- The type of treatment whether surgical,
chemotherapy or combination of both therapy is determined by the extent of
disease, patient age and her decision.
Early breast cancer treatment:
Surgery with wide local excision and breast conservation or mastectomy with or with out re-construction is done. Amount of breast tissue to be removed still remains controversial. At one time radical mastectomy was done
routinely although still performed, modified radical mastectomy, simple mastectomy or lumpectomy. Lumpectomy only removes cancerous portion of breast and auxiliary nodes. Radio therapy is given to conserve the breast after wide local excision to reduce local recurrence.
Adjuvant systemic treatment
Tamoxifen adjuvant therapy immediately following surgery is beneficial for estrogen-progesterone receptor positive disease and has reduced the relative risk of women dying from breast cancer by 25%.Most commonly therapy with cyclophosphamide and 5-Flurouracil plus methotrexate for 5 months reduces the absolute by 10% and relative risk of death by 20%.
Advance breast cancer:
Patient with establish metastasis disease may require endocrine therapy, chemo therapy or radiotherapy. The treatment is not curative but may be of great palliate benefits and consistent often with many years of good quality life. Recently addition of anti HER2 antibodies to chemo therapy has produce a modest survival advantage.
Endocrine therapy of advance breast cancer:
Women who have high level of estrogen receptor and progesterone in their tumour have greater chances of responding to endocrine therapy. A range of hormonal manipulations are as follows:
For pre-menopausal patients
1.Supression of ovarian function by means of oophorectomy, radiation-induced ovarian ablation
2.Anti-oestrogen,tamoxifen
2.Progestrone
For post menopausal women
1.Tamoxifen
2.Progesterone
3.Aromatase inhibitors(anastrozole)
Chemotherapy
patient who are unlikely to respond to hormonal therapy or who fail to respond to endocrine therapy or who requires rapid response is they are at any risk, they are given chemo therapy. The most common regimen used are:
CMF(cyclophosphamides,
Methotrexate,5-fluorouracil)
MM(mitoxantrone and methotrexate)
Doxyrubicin and cyclophosphamide
Paclitaxel or docetaxel used as single agent or in combination with an antracycline where initial therapy has failed or is inappropriate.
Side effect of chemotherapy:
nausea, vomiting
hair loss
fatigue
Mucositis( eg. oesophagitis, diarrhoea)
Drugs specific:
Anthracyclines causes cardio toxicity
5-fluorouracil causes skin dermatitis
Poor prognostic factors for breast cancer:
Young age
pre-menopausal women
Tumour size
metastasis of tumour
Oestrogen and progesterone receptor negative
positive nodes.
Should see the doctor after my treatment?
After primary therapy ,patients with breast cancer should be followed for life for at least two reason:
1.To detect recurrences and to observe the positive breast for secondary carcinoma.
2.Local or distant metastasis occur frequently with in the first 3 years. So during this period patient is examined every 6 months. Thereafter, every 6-12 months for 5 years, then after every 12 months.
Author: Dr.Deepak Ghimire zonemedicine.com Picture © Barnaby Jeans
