Breast Cancer: Treatment Options

How is it treated?

Treatment options for Breast Cancer (like all cancers) vary with the stage of development that the disease is in. Some form of surgery is almost always part of treatment. This can be as simple as the removal of a small cancerous lump or as extreme as removing the entire breast, underlying muscle and tissue, and surrounding lymph nodes. Early detection is the key factor that determines what type of treatment is necessary. Treatment options are different for each individual case, but there are several common procedures listed below. The information presented is intended to provide patients with treatment information that they can use in discussing treatment options with their physician. (Note: Treatment options may change during pregnancy to avoid harm to the fetus.)

Surgery for Breast Cancer

Surgery is often followed by radiation, chemotherapy, and/or hormone therapy to destroy cancer cells that may have spread or may have been missed during surgery. This is known as adjuvant therapy.
**Breast reconstruction following surgical treatment is covered by insurance in RI and can sometimes be performed at the time of the initial treatment surgery.

* Lumpectomy- The lump, or tumor, is removed as well as some surrounding tissue. The surrounding tissue can be examined to determine if the cancerous tissue was fully removed in the first surgery. In order to minimize the risk of cancer cells that had spread away from the lump, a 6-week period of radiation treatment commonly follows surgery and some lymph nodes under the arm may be removed.
* Partial Mastectomy- The cancer tissue is removed along with a portion of the surrounding breast tissue and the lining over the chest muscle below the tumor. Some lymph nodes under the arm may be removed and radiation therapy could follow.
* Total Mastectomy- The entire breast is removed, but the underlying muscle is left intact. Radiation therapy may follow surgery.
* Modified Radical Mastectomy- The entire breast is removed as well as the lining over the chest muscles, many of the underarm lymph nodes, and sometimes a portion of the muscles in the chest wall. Radiation treatment could follow surgery. This is currently one of the most common types of treatment for Breast Cancer.
* Radical Mastectomy- The entire breast is removed along with the underlying chest muscle, and all the lymph nodes under the arm. Radiation therapy could follow surgery. Today, this procedure is normally only used when the cancer has definitely spread to the chest muscles.

Other Treatments

* Radiation Therapy- In some cases X-rays can be used to kill or shrink cancer cells at the site of the tumor. The radiation may also be administered by a machine, such as a linear accelerator or cobalt apparatus, or from a radioactive source implanted within the diseased area. External beam radiation therapy uses radiation from outside the body to focus on the cancer and is, therefore, not the primary treatment for cancer that may have spread.
* Chemotherapy- Drugs are administered by mouth or injection to kill the cancer cells. The drugs enter the blood stream and can, therefore, reach areas of the body where the cancer may have spread.
* Hormone Therapy- Some types of Breast Cancer have receptors that are affected by different hormones. In these cases, hormone replacement, hormone alteration, or removal of certain hormone producing organs (i.e., ovaries) can be a treatment option. This is not a treatment option for all types of Breast Cancer.
* Clinical Trials- There are always new experimental treatments being tested that often have promising results. The effectiveness and side effects of clinical trials are not always known, but they can sometimes offer hope of survival especially for end stage cancer patients. Consult your physician or the Rhode Island Cancer Council to find out what clinical trials are going on near you and if you are eligible.

What are the side effects of the treatments?

Certain side effects have been associated with different types of treatments. Each patient's response to treatment will be different but there are some common effects.

Possible Side Effects from Surgical Treatment

* General
o Temporary swelling and tenderness
o Hardness from the scar tissue at the surgical site
o Breast disfigurement (can be corrected through breast reconstruction)
o Possibility of wound infection or internal bleeding at wound site

* If lymph nodes under arm are removed
o Swelling of arm if underarm lymph nodes are removed
o Limitations in arm and shoulder movement
o Numbness of upper inner arm

Possible Side Effects from Non-Surgical Treatments

*Most side effects are temporary and can often be relieved with medication.

* Radiation Therapy
o Occasional fatigue
o Swelling and heaviness in the breast (6-12 months)
o Skin changes similar to a sunburn at affected site (6-12 months)
o Breasts can possibly become smaller and firmer after treatment
o Can contribute to swelling of the arm if axilla (underarm) is irradiated after surgery

* Chemotherapy
o Nausea and vomiting
o Loss of appetite
o Loss of hair
o Mouth sores
o Increased susceptibility to infection
o Premature menopause
o Infertility

* Hormone Therapy
o Depends on the specific medication used and the individual patient
o Ask your physician about possible side effects before beginning treatment.