How is breast cancer treated?
The most common and recommended treatment for non-metastasized breast cancer is surgery. Extremely small tumours in older patients may be treated with active surveillance. Active surveillance does not treat the cancer but relies on regular diagnostic tests. If the tumour then begins to show signs of growth or activity, systemic therapies or surgery can be planned.
As with many types of cancer, surgery alone can be curative. However, breast cancer is usually treated with a combination of surgery, hormonal therapy, chemotherapy, and radiotherapy to lower the risk of recurrence. Immunotherapy and targeted therapies can also be used to slow down the progression of cancer that does not adequately respond to other treatment methods or to target certain cell types on a personalised basis. These treatment methods will be discussed in more detail further on.
Why do I need breast cancer treatment?
Treatment is necessary for any type of cancer to try to prevent cancerous cells from travelling to other organs via the surrounding blood and lymph vessels. When treated at an early to mid-stage, breast cancer can be cured; even advanced breast cancer can be kept under control for long periods of time with rapidly increasing treatment options. New therapies and procedures are continuously increasing longer-term breast cancer survival rates.
How do I prepare for breast cancer treatment? What can I expect?
Approximately 2 to 4 weeks before surgical cancer treatment or other therapy pathways you will be asked to supply the results of your blood tests and copies of any diagnostic and imaging results (ultrasound, CT, MRI, biopsy and/or PET). This means we can see how your breast cancer is progressing and will help us to advise the best treatment options. We will also need any information regarding medication use, other illnesses or disorders and your overall state of health.
You will need to undergo an MRI, PET or CT scan and possibly a bone scan – if these have not yet taken place - which will help us to see if cancer has spread to other organs.
Approximately 2 weeks before your treatment you will need to ask your home doctor to take blood for a preoperative or pre-treatment blood test. Remedazo will inform you well beforehand which tests your doctor will need to take blood for. For some procedures, blood-thinning and other medications will need to be temporarily stopped, others do not. Our or your own doctor will advise you what to do.
Breast cancer treatment
The information below covers all available treatments for breast cancer at Remedazo. If you would like information on any therapy not covered in this section, please do not hesitate to contact us.
Surgical breast cancer treatment
When the results of a biopsy are positive for breast cancer and this cancer has not spread to areas far from the original tumour, surgical removal is the first-line treatment. While surgeons used to remove the entire breast to ‘be sure’ of removing all the cancer, this is no longer the recommended procedure; the majority of surgeons will remove the lump and any affected lymph nodes. They will also send tissue samples for immediate testing while you are still asleep to check that they have removed all detectable cancer cells. This is why breast cancer surgery can sometimes take 2 to 3 hours, as each time a sample is sent to the pathologist the surgeon must wait for 30 to 45 minutes for the results.
Lumpectomy
Also known as breast-conserving surgery, this procedure involves the removal of a lump and its surrounding tissue rather than the entire breast. A number of lymph nodes may also be removed and tested. Removal of one or more regional lymph nodes is known as a sentinel lymph node biopsy. This surgery requires a lighter general anaesthetic that does not paralyse the muscles; this means your time in the recovery ward after surgery will probably not exceed 1 hour. Similarly, hospital stays rarely exceed 48 hours. Remedazo goes above and beyond standard aftercare protocols by providing strict monitoring for at least 24 hours after every breast cancer surgery. This is rarely considered necessary by many medical institutions but Remedazo chooses to exceed, rather than meet, current standards at all times. For small, easily accessible breast tumours, this procedure may be carried out under a local anaesthetic. You can discuss your options during your free Second Opinion.
Most lumpectomy procedures for breast cancer (not benign cysts) require postoperative radiation therapy after you have recovered from the surgery. Sessions usually begin within 1 to 2 weeks after the lumpectomy procedure and radiation treatments are given over the course of the next 6 weeks. Lumpectomy and subsequent radiation therapy provides comparable results to mastectomy and often avoids later considerations for reconstructive breast surgery.
Mastectomy
Mastectomy is the removal of the entire breast and usually one or more axillary lymph nodes. This procedure is performed under a general anaesthetic. In a small number of cases, reconstructive breast surgery can be carried out at the same time but significantly lengthens the operation time. In general, a mastectomy procedure takes between 1 to 3 hours depending on how many lymph nodes need to be removed. Recovery times from this type of surgery are rapid; you will be able to leave the hospital within 1 to 2 days. If you are able to combine reconstructive breast surgery with mastectomy, expect a procedure to last between 3 and 8 hours, 1 night in a medium care ward and a further 2 to 3 days in hospital.
Mastectomy procedures are only carried out when radiation therapy is not possible (due to pregnancy or earlier radiation therapy on the same breast), when multiple tumours are present or if a patient requests mastectomy as a preventive measure (a prophylactic mastectomy). However, it is still possible that your oncologist will recommend a full course of radiotherapy after mastectomy.
Nipple-sparing mastectomy, total mastectomy or radical mastectomy are subcategories of breast removal surgery. As the name suggests, the nipple-sparing mastectomy preserves the nipple but removes all of the breast tissue. Either during the same procedure (immediate) or at a later stage (delayed), a breast implant can be inserted to preserve your natural silhouette. The total mastectomy procedure removes the breast and nipple and sometimes lymph nodes very close to the breast tissue. No muscle tissue is removed. This is the operation of choice for women who opt for prophylactic mastectomy. The radical mastectomy removes all breast tissue and axillary lymph nodes. While the muscles under the breast used to be removed, this is no longer considered necessary.
When speaking with your selected surgeon for the first time, he or she may discuss different lymph node removal techniques. The most common lymph nodes affected by breast cancer are the internal mammary nodes and the axillary nodes. Some patients prefer to have more lymph nodes removed than may be necessary but many surgeons prefer to remove only the sentinel nodes. These are the lymph nodes that lie closest to the area of cancer and the ones most likely to be affected by travelling cancer cells. During surgery, these lymph nodes are removed and sent immediately to the pathology department. If they are free of cancer cells, there is no need to remove more lymph nodes during this single operation. If they do contain cancer cells, the surgeon can remove the next closest-lying group and test those. This happens during a single operation. Removing too many lymph nodes can mean that fluids do not drain well and lymphedema can occur. This may lead to swelling of the arm on the side of the operated breast as the lymph fluids have less channels to travel through.
You can also talk to expert plastic surgeons during a free Second Opinion online appointment to discover whether immediate or delayed breast reconstruction surgery is the best option for you.
Peri-operative breast cancer surgery care
You will be admitted to your chosen clinic on the day of the procedure. Certain people such as those with a very high BMI, breathing difficulties, diabetes or other chronic illnesses usually benefit from spending the night before the operation in a hospital setting.
From midnight of the day before your surgery, you will be asked to refrain from eating. Undigested stomach contents can create serious complications during general anaesthesia. Smokers should stop smoking at least one week before surgery; stopping smoking beforehand improves oxygen levels throughout the body. Between midnight and six hours before anaesthesia you may only drink water or clear liquids. You are not permitted to eat, drink or smoke in the six hours preceding anaesthesia. Failure to comply may mean the anaesthesiologist and surgeon will be forced to postpone your procedure. This is purely for your own safety. It is possible to brush your teeth during this period but no water may be swallowed. In certain circumstances, medical staff will administer oral medications with a little water. This is administered under the advice of the anaesthesiologist and is therefore permitted. If your lumpectomy is planned to proceed under local anaesthetic, you might still be asked to refrain from eating or drinking before surgery. This means that if you find the surgery or situation too uncomfortable, the anaesthetist has the option to use a light form of general anaesthesia to increase your comfort.
Approximately thirty minutes before the planned procedure time you will be collected from your room and brought to the surgical department either in your bed, on a gurney, in a wheelchair or on foot.
Preoperative breast cancer surgery preparation requires:
An intravenous line
A blood pressure cuff placed on the upper arm
The completely painless placement of electrodes to the chest to measure heart activity
A finger or ear sensor to measure oxygen levels in the blood
A general anaesthetic (perhaps a local anaesthetic for small, easily accessible tumours)
If breast reconstructive surgery is planned to coincide with mastectomy surgery, additional monitoring is required. This will include an arterial catheter and a second intravenous line, a thermometer and a urinary catheter.
At the surgeon’s signal, you will be anaesthetised.
What happens after breast cancer surgery? What can I expect?
You will be woken by the anaesthesiologist immediately after surgery and transported from the operating theatre to the recovery room. Here you will be carefully monitored. All patients remain in the recovery ward until they are fully responsive and any pain is well under control. If you have undergone a lumpectomy under local anaesthetic, you can return to a general ward immediately and return to your chosen accommodation the same day.
When the anaesthesiologist is satisfied you are fully awake and comfortable you will be brought to a surgical ward. Pain medication is given as standard but breast surgery pain, even for radical mastectomy procedures, is easy to control.
Your intravenous catheter will continue to administer fluids for up to 24 hours and your drain will be removed by a trained nurse or doctor within 2 days.
The majority of breast cancer patients are out of bed within 8 hours of exiting the recovery room. Average hospital stays range from 1 to 2 days. Upon discharge from hospital you will be transported to your accommodation and supported by your personal Remedazo team until you have safely and comfortably returned home or have completed further treatment. You will be able to travel within 2 days after discharge. We advise you to wear compression stockings when travelling.
Long-term postoperative care includes the removal of stitches after 5 to 8 days. This can be done by your general practitioner at home if you are not attending further treatment sessions. Full recovery from breast surgery only requires a few days to 2 weeks. Further radiotherapy is prescribed after most lumpectomy and some mastectomy procedures.
Non-surgical breast cancer treatment
While many surgical procedures cure breast cancer, most oncologists recommend courses of non-surgical therapies to lower the risk of recurrence or kill cancer cells that may have been left behind. The most common non-surgical treatment for invasive and non-invasive breast cancer is radiotherapy.
Nonsurgical treatments are also offered to those unable to undergo surgery due to low overall levels of health or those who need to keep metastatic or potentially recurring breast cancer under control. These treatments include radiofrequency ablation of very localised non-invasive and small breast tumours that destroys cancer cells using electrical current and is an outpatient procedure that may need to be repeated. Another option is cryotherapy where, instead of electricity, low temperatures are applied directly to a tumour to freeze and kill the cancerous cells.
Breast cancer radiation therapy
Radiotherapy may be given before breast cancer surgery to shrink a larger, early-stage tumour (neo-adjuvant radiotherapy) or after surgery to reduce the risk of the cancer recurring (adjuvant radiotherapy).
Radiotherapy as a stand-alone cancer therapy was only previously considered in the treatment of inoperable breast cancer. Today, new chemo-radiotherapy combinations of approximately 25 radiotherapy treatments given over the course of 5 weeks with 2 cycles of chemotherapy at 3 week intervals has been known to cure invasive breast cancer, significantly shrink tumours and decelerate tumour growth.
Fractionated external beam radiation therapy (EBRT) is usually prescribed to prevent the growth of potentially remaining cancer cells after surgery. This therapy is given over the course of 3 to 7 weeks in low doses. More recently, stereotactic body radiation therapy (SBRT) has provided patients with a higher dose, shorter course of radiation therapy. If cancer has spread to the bone tissue (bone metastasis), patients may be offered radiopharmaceuticals. These are injected drugs that contain radioactive substances that settle in areas of damaged bone. Here, they emit radiation that kills cancer cells. These drugs also relieve bone pain caused by metastasis and can extend life.
External beam radiation therapy focuses beams of radiation into the affected area of breast tissue and requires short (10 to 30 minute) visits to the hospital 5 times a week for several weeks. Long-term stays with all accommodation, home nursing care, catering, transportation and follow ups can be seamlessly arranged by your Remedazo team.
EBRT is a painless treatment and recent technology now enables oncologists to be even more precise with dosage and range. Additional options such as three-dimensional conformal radiation therapy or 3D-CRT use computers to map the area that requires treatment and shape the radiation beams to avoid damaging non-cancerous tissues. The even more advanced intensity modulated radiation therapy (IMRT) machine moves around the patient, shapes the beams and adjusts radiation intensities. This may be done with built-in scanners (image guided radiation therapy or IGRT) or using a more rapid but not necessarily more effective technique called volumetric modulated arc therapy or VMAT. You will be able to discuss all of these alternatives with a Remedazo oncology specialist.
The side effects of radiation therapy often depend on its effects upon healthy tissues that are found close to the breast including major blood and lymph vessels, lungs and heart. In addition, radiation treatments can make you feel tired for weeks to months. At Remedazo, all associated information will be given upon or shortly after your consultation; you can then make an informed decision regarding the types of radiotherapy available to you.
Breast cancer chemotherapy
Early stage breast cancer is treated with surgery in combination with radiotherapy. Sometimes the choice is made to undergo a course of chemotherapy after surgery and before radiotherapy in breast cancer types that are expected to recur without this treatment. Chemotherapy may be given to shrink tumours prior to surgery, to treat cancer types with the potential to return, and also to destroy any cancer cells that may have been left behind after surgery. Some women may be able to opt for a lumpectomy instead of a mastectomy if they undergo a course of chemotherapy before surgery. Early stages of cancer can benefit from cytotoxic (cell-toxic) drugs such as epirubicin, methotrexate, carboplatin and capecitabine that are administered over the course of 3 to 6 months. Chemotherapy is given in cycles, giving you time to recover between treatments.
Where surgery is not indicated, chemotherapy is a primary breast cancer treatment usually supported by other non-surgical therapies, most of them listed within this section. Chemotherapy for metastatic breast cancer can include drugs such as ixabepilone, methotrexate, doxorubicin and cisplatin. Multiple cytotoxic (cell-toxic) combinations exist, all of which can be discussed with a Remedazo oncology specialist.
Chemotherapy drugs are administered intravenously via a portacath, PICC line or central venous catheter. Drug cycles usually last for 21 days and, depending on your type of cancer, may be repeated up to 6 times. This can mean up to 6 months of therapy with regular blood tests and follow ups of symptoms and side effects. Ask Remedazo for more information regarding longer-term stays where all of your physical, psychological and emotional needs are catered for during this stressful time. Alternatively, we can arrange similar accommodation and familiar, trusted team members for regular returns to your clinic of choice and cater for your accompanying family members or friends.
Breast cancer hormone (endocrine) therapy
As already discussed, most breast cancers can use oestrogen/or and progesterone to increase in size. Biopsy reports tell the oncologist whether cancer cells contain receptors for certain substances. If they do, stopping these substances from being used by cancer cells can slow or stop cancer growth. Hormonal therapy is not used for triple-negative cancer types.
Hormonal treatment is long-term therapy that needs to be taken for 5 to 10 years. These therapies lower the amount of oestrogen in the body or stop oestrogen from connecting with the cancer cells and encouraging them to grow.
The most well-known anti-oestrogen for breast cancer is tamoxifen. It stops oestrogen from connecting with cancer cells. The reason why tamoxifen is the drug of choice on a global scale is that it is selective and only blocks the action of oestrogen in the breast tissue, not in other organs that use oestrogen such as the bones and the womb.The same can be said for drugs such as onapristone – currently being tested in clinical trials - that prevent PR+ cancer cells from using progesterone. These drugs have a range of uses, from lowering risk, from stopping cancer from recurring, for slowing metastatic cancer and for shrinking tumours. Side effects are similar to those of the menopause. Using these treatments on hormone-responsive cancers should lower your Ki67 results as they stop cancer cells from moving into the multiplication stage.
Drugs that stop oestrogen from being produced in the body are another option. Most oestrogen is made in the ovaries. When the menopause stops oestrogen production in the ovaries, a small amount is still produced in fat tissue. This small amount can cause breast cancer in post-menopausal women. When this production is prevented through drugs such as letrozole or exemestane, breast cancer progression can be halted or slowed within this older age group. Younger women may also take these drugs but in combination with tamoxifen as a combination of drugs works more effectively.
Breast cancer in younger women can also be treated by temporarily stopping oestrogen production in the ovaries. Drugs include goserelin and leuprolide. Sometimes surgery to remove the ovaries is recommended. The woman will then enter the menopause.
Breast cancer immunotherapy
Checkpoint inhibitors allow your immune system to respond to the presence of specific cancer cells and attack them. This response is often absent during tumour growth. It has been shown that some advanced breast cancers respond well to immunotherapy treatment but this certainly does not apply to all. Ask about immunotherapy options during your free Second Opinion.
Drugs such as atezolizumab block the activity of a protein that prevents your immune cells from recognizing and attacking inflamed tissues and cancer cells. Atezolizumab in combination with chemotherapy has recently been approved for the treatment of triple-negative metastatic breast cancer. Oncologists partnered with Remedazo are renowned for their knowledge of the most recent clinical studies and research pertaining to effective and new cancer-fighting drugs.
Each intravenous immunotherapy treatment requires at least a 2 hour stay in a clinical setting and should be repeated every 2 to 3 weeks. Immunotherapy has been shown to increase survival times in metastasised cancer; however, it is rarely offered before other types of therapy have been tried. This may change as research continues.
The side effects of immunotherapy are many and can be serious. Those offered this type of treatment are given in-depth information regarding side effects and the detection of their early signs. Remedazo can put you in touch with one of our specialist oncologists to discuss your eligibility for immunotherapy based upon your personal medical history.
Breast cancer HER2 targeted therapy
Human epidermal growth factor receptor 2 (HER2) acts as a tyrosine kinase. Tyrosine kinase proteins encourage cancer cell growth. In breast cancer, HER2 proteins bind to part of the cancer cell membrane and make them more likely to multiply. A drug called trastuzumab inhibits this connection. Trastuzumab in combination with checkpoint inhibitors (immunotherapy) has been proven to be effective in the treatment of non-invasive and metastatic breast cancer; however, not every type of breast cancer responds in the same way to either inhibitory drugs or immunotherapy. Only about 15% of breast cancers will respond to HER2 inhibitors.
Tyrosine kinase inhibitors are drugs that prevent the growth of a tumour’s own blood supply network and are sometimes combined with early treatment modalities such as lumpectomy. These drugs either alone or in combination with other treatments have achieved breakthrough advances in the management of a number of hard-to-treat malignancies, including advanced cases of breast cancer.
Benefits of breast cancer treatment
Breast cancer surgeries aim to remove cancer in its entirety and so have the potential to be curative procedures. Surgery is always recommended in cases of non-metastatic cancers; however, most treatment pathways integrate multiple therapies. In the case of breast cancer, these are most commonly chemotherapy and radiotherapy. Prophylactic mastectomy can increase peace of mind in those who have a family history of breast cancer or the BRCA gene. Breast cancer has benefitted from extensive research and even invasive cancers can be successfully treated.
Breast cancer surgery is not linked to high levels of pain and recovery times and hospital stays are short. Advances in surgical techniques mean that larger amounts of breast tissue can be left intact and preserve the shape of the breast. Biopsies can be removed for immediate testing without the need of multiple surgeries. For mastectomy that does not require postoperative courses of radiotherapy, simultaneous reconstructive breast surgery is an option.
Disadvantages of breast cancer treatment
Postoperative infection is a slight risk with this type of surgery and patients are sometimes administered antibiotics as a preventive measure before surgery commences. Other short-term risks include bleeding, adverse reactions to the anaesthesia, blood clots and breathing problems.
Long-term complications of breast cancer surgery are few. Where larger numbers of lymph nodes are removed, lymphedema may cause swelling of the arm on the operated side.
Lumpectomy procedures usually require further radiotherapy treatment that can last for approximately 6 weeks, bringing with it a number of unpleasant side effects. Postoperative radiation therapy also applies to some mastectomy operations. Unpleasant and serious side effects are also linked to adjunct non-surgical cancer treatments such as chemotherapy and immunotherapy, and in a lesser degree, targeted therapy. Breast cancer treatment is obligatory if you wish to slow or stop its progression; unfortunately, the majority of current treatments bring with them unpleasant and often serious side effects.
Breast cancer alternatives
It is possible that you have been given a choice of one or more alternative treatments or have not yet made an appointment for your free e-consult and are simply browsing the possibilities.
The accepted and current breast cancer treatment alternatives have been described in detail above. Recent advances mean that some stage IV breast cancers can go into complete remission for well over 5 years. Complementary breast cancer remedies are unproven and should not take the place of accepted treatment courses. Cancer stem cell therapies for breast cancer are, as yet, insufficiently developed to be used as first-line treatment.
Of course, there is no alternative for professional medical advice. Please call us to arrange your free e-consult and the opportunity to speak personally with specialist surgical oncologists and radiologists to determine the best treatment type for you. You can discuss all breast cancer treatment alternatives with them, ask for second or third opinions, and take the first step towards your personalised Remedazo holistic care package.
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