In breast cancer, there are different treatment options depending on the type, stage, degree of cancer, the organ where it has spread, the age of the patient, whether he has entered menopause, his general condition or whether there is any additional disease. The treatment is determined by a specialist team and the patient is told about the options for the treatment plan.
Table of contents
Breast cancer treatment options:
- Surgical treatment,
- Radiotherapy,
- Chemotherapy,
- Hormone therapy,
- Targeted therapy,
- Immunotherapy,
- Bone marrow or stem cell transplant.
The treatment plan is made according to the stage of the cancer and the status of the estrogen receptor (ER), progesterone receptor (PR), HER2 protein. Treatments can be applied alone or in double or triple combinations.
1.Surgical treatment:
The main goals of surgical treatment in breast cancer are:
- Removing as many cancerous cells as possible,
- Removing or biopsying lymph nodes with cancerous cells,
- Repairing the deteriorated breast tissue after cancer treatment,
- To relieve the patient’s complaints in advanced cancer cases.
Two types of surgical treatment can be applied in breast cancer.
- Breast conserving surgery : It is the removal of only the tumor area and minimal breast tissue in the breast. The patient has minimal cosmetic problems. Additional treatments such as radiotherapy are given with it. It can be performed as lumpectomy (removal of a single breast lobe), quadrantectomy (removal of a single breast quadrant), partial mastectomy or segmental mastectomy.
- Mastectomy: The breast tissue is completely removed along with the surrounding lymph nodes.
Factors such as the type, size, stage of the cancer and whether or not he has received radiotherapy before determine what type of surgical procedure will be applied to the patient. In advanced breast cancers, different surgical procedures can be performed in order to relieve the patient’s complaints and to intervene in the spreading organ.
An important part of breast surgery is cleaning the surrounding lymph nodes. May be necessary to prevent spread. This procedure can be performed as sentinal lymph node biopsy (removal of sentinal lymph nodes, where the cancer will spread first in the armpit, for protection purposes) or axillary lymph node dissection (removal of all more than 20 axillary lymph nodes because of spread).
Reconstructive surgery can be applied to patients after surgery . This procedure is performed in order to eliminate cosmetic problems in the breast due to previous surgery. In some patients, reconstruction can be performed by grafting from parts taken from other body tissues.
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Radiotherapy:
It is a treatment option applied using low-dose radiation beams to kill cancer cells. Although it is applied alone in some patients, it is mostly applied to destroy the remaining cancer cells after surgical treatment and to prevent recurrences.
Radiotherapy can be applied to the breast unilaterally or bilaterally, to the chest wall or to the surrounding lymph nodes. Radiotherapy is preferably started one month after surgery or when chemotherapy is completed. The aim is not to leave cancerous cells behind.
Before the procedure, with the help of computed tomography, MR, and ultrasound, the borders of the tumor area are determined thoroughly. Then, radiation is applied while protecting other normal body cells. The application usually takes 6-7 weeks, 5 days a week. The procedure is painless, the patient can do his daily activities during the procedure. In some cases, 3-4 weeks of radiotherapy can be applied with a higher dose.
In some cases, internal radiotherapy can be applied with probes inserted into the removed breast tissue. This is called brachytherapy.
Although the radiotherapy process focuses on cancerous cells, it does not differentiate between normal cells and cancerous cells. Therefore, normal cells can be damaged. Some undesirable effects may occur due to this. These:
- Chest swelling,
- Redness, spotting in the treated area,
- Weakness, fatigue,
- Numbness, pain, weakness due to nerve damage in the arm,
- Edema in axillary lymph nodes,
- Rib fractures,
- Rarely, angiosarcoma.
- Breast infections in brachytherapy, fluid collection in the breast.
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Chemotherapy:
It is the process of killing cancer cells with drugs. Cytotoxic drugs can be given intravenously, orally, and sometimes through the spinal cord.
Chemotherapy can be used to shrink the tumor before surgery, to kill the remaining cancerous cells after surgery, and to destroy the cancerous cells in the organs in the presence of spread.
There are different chemotherapy options according to the application time and purpose. The type, extent and size of the cancer are determined by the treatment team according to the characteristics of the patient, and it is applied with the consent of the patient. The drugs can be given alone or in double or triple combinations.
Chemotherapy is lethal to normal body cells as well as cancerous cells. Therefore, chemotherapy can have some side effects. These:
- hair loss,
- susceptibility to infections,
- Weakness, fatigue,
- Anorexia,
- Diarrhea,
- Sores in the mouth,
- Nail changes,
- Bleeding disorders, skin bruising,
- Heart problems (doxorubicin, epirubicin etc.)
Some rare serious side effects:
- Early menopause,
- Nerve damage (may be in treatment with docetaxel, paclitaxel, carboplatin, cisplatin, vinorelbine, eribulin and ixabepilone),
- Hand-foot syndrome (Irritation of palms and soles may occur in treatment with capecitabine and liposomal doxorubicin),
- Decrease in mental functions,
- Leukemia (due to bone marrow suppression).
Possible side effects of chemotherapy resolve with the end of treatment. The treatment team will make recommendations to the patient regarding the side effects, teach the methods of struggle, and apply supportive treatments if necessary.
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Hormone Therapy:
It is the process of controlling estrogen and progesterone hormone levels, which some breast cancers feed on. In patients with positive hormone receptors, drugs are used that bind to them and reduce estrogen and progesterone activity, thus killing tumor cells and shrinking the tumor. However, the use of these drugs is determined by the type of cancer, its spread, the age of the patient, whether he has entered menopause, whether he has a hormone receptor, and other treatments he uses.
Hormone therapy can be used before surgery to shrink the tumor and relieve the procedure. In some patients, it can be given to prevent cancer cells from remaining after surgery and to prevent recurrence. Sometimes, it can be used for a long time to keep the tumor under control in patients who are unable to apply other treatments.
Drugs used for this purpose:
- Tamoxifen: Blocks estrogen receptors. It can be applied for preventive purposes in people with a high risk of breast cancer. It can be given to prevent cancer cells from remaining after surgery and to reduce the recurrence of cancer. It has side effects such as hot flashes and dryness in the vagina. Rarely, serious side effects such as cervical cancer, coagulation problems, and stroke may occur.
- Toremifene (Fareston): It blocks estrogen receptors, has a similar mechanism of action and side effects with tamoxifen.
- Fulvestrant (Faslodex): It is an estrogen receptor blocker used in postmenopausal breast cancer patients.
- Aromatase inhibitors (Letrozole, anastrozole, exemestane): It can be preferred in postmenopausal women.
- Megestrol acetate: It is a progesterone-like drug.
Surgical ablation of the ovaries in patients with breast cancer who have not yet reached menopause also has an effect on hormones. For some patients, LHRH (Luteinizing Hormone Releasing Hormone) agonists (goserelin) can also be used to suppress the ovaries.
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Immunotherapy:
In some breast cancers, targeted therapies are applied to inhibit the growth and spread of cancer cells. They introduce cancerous cells to the immune system. Drugs used for this purpose:
- Pembrolizumab (Keytruda),
- Atezolizumab (Tecentriq)
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Traditional and Complementary Therapies:
They are used to relieve the patient and reduce their complaints rather than treating them. Acupuncture, aromatherapy, massage, breathing exercises can be given as examples. It also relaxes the patient psychologically. The treatment team will give the patient detailed information about this treatment option. The use of these drugs without their approval and monitoring may harm other treatments.