keep cancer cells from spreading.  Radiation therapy is commonly utilized in getting rid of dead or additional cancer cells that may be lingering in the tissue of the breast after other types of surgery.  Radiation therapy is used on about half of all cancer patients.

Radiation therapy may also be effective in shrinking tumors. In women with early stage breast cancer, radiation may be used after lumps have been taken out. During these common lumpectomies the cancerous breast lump and some of the surrounding tissue is surgically removed. 

The surgery, known as breast-conserving therapy, is usually followed by a couple of months of radiation therapy. The additional radiation therapy is used to:

  • ensure that the cancer cells are completely eradicated and do not re-grow
  • killing cancer cells following mastectomy
  • shrinking the tumors of women who have advanced breast cancer

The two types of radiation therapy are external and internal. External radiation therapy is the most common method and involves a machine that shoots radiation into the body.  Internal radiation therapy occurs with implantable devices near the tumor and usually requires hospital stays.

External radiation treatments take place on an outpatient basis. External radiation therapy may occur as frequently as five times a week for two months. The treatment takes about half an hour.

Side effects of external radiation therapy most often include:

  • some amount of fatigue
  • reduction of white blood cells
  • breast tenderness
  • reddened appearance of the breast
  • loss of appetite

Internal radiation therapy is still an experimental type of treatment for breast cancer.  Surgical implants of small plastic tubes are placed in the breast that feed pellets of radioactive substances into the surrounding tissue.  There is very little occurrence of side effects with internal radiation therapy, though it is not a common form of treatment for breast cancer.

While experimentation continues and research uncovers further information about breast cancer, the best course of action happens with early detection. Seeing a doctor and performing frequent breast exams are both key in stopping potential cases of breast cancer.

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