Treatment

Typically, treatment of breast cancer will involve surgery, preceded or followed by chemotherapy, hormonal therapy or another type of anti-cancer therapy and radiation. However, treatment can vary greatly from patient to patient depending on the stage and characteristics of the cancer.

Surgery

Removal of the lump (called a lumpectomy) is the preferred technique. Removal of lymph nodes in the armpit may be undertaken as well. Removal of the breast (called a mastectomy) is only performed if it is absolutely necessary. Standard practice requires that the surgeon must establish that the tissue removed in the operation has margins clear of cancer, indicating that the cancer has been completely excised. If the tissue removed does not have clear margins, then further operations to remove more tissue may be necessary.

Chemotherapy

It can be given both before and after surgery. There are medicines that interfere with cancer cell growth and divisions, and are given to kill the cancer cells and thus reduce the size of tumours. There are several different chemotherapy regimens that may be used. The determination of the appropriate regimen depends on many factors including the character of the tumour, lymph node status, and the age and health of the patient.

More information on chemotherapy in breast cancer can be found at:

Hormonal therapy

Hormones are substances secreted by specialised cells. They are transported by the blood to another area to have an effect. Some cancers may be stimulated by hormones. Oestrogen is a hormone that promotes the growth of some breast cancers. Hormonal treatments, such as anti-oestrogens, aromatase inhibitors or LHRH analogues, are designed to block the effects of oestrogen or its production, which stops or slows the growth of cancer cells.

More information on hormonal therapy can be found at:

www.cancerhelp.org.uk/help/default.asp

Targeted therapies

Targeted cancer therapies are treatments that target specific biologically important processes of cancer cells, usually a signaling pathway for growth. The target should be measurable in the clinic, and measurement of the target (in either quantitative or qualitative terms) should correlate with clinical outcome when the targeted therapy is administered. The targeted therapies use small molecules that can get into the cell and disrupt the function of the cells, causing them to die. Some examples of targeted therapies used for breast cancer are trastuzumab (Herceptin^r) and bevastizumab (Avastin^r). Others are small molecules taken orally e.g. lapatinib (Tykerb^r)

Radiation therapy

Radiotherapy uses radiation to treat cancer. At present, the types of radiation used are mainly X-rays and electrons, other types of radiation such as protons are less common. Radiotherapy can be delivered by a radiation source external to the body (external radiotherapy), or internal to the body (brachytherapy) where the radioactive material is placed near to the tumour site. Radiation therapy for breast cancer is usually delivered after surgery has been performed and is an essential component of breast conserving therapy. The purpose of radiation is to reduce the chance that cancer will recur locally. When delivering external radiotherapy, one needs to restrict the amount of dose that can be given at one time so that normal tissues are not harmed. So the course usually lasts for several days, typically every 5 to 6 weeks.

Further general information on radiotherapy can be found at:

Of course, no one treatment fits every patient, and combination therapy is usually required. The choice is determined by many factors, including the age of the patient, menopausal status, the kind of cancer (ductal vs. lobular), its stage, and its biological characteristics (expression of hormonal receptors and HER2).

More information about treatments in general can be found at:

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