The breast cancer treatment depends on patient’s menopausal status, the hormonal receptor and HER2 status, the type of breast cancer, stage and grade of the tumor, and patient’s performance status, along with other factors. Following are the preferred treatment approaches for different stages of breast cancer, but the final decision is taken after clinical assessment of the patient by an oncologist.
|I||Stage I breast cancer is generally treated with modified radical mastectomy (MRM) or breast conservation surgery (BCS). Radiation therapy is given after BCS in all cases. Chemotherapy and/or hormonal therapy and/or HER2 targeted therapy may be given in selected cases as per oncologist’s discretion.|
|II||Stage II breast cancer is generally treated with MRM or BCS. Radiation therapy is given in all cases after BCS and in some cases after MRM. Chemotherapy and/or hormonal therapy and/or HER2 targeted therapy may be given in selected cases as per oncologist’s discretion.|
Stage III breast cancer is mostly upfront unresectable (except T3N1) and is generally treated with chemotherapy and/or hormonal therapy and/or HER2 targeted therapy to shrink the tumor size. This is followed by MRM or BCS. Radiation therapy has to be given in all cases after surgery.
T3N1 disease is generally treated with modified radical mastectomy (MRM) or breast conservation surgery (BCS). Radiation therapy is given in all cases. Chemotherapy and/or hormonal therapy and/or HER2 targeted therapy may be given as per oncologist’s discretion.
Stage IV breast cancer is generally treated with chemotherapy and/or hormonal therapy and/or HER2 targeted therapy.
Other treatment options like surgery, radiation therapy or bone-directed therapy may be considered for palliation or relief of symptoms.
SURGERY FOR BREAST CANCER can be better understood from the video below.
Following video explains the CHEMOTHERAPY, TARGETED THERAPY, AND HORMONAL THERAPY for breast cancer.
Following is the brief description of various treatment types commonly used for breast cancer:
Surgery: Surgery is the treatment for most localized and locally advanced tumors that have not spread to distant body parts and can be completely removed by a surgical procedure. Following are some commonly employed surgical procedures for the treatment of breast cancer:
Breast Conservation Surgery: In this surgical procedure, only a part of the affected breast is removed, along with the axillary lymph nodes. This surgery is sometimes referred to as lumpectomy, quadrantectomy, partial mastectomy, or segmental mastectomy. The advantage of this technique is that the patient can retain most of her breast. In most of the cases, breast-conversion surgery is followed by radiation therapy to prevent disease recurrence. If the patient is willing for the same, it may be done upfront in the early stage and after neoadjuvant chemotherapy in the advanced stage if the patient is the suitable candidate for the same as assessed by the oncologist.
Modified Radical Mastectomy: In this surgical procedure, the entire breast containing the tumor is removed, along with axillary lymph nodes. Radiation therapy is not required in all the cases after mastectomy, hence the procedure can be employed in patients who are not good candidates for the same (e.g., pregnant women, prior radiation to the chest wall). Also, it may be preferred in patients with certain genetic mutations (eg, BRCA) when there are high chances of tumor recurrence.
Sentinel Lymph Node Biopsy (SLNB): In this surgical procedure, sentinel lymph nodes (the first draining lymph node station from the tumor) are removed and checked for the presence of cancer cells. The advantage of SLNB is that it allows removal of relatively less number of lymph nodes. An absence of cancer in the sentinel lymph nodes indicates cancer has not spread to other lymph nodes. To find the sentinel lymph node, a surgeon first injects a radioactive substance and/or a dye into the cancer tissue. The sentinel lymph node is then determined as the first node detected to have radioactivity and/or the dye color.
Axillary Lymph Node Dissection (ALND): In this surgical procedure, axillary lymph nodes are removed and checked for the presence of cancer cells. It is mostly performed along with mastectomy or breast-conservation surgery as the same procedure.
Breast Reconstruction Surgery: Some patients may wish to restore their breast’s appearance after deformation of breasts due to breast cancer surgery. This can be achieved by a breast reconstruction surgery that can be performed at the same time as breast cancer surgery or at a later time as a separate procedure. Artificial graft or patient’s own tissue may be used for breast reconstruction.
s by using an external radiation source (external beam radiation therapy) or by directly placing the source of radiation near the cancer tissue (brachytherapy). It is used in all cases after BCS and in selected cases after MRM. It may sometimes be used for palliation of symptoms such as pain, bleeding, etc.
It is very important to assess the benefits of each treatment option versus the possible risks and side effects before making a treatment decision. Patient’s choice and health condition are also important to make a treatment choice.
Following are the goals of treating advanced-stage breast cancer:
-Prolongation of life
-Reduction of symptoms
-Improvement of overall quality of life
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TREATMENT FOR LOCALISED BREAST CANCER is explained in the video below in an easy manner.
Following video explains the TREATMENT FOR LOCALLY ADVANCED BREAST CANCER.
TREATMENT FOR METASTATIC BREAST CANCER can be understood from the video below.
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