Different types of treatment are available for patients with breast cancer; they depend on the type of cancer and the stage at which it has been diagnosed. 

Radiotherapy

Surgery

Most patients with breast cancer have surgery to remove the cancer from the breast. Some of the lymph nodes under the arm are usually also taken out for biopsy.

• Breast-conserving surgery (lumpectomy or partial mastectomy) is an operation to remove the cancer but not the entire breast.
• Total mastectomy (also called simple mastectomy): surgery to remove the whole breast that has cancer.
• Radical mastectomy: surgery to remove the breast that has cancer, chest wall muscles under the breast, and all of the lymph nodes under the arm. A Modified radical mastectomy could be used toremove the whole breast that has cancer, many of the lymph nodes under the arm, the lining over the chest muscles, and sometimes, part of the chest wall muscles.
• Breast reconstruction (surgery to reshape the breast after a total or radical mastectomy) may be considered and may be performed at the time of the mastectomy or later on.
• Lymphedema is a condition, often caused by lymph nodes removal during surgery, in which fluid collects in tissue and causes swelling. It may occur in the arm after underarm lymph nodes are removed or treated with radiation. The swelling produced by lymphedema is usually not painful, but it may cause discomfort and limit a person’s ability to use her arms.

Even if all of the cancer that can be seen at the time of the surgery is removed, some patients may be given radiotherapy, chemotherapy, or hormone therapy after surgery as adjuvant therapy, in order to kill any cancer cells that could have been left behind, undetected. In addition, if diagnosis tests show that the cancer cells express a receptor where hormones can attach, other treatment options can be proposed. For example, ovarian ablation is sometimes performed to eliminate the source of estrogen, as the hormone estrogen, which makes some breast cancers grow, is produced mainly by the ovaries.

Hormone therapy

Most breast cancer cells need hormones to grow. Thus hormone therapy in cancer treatment is used to remove hormones or to block their action, impairing cancer cell growth. Hormone therapy using tamoxifen or an aromatase inhibitor may be given in these cases.

Targeted therapy

In about 25% of breast cancer patients, the tumors will express an elevated amount of a receptor called HER2 (also known as ErbB2), allowing the cancer cells to grow more aggressively. Trastuzumab (Herceptin) is a monoclonal antibody that blocks the effects of this receptor and can thus be used, in combination with chemotherapy, to treat these patients.

Aditionally, tyrosine kinase inhibitors can be used with other anticancer drugs as adjuvant therapy. Tyrosine kinases are a class of proteins that modify (and mostly activate) other proteins. Cancer cells often express high levels of these kinases. Tyrosine kinase inhibitors such as lapatinib are a class of molecules that can interfere with these kinases. For example, lapatinib is used to treat patients with HER2-positive breast cancer that has progressed following treatment with trastuzumab.

References