Continuation from the previous post……
- People with an abnormal breast lump should seek medical care, even if the lump does not hurt.
Although most breast lumps are not cancer. Breast lumps that are cancerous are more likely to be successfully treated when they are small and have not spread to nearby lymph nodes.
Breast cancers may spread to other areas of the body and trigger other symptoms. Often, the most common first detectable site of spread is to the lymph nodes under the arm although it is possible to have cancer-bearing lymph nodes that cannot be felt.
Over time, cancerous cells could spread to other organs including the lungs, liver, brain, and bones. And, once they reach these other parts of the body, new cancer-related symptoms such as bone pain or headaches may appear.
Treatment
Treatment for breast cancer depends on the subtype of cancer and how much it has spread outside of the breast to lymph nodes (stages II or III) or to other parts of the body (stage IV).
Doctors usually combine treatments to minimize the chances of the cancer coming back (recurrence). And these include:
- surgery to remove the breast tumor
- radiation therapy to reduce recurrence risk in the breast and surrounding tissues
- medications to kill cancer cells and prevent spread, including hormonal therapies, chemotherapy, or targeted biological therapies.
- Treatments for breast cancer are more effective and are better tolerated when started early and taken to completion.
Surgery may remove just the cancerous tissue (called a lumpectomy) or the whole breast (mastectomy). Surgery may also remove lymph nodes to assess the cancer’s ability to spread.
Advanced cancers can erode through the skin to cause open sores (ulceration) but are not necessarily painful. Women with breast wounds that do not heal should seek medical care to have a biopsy performed.
Medicines to treat breast cancers are selected based on the biological properties of the cancer as determined by special tests (tumor marker determination TMD).
The great majority of drugs used for breast cancer are already on the WHO Essential Medicines List (EML).
Lymph nodes are removed at the time of cancer surgery for invasive cancers. Complete removal of the lymph node bed under the arm (complete axillary dissection) in the past was thought to be necessary to prevent the spread of cancer. A smaller lymph node procedure called “sentinel node biopsy” is now preferred as it has fewer complications.
Medical treatments for breast cancers, which may be given before (“neoadjuvant”) or after (“adjuvant”) surgery, is based on the biological subtyping of the cancers. Certain subtypes of breast cancer are more aggressive than others such as triple negative (those that do not express estrogen receptor (ER), progesterone receptor (PR) or HER-2 receptor).
Cancers that express the estrogen receptor (ER) and/or progesterone receptor (PR) are likely to respond to endocrine (hormone) therapies such as tamoxifen or aromatase inhibitors. These medicines are taken orally for 5–10 years and reduce the chance of recurrence of these “hormone-positive” cancers by nearly half. Endocrine therapies can cause symptoms of menopause but are generally well tolerated.
Cancers that do not express ER or PR are “hormone receptor negative” and need to be treated with chemotherapy unless the cancer is very small.
The chemotherapy regimens available today are very effective in reducing the chances of cancer spread or recurrence and are generally given as outpatient therapy. Chemotherapy for breast cancer generally does not require hospital admission in the absence of complications.
Breast cancers that independently overexpress a molecule called the HER-2/neu oncogene (HER-2 positive) are amenable to treatment with targeted biological agents such as trastuzumab. When targeted biological therapies are given, they are combined with chemotherapy to make them effective at killing cancer cells.
Radiotherapy
Radiotherapy plays a very important role in treating breast cancer. With early-stage breast cancers, radiation can prevent a woman from having to undergo a mastectomy. With later-stage cancers, radiotherapy can reduce cancer recurrence risk even when a mastectomy has been performed. However, for advanced stages of breast cancer, in some circumstances, radiation therapy may reduce the likelihood of dying of the disease.
The effectiveness of breast cancer therapies depends on the full course of treatment. Partial treatment is less likely to lead to a positive outcome.
Stay tuned for the next and final edition on our Breast Cancer Series.
Source: www.cdc.gov , www.who.int , www.nyahomedical.com
