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Common Ways of Treatment of Breast Cancer

Treatments exist for every type and stage of breast cancer. Most women will have surgery and an additional (adjuvant) therapy such as radiation, chemotherapy or hormone therapy. And several experimental treatments are now offered on a limited basis or are being studied in clinical trials.

Surgery

  • Lumpectomy: This operation saves as much of your breast as possible by removing only the lump plus a surrounding area of normal tissue.
  • Partial or segmental mastectomy: This is also considered a breast-sparing operation, partial mastectomy involves removing the tumor as well as some of the breast tissue around the tumor and the lining of the chest muscles that lie beneath it.
  • Simple mastectomy: During a simple mastectomy, your surgeon removes all your breast tissue- the lobules, ducts, fatty tissue and a strip of skin with the nipple and areola. 
  • Modified radical mastectomy: In this procedure, a surgeon removes your entire breast and some underarm (axillary) lymph nodes, but leaves your chest muscles intact. 
  • Sentinel lymph node biopsy: Breast cancer first spreads to the lymph nodes under the arm. That's why all women with invasive cancer need to have these nodes examined. Until recently, surgeons would remove as many lymph nodes as possible. 

Reconstructive surgery

Most women who undergo mastectomy are able to choose whether to have breast reconstruction. This is a very personal decision, and there's no right or wrong choice. You may find, however, that you have feelings you didn't expect about your breasts. It's important to understand these feelings before making any decision.

  • Reconstruction with implants: Using artificial materials to reconstruct your breast involves implanting a silicone shell filled with either silicone gel or salt water (saline). 
  • Reconstruction with a tissue flap: Known as a transverse rectus abdominis myocutaneous (TRAM) flap, this surgery reconstructs your breast using tissue, including fat and muscle, from your abdomen.
  • Deep inferior epigastric perforator (DIEP) reconstruction: In this procedure, fat tissue from your abdomen is used to create a natural-looking breast.
  • Reconstruction of your nipple and areola: Using tissue from elsewhere in your body, your surgeon first creates a small mound to resemble a nipple.

Radiation therapy

Radiation therapy uses high-energy X-rays to kill cancer cells and shrink tumors. It's administered by a radiation oncologist at a radiation center. In general, radiation is the standard of care following a lumpectomy for both invasive and noninvasive breast cancer. Oncologists are also likely to recommend radiation following a mastectomy for a large tumor that has spread to more than four lymph nodes in your armpit.

Radiation is usually started three to four weeks after surgery. You'll typically receive treatment five days a week for five to six consecutive weeks. The treatments are painless and are similar to getting an X-ray. Each takes about 30 minutes. The effects are cumulative, however, and you may become quite tired toward the end of the series. Your breast may be pink, puffy and somewhat tender, as if it had been sunburned.

In a small percentage of women, more serious problems may occur, including arm swelling, damage to the lungs, heart or nerves, or a change in the appearance and consistency of breast tissue. Radiation therapy also makes it somewhat more likely that you'll develop another tumor. For these reasons, it's important to learn about the risks and benefits of radiation therapy when deciding between lumpectomy and mastectomy. You may also want to talk to a radiation oncologist about clinical trials investigating shorter courses of radiation.

Chemotherapy

Chemotherapy uses drugs to destroy cancer cells. Your doctor may recommend chemotherapy following surgery to kill any cancer cells that may have spread outside your breast. Treatment often involves receiving two or more drugs in different combinations. These may be administered intravenously, in pill form or both. You may have between four and eight treatments spread over three to six months.

Hormone therapy

Hormone therapy is most often used to treat women with advanced (metastatic) breast cancer or as an adjuvant treatment- a therapy that seeks to prevent a recurrence of cancer - for women diagnosed with early-stage estrogen receptor positive cancer. 

Medications that reduce the effect of estrogen in your body include:

  • Tamoxifen (Nolvadex): A synthetic hormone belonging to a class of drugs known as selective estrogen receptor modulators (SERMs). 
  • Aromatase inhibitors: This class of drugs blocks the conversion of a hormonal substance (androstenedione) into estrogen.

Biological therapy

Sometimes called biological response modifier or immunotherapy, this treatment tries to stimulate your body's immune system to fight cancer. Using substances produced by the body or similar substances made in a laboratory, biological therapy seeks to enhance your body's natural defenses against specific diseases. Many of these therapies are experimental and available only in clinical trials. One medication, trastuzumab (Herceptin), is a monoclonal antibody- a substance produced in a laboratory by mixing cells- that's available for treating certain advanced cases of breast cancer. Herceptin is effective against tumors that produce excess amounts of a protein called HER-2.

Clinical trials

A number of new approaches to treating cancer are being studied. The emphasis is on methods that can successfully treat women or extend their survival with minimal side effects. Among these are drugs that block the biochemical switches that cause normal cells to turn cancerous. In addition, a procedure known as anti-angiogenesis- which targets the blood vessels that supply nutrients to cancer cells- is also being studied.

Of particular interest to both women and their doctors are methods of removing breast cancer without actually cutting into or removing the breast. Nonsurgical methods being studied include techniques that use heat or cold to kill cancer cells deep within the breast, leaving only minimal scars.

One of the most researched techniques, radiofrequency ablation, uses ultrasound to locate the tumor. Then a metal probe about the size of a toothpick is inserted into the tumor where it creates heat that destroys cancer cells. In early tests, the procedure has proved successful. Still, not all women would be candidates for the procedure if it eventually were approved for widespread use.

Some of these new treatments are available through clinical trials - the standard way new therapies are tested in people. If you have advanced breast cancer and are interested in participating in a clinical trial, talk to your doctor or contact the National Cancer Institute's Cancer Information Service at (800) 422-6237 for more information.

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