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Much controversy exists over breast cancer treatments. In choosing therapy, the patient and physician should take into consideration the stage of the disease, the woman's age and menopausal status, and the disfiguring effects of the surgery. Treatment of breast cancer may include one or any combination of the following:
❑Surgery involves either mastectomy or lumpectomy. A lumpectomy may be done on an outpatient basis and may be the only surgery needed, especially if the tumor is small and there's no evidence of axillary node involvement. In many cases, radiation therapy is combined with this surgery.
A two-stage procedure, in which the surgeon removes the lump and confirms that it's malignant and then discusses treatment options with the patient, is desirable because it allows the patient to participate in her plan of treatment. Sometimes, if the tumor is diagnosed as clinically malignant, such planning can be done before surgery. In lumpectomy and dissection of the axillary lymph nodes, the tumor and the axillary lymph nodes are removed, leaving the breast intact. A simple mastectomy removes the breast but not the lymph nodes or pectoral muscles. Modified radical mastectomy removes the breast and the axillary lymph nodes. Radical mastectomy, the performance of which has declined, removes the breast, pectoralis major and minor, and the axillary lymph nodes.
The spread of breast cancer to regional lymph nodes is considered a vital prognostic indicator. Sentinel lymph-node biopsy, a reliable and minimally invasive procedure, is used to identify and sample the sentinel lymph node closest to the breast tumor. During the patient's surgery, the axillary node is injected with dye to help with identification and then sent to the pathologist to assess for cancer spread. If the node is negative, the patient can be spared an axillary node dissection, which carries its own risks and the potential for long-term complications .
Reconstructive breast surgery can be performed at the same time as mastectomy or it can be planned for a later date. Several options are available for breast reconstruction, including the insertion of breast implants or a transverse rectus abdominis musculocutaneous flap.
❑Chemotherapy, involving various cytotoxic drug combinations, is used as either adjuvant or primary therapy, depending on several factors, including the TNM staging and estrogen receptor status. The most commonly used antineoplastic drugs are cyclophosphamide, fluorouracil, methotrexate, doxorubicin, vincristine, and paclitaxel. A common drug combination used in both premenopausal and postmenopausal women is cyclophosphamide, doxorubicin, and paclitaxel.
Tamoxifen, an estrogen antagonist, is the adjuvant treatment of choice for postmenopausal patients with positive estrogen receptor status. It's also been found to reduce the risk of breast cancer in women at high risk.
❑ Peripheral stem cell therapy is an option, but it's rarely used for advanced breast cancer.
❑ Primary radiation therapy before or after tumor removal is effective for small tumors in early stages with no evidence of distant metastasis; it's also used to prevent or treat local recurrence. Presurgical radiation to the breast in inflammatory breast cancer helps make tumors more surgically manageable.
❑ Estrogen, progesterone, androgen, or antiandrogen aminoglutethimide therapy may also be given to breast cancer patients. The success of these drug therapies — along with growing evidence that breast cancer is a systemic, not local, disease — has led to a decline in ablative surgery.
Source: Professional Guide to Diseases (Eighth Edition), 2005
Much controversy exists over breast cancer treatments. In choosing therapy, the patient and physician should consider the stage of the disease, the woman’s age and menopausal status, and the disfiguring effects of the surgery. Treatment for breast cancer may include one or any combination of the following.
With breast cancer, surgery involves either lumpectomy or mastectomy. A lumpectomy may be done on an outpatient basis and may be the only surgery needed, especially if the tumor is small and there’s no evidence of axillary node involvement. Radiation therapy is often combined with this surgery.
A two-stage procedure, in which the surgeon removes the lump, confirms that it’s malignant, and discusses treatment options with the patient, is desirable because it allows the patient to participate in her treatment plan. Sometimes, if the tumor is diagnosed as malignant, such planning can be done before surgery. In lumpectomy and dissection of the axillary lymph nodes, the tumor and the axillary lymph nodes are removed, leaving the breast intact.
A simple mastectomy removes the breast but not the lymph nodes or pectoral muscles. A modified radical mastectomy removes the breast and the axillary lymph nodes. A radical mastectomy, the performance of which has declined, removes the breast, the pectoralis major and minor, and the axillary lymph nodes.
After a mastectomy, reconstructive surgery can create a breast mound if the patient desires it and doesn’t have evidence of advanced disease.
Various cytotoxic drug combinations are used as either adjuvant or primary therapy, depending on several factors, including staging and estrogen receptor status. The most commonly used antineoplastics are cyclophosphamide, fluorouracil, methotrexate, doxorubicin, vincristine, paclitaxel, and prednisone. A common drug combination used in both premenopausal and postmenopausal women is cyclophosphamide, methotrexate, and fluorouracil.
Tamoxifen, an estrogen antagonist, is the adjuvant treatment of choice for postmenopausal patients with positive estrogen receptor status.
Peripheral stem cell therapy may be used for patients with advanced breast cancer.
Used before or after tumor removal, primary radiation therapy is effective for small tumors in early stages with no evidence of distant metastasis; it’s also used to prevent or treat local recurrence. Presurgical radiation to the breast in patients with inflammatory breast cancer helps make tumors more surgically manageable.
Breast cancer patients may also receive estrogen, progesterone, androgen, or antiandrogen aminoglutethimide therapy. The success of these drug therapies with growing evidence that breast cancer is a systemic, not local, disease has led to a decline in ablative surgery.
Source: Handbook of Diseases, 2003
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