Update 2018: information about breast cancer updated. The treatment guidelines for breast cancer are being revised. New directions coming in different sections.
The most common treatments used for breast cancer are:
- operation
- irradiation
- chemotherapy
- hormonal therapy
- targeted therapy
- breast prosthesis and reconstruction
Many people get a combination of the mentioned treatments. Your doctor will explain which treatment best fits your situation. As a patient you are entitled to good and complete information about your illness and treatment, so you can decide for yourself. These rights are legally established. Ask your doctor or nurse for more information.
In addition to the above treatments, you can sometimes take part in the treatment in the context of the study (trials). For example, you will receive a new treatment or combination of treatments that doctors still investigate. With this medical scientific study, doctors test whether new treatments are better than standard treatments.
Side effects and final effects of breast cancer treatment
Different treatments for breast cancer regularly carry side effects. Sometimes you will only be confronted with this long after treatment. This is also called the 'late consequence'. For various treatments, you can read the side effects you can expect.Treatment options
In order to provide the best possible care, it is important to know:- what characteristics the tumor has
- at what stage of breast cancer
- whether there are inherited taxes
- is there any metastasis
But your personal situation also plays a role, such as age, gender, whether you are in transition, whether you want to have children, and so on. Therefore, the treatment plan is an adjustment.
Therefore, allow yourself to be informed about treatment options so that you can make informed decisions.
Question
The following questions are used to determine the treatment.- How old are you?
- Are you in transition (menopausal status)?
- how big is the tumor in the chest?
- what type of breast cancer do you have?
- how aggressive is the tumor?
- is the tumor susceptible to hormone (hormone receptor status)?
- what is HER2 / neu status?
- is there a hereditary load?
- Would you prefer breast conservation treatments (if possible)?
- Or do you want a mastectomy?
- is there metastasis (in lymph nodes or in the distance)?
After the surgery, you can ask if the tumor is completely gone (are the edges free?). This is important for any advanced treatment.
The answers to these questions together determine the best treatment method and thus the prognosis.
Healing or enlightenment
First, the doctor will discuss with you what is the best course of action for you. It depends entirely on your personal situation. For example, the type of breast cancer and the extent to which the disease has spread to other parts of your body.
In many patients there is a chance of healing. The purpose of this treatment is to remove the tumor from the breast and destroy the remaining cancer cells.
Unfortunately, not everyone can recover. In this case care should extend life and maintain the best quality of life possible. This occurs, inter alia, by slowing the growth of metastasis.
Age
More aggressive forms of cancer often occur in young women. Women up to age 40 years therefore often receive chemotherapy. In addition, there is no upper limit for chemotherapy, although chemotherapy is given less frequently in women over 70 years.Status of menopause
For additional care, it's important to know if you're in transition. You will receive additional treatment after a previous treatment that heals on purpose. Adjuvant treatment is intended to achieve better outcomes. Treatment also has consequences for a possible desire to have a child. Is the tumor sensitive to hormones? Then women who are not yet in transition will receive different treatment advice from women who are in transition. A young woman is affected by hormone care in transition.Size of tumor
The size of the tumor is a predictor for prognosis. Larger tumors have been around for some time and may spread further. If a large tumor is not treated after surgery, the likelihood of comeback or metastasis increases. If the tumor is larger than 2 cm, additional treatment usually follows. If the tumor is small, breast-saving surgery can be performed more frequently. Is the tumor large or relatively large in small breasts? Then an amputation is considered or you will receive chemotherapy first to reduce the tumor.Type of breast cancer
Different types of diagnoses are possible: DCIS, LCIS, IDC, ILC and microcalcifications (lime spatters). The most common types of breast cancer are invasive ductal and invasive lobular carcinomas. Both types can appear in both the lobe of the gland and the milk ducts. However, they respond differently to drugs. The type of breast cancer determines which treatment is most suitable.Aggressiveness of tumors
The degree of differentiation of tumor tissue explains the extent to which tumor cells diverge from the original tissue. The larger the deviation, the more aggressive the tumor. As a rule, the more aggressive the cancer develops, the more complex the treatment is.Sensitivity of tumor hormones
Breast cancer can be sensitive to hormones or insensitive to hormones. It's important to know before treatment, because hormone therapy only works with hormone-sensitive breast cancer. About 70 to 80% of breast cancers are sensitive hormones. Hormone-prone tumors generally appear less frequently in the same breast, sowing faster and have a better chance of survival. The sensitivity of breast cancer hormones affects the choice of care and certain resources.HER2 / neu status
In a HER2 / neu-positive tumor, the tumor contains proteins on the cell surface, which can receive signals that promote tumor growth. HER2 / neu-positive tumors are aggressive tumors that target specific therapies are available. This improves prognosis. This therapy is called Trastuzumab (Herceptin®).Inherit tax
About 5 to 10% of all women with breast cancer have received the disease due to hereditary tendencies. The most important hereditary predisposition is a mutation in the BRCA1 or BRCA2 gene. Then there is a higher risk of breast cancer and ovarian cancer. In hereditary breast cancer disease develops on average at a younger age than non-hereditary breast cancer. Breast cancer or ovaries often occur in some family members. It is also more common in hereditary breast cancer that tumors are found in both breasts. Read more about hereditary breast and / or ovarian cancer.Metastasis
To be able to correctly assess whether there is metastasis in the axillary lymph nodes or elsewhere in your body ('at a distance'), additional research is needed. The presence of metastases affects treatment. Armpit always checked; research on the rest of your body is only done if the tumor has a certain stage.Appointment of tumor completely
Operation
In many cases, surgery is the first step in the treatment process. Thus the surgeon will remove the tumor as completely as possible. If possible, he tries to save your chest. Whether this may depend on the size of your breast and tumor.For example, if the tumor is very large in relation to your breast, then surgery breast (lumpectomy) is not possible. The same is true if you have multiple tumors in your chest. Then a mastectomy (mastectomy) becomes necessary.
Your personal preferences will also be considered in consideration. Some women find it better to remove all of their breasts. Others hope to keep their breasts. Because amputations are often experienced as mutilations, many patients then opt for breast reconstruction.
In case of surgery, lymph nodes are also removed from your armpit. Malignant cells can spread through the lymph nodes. Your doctor will see whether the gland is 'clean' or not. That says a lot about further metastasis. Based on these results, he determines what the rest of your treatment will be like.
In breast cancer, it is important to remove the tumor completely. If this does not work, chances are higher that the tumor will return. The so-called ends are not clean. The second operation often follows to remove the remaining tumor.
Irradiation
Most women are irradiated at any given moment. Irradiation means that strong X-rays are directed to the site of the tumor. The rays destroy cancer cells. After breast preservation surgery you always get irradiation treatment, but even after this amputation may be required.If you have metastasis throughout your body, you get radiation in places where you suffer. So it's about relieving symptoms (pain), not about healing.
Chemotherapy
In chemotherapy you get treatment with drugs: cytostatics. They inhibit cell division and destroy cancer cells in your body. There are all types of sitostatics and you can receive them with infusion, injections and tablets.Usually you get your medicine, then take a few weeks off and then you get chemotherapy again. That's what happened for a few months to half a year.
Many patients are afraid of serious side effects such as nausea, vomiting, fatigue and hair loss. For some women, the treatment is very heavy, with other side effects not too bad. However, there are good medicines today that suppress nausea.
Hormone therapy
Milk cells require the hormones estrogen and progesterone to grow. These hormones are mainly made in the ovaries and attached to the receptors called on the cells of the mammary glands. Sometimes breast cancer cells also have these receptors. Then estrogen and progesterone ensure that the tumor can grow faster.Therefore it is important to reduce the production of these hormones. This can be done through special medicines: hormonal preparation. Sometimes it is decided to remove the ovaries. If that happens when you are still menstruating, you come into an early transition period.
Not all breast cancer cells are sensitive to hormones. This means that not everyone is eligible for hormone therapy.
Immunotherapy
Breast cancer can also be treated with trastuzumab antibodies. These antibodies strengthen your immune system and attack cancer cells. Trastuzumab attaches to a particular protein (HER2), which is outside the cancer cell. This ensures that the tumor can no longer grow.Not all cancer cells have this protein and the treatment is not suitable for everyone. It is imperative that the HER2 test be performed promptly on the diagnosis to see if the patient is eligible for treatment with trastuzumab antibodies.
Gene profile
There are profitable and unfavorable gene profiles. It says something about how the tumor will behave. A gene profile test is a good tool to help determine this. For example, a particular tumor stage can determine whether chemotherapy is needed. In the future it will become increasingly clear which factors and tests predict how the tumor will behave best. There is a lot of research on this. You can read more about the relationship between genes and cancer at the Cancer Genomic Center website. This organization is involved in research into genes.Pregnancy
If you are pregnant and have breast cancer, treatment can usually be done. Operation is safe for you and your child. However, direct breast reconstruction is usually not recommended, since surgery every hour carries more complications.Irradiation is possible, but not always safe for children. It is advisable to delay this treatment until after delivery, if possible. Chemotherapy can be given after the first 3 months of pregnancy. Birth delivery for week 37 is therefore often avoidable. Premature birth can cause complications, rather than chemotherapy.
Hormonal therapy is unsafe and causes complications during pregnancy. Trastuzumab also causes complications. This is harmful to the child's heart. This treatment should be postponed until after delivery.
An important development here is the choice of therapy can be tailored to the specific characteristics of individual patient tumors. Examples are hormone therapy directed against ER / PR receptors and antibody therapy directed against HER2 proteins. Another new therapeutic group is the angiogenesis inhibitor.
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