Breast Cancer Management and Treatment

How is breast cancer treated?

Patients should be aware that there is no definitive or pre-determined treatment for breast cancer. The decision is made based on several factors, including the type of cancer, its stage, and characteristics along with the patient’s overall health and preferences. The best approach is recommended by the multidisciplinary team of doctors(medical oncologist, surgical oncologist, radiation oncologist, and a plastic surgeon) to address each patient’s unique condition and the options are discussed with the patient to help them make a well-informed decision about breast cancer treatment.

The various treatment methods for breast cancer are explained below in detail.

Breast Cancer Surgery

Surgery is usually the first step and most critical component of breast cancer treatment. Each type of surgery has specific indications, benefits, and risks and the correct type is chosen based on the type and stage of the cancer and the patient’s overall health. The most commonly used procedures are explained below:

Lumpectomy (Breast-Conserving Surgery)

A lumpectomy involves removing the breast tumor along with a small margin of the surrounding healthy tissues from the breast. This procedure focuses on the removal of cancer while preserving breast tissues as much as possible, and that’s why it is called breast-conserving surgery. A lumpectomy is usually recommended in the early stages of breast cancer when the tumor is small and localized, i.e., confined within one area of the breast.

Mastectomy

A mastectomy involves partial or complete removal of the breast tissues and it is usually performed when cancer has spread throughout the breast. When the tumor is large in size or multiple tumors of small sizes are present throughout the breast, mastectomy is considered the optimal approach.

In some cases, a prophylactic mastectomy may be recommended as a preventative measure to reduce the risk of breast cancer. It is recommended for women who have the breast cancer genes, e.g., BRCA1 or BRCA2.

Unfortunately, mastectomy has a greater impact on the physical and emotional health of the patient. After the surgery, the patient usually needs a longer time to recover and has to rely on reconstruction procedures or prosthetics to address the body-image issues and emotional well-being.

Lymph Node Removal Surgery

A lymph node removal surgery, also known as lymphadenectomy, is a procedure performed to remove the cancerous cells that have spread to the lymph nodes in the underarm (axilla). Breast cancer usually starts to spread to the lymph nodes in the later stages and this surgical method is combined with mastectomy or lumpectomy based on the tumor growth, size, and location.

A lymph node removal surgery is recommended by the doctor when he/she suspects that the cancer has advanced to second or later stages. The method is used in conjunction with breast surgery to ensure the patient doesn’t have to undergo two surgical procedures in a short span.

Reconstructive Surgery

A breast reconstruction surgery is performed to restore and rebuild the shape and appearance of the breast after mastectomy or lumpectomy. The reconstruction procedure can be performed either immediately after the surgery or after the patient's full recovery. It can be performed using breast implants (a prosthetic device to reconstruct the breast) or through autologous tissues (a tissue flap taken from another part of the body). When breast reconstruction is done along with mastectomy or lumpectomy, the procedure is also called oncoplastic surgery.

Patients are usually informed about the complexities of breast reconstruction procedures and the risks associated with them, such as scarring and implant-related risks (capsular contracture, infection, implant rupture, etc.).

Radiation Therapy

Radiation therapy for breast cancer is a very common and effective treatment that utilizes high-energy particles to destroy the cancer cells. It is used in combination with surgical procedures and chemotherapy to eliminate the risk of breast cancer recurrence.

The goal of radiation therapy for breast cancer is to destroy the cancer cells while keeping the damage minimal to the surrounding tissues. This therapy can be administered through fluids, a machine, or by placing a radioactive source inside or near the tumor.

The patients need to understand the treatment and discuss the potential benefits and side effects of the therapy to learn about the impact on their regular lives.

Chemotherapy

Chemotherapy is another systemic treatment for breast cancer. It uses a powerful drug to target cancerous cells. It is often used as neoadjuvant therapy (therapies administered as a first step to shrink the tumor size) and can also be used after surgery (adjuvant therapy) to eliminate the remaining cancer cells from the body.

The drugs used for chemotherapy interfere with the cancer cells and prevent them from growing. The drugs that are commonly used for breast cancer in combination with other treatments, such as surgery or radiation are anthracyclines, taxanes, alkylating agents, antimetabolites, platinum-based (cisplatin and carboplatin), antitumor antibiotics (doxorubicin and epirubicin), topoisomerase inhibitors (Irinotecan and Etoposide), and other agents like Eribulin and Vinorelbine.

Hormone Therapy

Also known as endocrine therapy, hormone therapy is a treatment that targets the hormone receptors in the cancer cells. This therapy is most effective in hormone receptor-positive breast cancer, where the cell growth is triggered in response to hormone abnormalities like increased levels of estrogen and progesterone. This therapy reduces the levels of hormones and blocks their effects to slow down the growth of cancer cells. Hormone therapy effectively reduces the risk of recurrence.

Tamoxifen

Tamoxifen is a very commonly used hormone therapy that works as a selective estrogen receptor modulator (SERM). It blocks the estrogen receptors present in the cancer cells and prevents the hormone from stimulating cell growth. It is a suitable option to treat estrogen receptor-positive (ER+) cancer in premenopausal and postmenopausal women.

It is used as a neoadjuvant therapy (used before surgery) to shrink the tumor and an adjuvant therapy (used after surgery) to reduce cancer recurrence. Tamoxifen is also very effective in slowing down the spread of cancer in advanced stages. It provides long-term protection against cancer recurrence and is very effective in treating both early-stage and advanced breast cancer.

Aromatase Inhibitors (AIs)

Aromatase inhibitors are also a popular class of hormonal therapy drugs used for hormone receptor-positive breast cancer treatment. These inhibitors, as the name suggests, reduce the production of estrogen, thereby depriving the cancer cells of the estrogen. The commonly used aromatase inhibitors are anastrozole (Arimidex), letrozole (Femara), and exemestane (Aromasin). They are used as both adjuvant and neoadjuvant therapy and sometimes in combination with Tamoxifen to reduce the risk of breast cancer recurrence.

Among these two hormonal therapies, the correct option is chosen based on the patient’s condition. Typically, tamoxifen is the first choice for premenopausal women with ER+ breast cancer, and for postmenopausal women, aromatase inhibitors are a more suitable option. In some cases, both therapies are joined to reduce cancer recurrence and improve the patient’s survival rates.

Targeted Therapy

In targeted therapies, special drugs are designed to target the molecules that are responsible for the growth, progression, and spread of cancer. Targeted therapy is a more precise approach for breast cancer treatment compared to traditional chemotherapy and destroys cancer cells while preserving the damage to healthy cells. The two most commonly used therapies are HER2-Targeted therapy and PARP inhibitors.

HER2-Targeted Therapies

HER2 stands for human epidermal growth factor receptor 2. It is a protein that promotes the growth of breast cancer cells and about 20% of cases are caused due to overexpression of this protein. The HER2-targeted therapy is designed to block the HER2 protein and prevent cancer growth.

Some common drugs that are used are Trastuzumab, Pertuzumab, Lapatinib, Ado-Trastuzumab Emtansine (Kadcyla), Neratinib (Nerlynx), etc. These therapies significantly improve the survival rate of patients with HER2-positive breast cancer and it is also used in combination with other therapies like chemotherapy to improve their effectiveness.

PARP Inhibitors

PARP inhibitor stands for Poly ADP-Ribose Polymerase inhibitors which is effective in breast cancers caused due to genetic factors, i.e., BRCA1 and BRCA2. These genetic mutations impair the cell’s ability to repair damage to the DNA and these inhibitors block the DNA repair entirely. Normally, when cancer cells are damaged, the PARP enzyme repairs it, which prevents other treatments from destroying cancer cells. And the PARP inhibitors are used to halt the repair process which results in cancer cell death.

Two commonly used PARP inhibitors are Olaparib (Lynparza) and Talazoparib (Talzenna). These drugs inhibit the PARP enzyme and the damage to the cancer cells accumulates, causing death of the cancer cells. These inhibitors are effective in treating HER2-negative breast cancer as well as metastatic cancer. They are usually administered orally as pills, making them a more convenient option than other treatments.

Immunotherapy

Immunotherapy is the treatment method that harnesses and enhances the body’s immune system to fight against cancer cells. Its application and usage are still being explored for many types of cancers.

The standard immunotherapy drugs available for patients are checkpoint inhibitors, such as pembrolizumab and atezolizumab. They work by blocking specific proteins that prevent immune cells from attacking and destroying cancerous cells and boosting the immune cell’s ability to destroy cancer. This therapy is often used in combination with chemotherapy to treat cancer at advanced stages or when a tumor is deemed inoperable.

As immunotherapy is still in the study phase, the patient selection is done very carefully and not all breast cancer patients can opt for this treatment method. Currently, most patients who have triple-negative breast cancer (TNBC) are accepted in the experimental studies. To learn more about this approach, it’ll be best to talk to an experienced doctor.

About Oncare Cancer

At Oncare Cancer, we are deeply committed to providing comprehensive care and support to people affected by cancer. We understand that a cancer diagnosis is overwhelming for the patient and his/her loved ones. That’s why, our approach focuses on tending to the emotional and psychological well-being of the patients along with providing advanced medical treatments. We offer personalized care that meets the unique needs of each patient and guide them at every step to navigate through the complexities of the treatment options.

The key aspects of Oncare Cancer's services include the following:

• A multidisciplinary team of specialists, including oncologists, surgeons, nurses, and support staff, to provide the best possible medical care to all patients.
• 24x7 assistance from our care coordinators to keep the patients informed and educated about the treatment options.
• Our surgery plans are customized and affordable for the patients as we offer competitive pricing.
• We accept insurance plans and have several discount options that further reduce the expense of overall cancer treatment.
• Comprehensive care from diagnosis tests, neoadjuvant therapies, surgeries, systemic therapies, to post-operative care.

Get in touch with Oncare Cancer and get cutting-edge treatment for breast cancer and other types of cancer, and have a trustworthy and experienced guide and companion in your treatment journey.

Get Expert Breast Cancer Treatment in Delhi

If you or a loved one is seeking expert breast cancer treatment in Delhi, Oncare Cancer is here to provide holistic and personalized care. Our dedicated team of specialists in Delhi ensures that all patients who come to us receive the best-quality treatment, tailored to their needs.

With us, you can rest assured knowing that your comfort and well-being are our top priority. We offer supportive care to our patients and help them to navigate their treatment journey. Contact us today and don’t wait to get the breast cancer care you deserve.