Breast Cancer Treatment

How breast cancer is treated

Early breast cancer, when the tumor is small, is treated with breast-conserving surgery, usually followed by adjuvant chemotherapy, radiotherapy and — depending on hormone-receptor status — hormonal therapy. When a larger but non-metastatic tumor is diagnosed and breast-conserving surgery looks unlikely to succeed, the patient is operated on after neoadjuvant chemotherapy, given before surgery to shrink the tumor and bring the disease under systemic control. If the tumor responds and shrinks, conserving surgery is performed; if not, a mastectomy. Removal of the axillary lymph nodes is increasingly being replaced by sentinel-node biopsy, to preserve quality of life and avoid arm swelling. Locally advanced tumors are treated with chemotherapy and hormones, with surgery and radiotherapy added according to how the disease responds. Treatment of metastatic cancer is aimed at systemic control and depends on HER-2 expression and the status of the estrogen and progesterone receptors.

Breast cancer surgery (surgical treatment)

After assessing the disease stage, tumor morphology and multicentricity, either breast-conserving surgery or a mastectomy is performed. Breast-conserving surgery is not done when there is more than one tumor focus in the breast, widespread intraductal carcinoma, skin lymphangiosis, or a tumor larger than 3–4 cm where breast tissue cannot be preserved. During either operation, an axillary lymphadenectomy or a sentinel-node biopsy is carried out.

Breast cancer radiotherapy

Radiotherapy is mandatory after breast-conserving surgery. It may be postponed until the end of adjuvant chemotherapy if a high risk of systemic dissemination is found. Depending on the prognostic factors, the number of affected regional nodes and the tumor’s location, the axillary, supraclavicular/infraclavicular and/or parasternal nodes may be irradiated. After a mastectomy, the extent of radiotherapy depends on how far the tumor has spread locally; beyond the regional nodes, the scar itself is sometimes irradiated to prevent local recurrence. Modern radiotherapy, planned in three dimensions, avoids the complications of older treatment — pneumonitis, heart damage, arm edema, brachial plexopathy. Palliative radiotherapy matters once breast cancer has metastasised, treating metastases in the brain, bones and soft tissues.

Breast cancer chemotherapy

Neoadjuvant — given before surgery to reduce tumor size, enable breast-conserving surgery, and control systemic disease.

Adjuvant — given after surgery, based on prognostic factors, for prevention and control of systemic disease.

Metastatic chemotherapy — when the disease has spread to other organs, to reduce or destroy metastases and prolong the patient's life. If the tumor expresses HER2 receptors, targeted therapy is added.

Hormonal therapy

Tumors sensitive to adjuvant hormone therapy are those in which at least 10% of cells carry steroid-hormone receptors. If the tumor tissue has no estrogen (ER) or progesterone (PR) receptors, hormones will not control the disease. Around 50–60% of breast tumors are ER-positive, 40–50% PR-positive. With positive ER, 60% of patients respond to hormonal therapy; with both ER and PR positive, 75%; with PR alone, 30%. The drugs used are antioestrogens, selective aromatase inhibitors, progestins and LHRH agonists. Where HER2 expression is raised, targeted therapy with trastuzumab or lapatinib is added — trastuzumab, a monoclonal antibody that blocks HER2 from outside the cancer cell; lapatinib, a small-molecule tyrosine-kinase inhibitor that enters the cell and blocks HER2 from within. Lapatinib crosses the blood–brain barrier, lowering the risk of brain metastases and acting on those already present.

Immune support during treatment

Chemotherapy suppresses the immune system, leaving the body vulnerable. Concentrated mushroom-polysaccharide formulas, backed by clinical research, are studied for their role in supporting the immune system during oncological disease.

Frequently Asked Questions