Breast Cancer Treatment
With early detection and treatment breast cancer survival rates have improved significantly. In fact, some physicians are calling Stage 0 and Stage 1 breast cancer curable. The survival rates appear to be close to 100% for 10 years for both the early stages.
After breast cancer has been detected, diagnosed and staged treatment is begun. There are several options that physicians have and use, depending upon many factors.
The doctor and cancer team will consider your general state of health, the stage of the disease, the histology (or cell type) of the cancer, and the position/location of the primary breast cancer tumor.
During breast cancer treatment you may here terms that are confusing. When your physician mentions a cure they mean when there is no remaining evidence of the cancer for a defined period of time (specific to your cell type). However, in breast cancer, recurrence can happen up to 30 years later.
The response rate for a given treatment is the measure of the treatments effectiveness. The measurement is usually done with a computed tomography (CT) or x-ray studies. Complete response means no evidence of the tumor is detected; partial is more than a 50% decrease; minor is less than a 50% decrease and stable is no measurable decrease or increase in the size of the tumor during treatment.
The clinical benefit of a therapy encompasses complete and partial responders to therapies as well as those who had minor and stable disease. This measurement rate is being used in clinical trials and research. Both the response rate and the clinical benefit rate give an estimate of the likelihood of a benefit to a specific therapy. The disease progression indicates that the cancer continues to grow despite therapy.
For every stage breast cancer treatment can be considered in three broad categories. Local treatment is directed to the breast and lymph nodes around the breast. Regional refers to the nodes in the region surrounding the breast. Systemic treatments are aimed at the whole body or the system. Alternative and holistic therapies are directed to the whole person, not just the body but the mind and spirit as well.
Initial diagnosis of the breast cancer can involve surgery which may be diagnostic or diagnostic AND therapeutic at the same time. In the case of a fine needle biopsy or core biopsy the surgeon is looking for the tissue type and histology that will confirm or rule out the diagnosis of breast cancer. The initial surgery may be also therapeutic when all of the tumor is removed during the diagnosis. At this time no further surgery will be necessary. This surgery can be a lumpectomy where the lump itself and surrounding tissue are removed or a mastectomy, which involves the removal of the entire breast when the physician and patient are sure from other markers that the tumor is invasive breast cancer.
Both options are considered effective for women whose tumor measures 4 cm or less. Most physicians would rather remove the entire breast tissue which is interconnected with ducts and lobules and which provides a system for cancer growth. Using the non-standard lumpectomy the doctor will recommend radiation and close observation using mammography and physical examination.
If a lumpectomy is used for breast cancer treatment the cancer team may use certain criteria to avoid a complete mastectomy. If the cell formation is low grade, the tumor completed removed and the removed tissue has wide and clear margins of resection without tumor growth the lumpectomy maybe the last surgical option for breast cancer treatment of that breast cancer growth.
During breast cancer treatment the cancer team will make recommendations to treat the possible cancer cells in the lymph nodes beneath the arm or chest wall. If cancer was present in the lymph nodes that are removed during surgery radiation is considered for the remainder of the lymph nodes. Breast cancer treatment will also include systemic therapy, which may be considered an insurance policy to address any cells that may have spread throughout the body and begun growing.
The decisions about systemic therapy will be made on the histology report of the cancer itself. If the cancer is aggressive the treatment will be different than if the cell type is more moderate. Systemic therapy can include hormone therapy, chemotherapy, anti-angiogenesis and immune therapy.
Hormonal breast cancer treatments are aimed at the cancer cells that are receptive to estrogen, or use the estrogen in the body to promote growth of the cancer cells. Medication is used to reduce or eliminate the estrogen in the body that can potentially feed a new cancer growth.
Chemotherapy is medication given by IV, injection or pill that enters the bloodstream and is directed to destroy rapidly growing cells (cancer) as well as interfering with the ability of the cancer cells to reproduce.
Immune therapy is relatively new and attempts to use or imitate the body’s own defense mechanism to fight the disease and defeat the cancer. The goal is to stimulate the defenses to block or counterattack the cancer cell activity.
Anti-angiogenesis therapy attempts to stop the growth of the new blood vessels that bring nutrients and oxygen to the cancer cells. The goal is to starve the tumor it needs to survive. At this time these drugs are used in clinical trials and research on a limited basis.
Which of the regimens works best for you is an individual equation depending upon testing of the tumor, your genetics and the response of the cancer to treatment. Longer or more aggressive breast cancer treatment is not necessarily better since there are side effects to long-term chemotherapy that includes secondary cancers. Decisions about taking systemic breast cancer treatment, when to switch to another, whether you take the therapy before or after surgery, if you receive radiation – are all dependent on your individual cancer factors and these decisions may change over time as your cancer adapts to the treatments that are being given.
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