Treatment of Cancer of the breast

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Treatment options depend on how advanced the cancer is when it is diagnosed. The team at the hospital will offer support, give information, and discuss which treatments are likely to be most effective.

Early breast cancer:

Surgery

Women with early breast cancer (where the cancer is either only in your breast or has spread only to nearby lymph nodes) will be offered an operation to remove the cancer. Although some women may feel that a mastectomy (operation to remove the whole breast) is the safest option; actually a lumpectomy (operation to remove only the cancerous lump but conserve most of the breast) is just as effective in most cases (you are just as likely as a woman who has had a mastectomy to live for at least another ten years).

Radiotherapy

After surgery, women will be offered radiotherapy to the breast area to destroy any cancer cells that may remain and ensure that the cancer does not return. However, sometimes some cancer cells can separate off from the cancer in the breast and travel to other parts of the body via the blood or lymphatic system. These areas may be too small to be seen on scans. For this reason, doctors often suggest that women should also have some sort of extra treatment. The idea behind this treatment is to prevent or delay the chances of the cancer coming back. This treatment is often called adjuvant therapy and may include hormone therapy, chemotherapy or both.

Chemotherapy

Some women will be offered chemotherapy after surgery and radiotherapy. This is given to treat any active cancer cells that may be left behind anywhere in the body. The decision on whether to use chemotherapy will depend on the size of the cancer, its appearance under the microscope and the presence of spread to lymph nodes under the arm. Patients will need to discuss the risk of the cancer coming back together with the advantages and disadvantages of chemotherapy. Chemotherapy drugs are less often given to older women, as they appear to get less benefit.

Hormone therapy

Hormones are also commonly used after surgery and radiotherapy. When breast cancer contains hormone receptors, tamoxifen, anastrozole and other hormones can reduce the risk of the cancer coming back.

Deciding when to use extra therapy

When doctors decide which women might be helped by this extra chemotherapy or hormone therapy, they consider several factors including:

A womans age, whether or not she has reached the menopause,
The size of the cancer, how rapidly the cancer is growing,
Whether or not the cancer cells have special proteins on their surfaces called hormone receptors and whether or not the cancer has spread to the lymph nodes.

This allows doctors to give each woman a good idea of how likely her cancer is to return if she has no extra treatment. Doctors can then discuss how much each woman can be helped by having hormone therapy, chemotherapy or both and what the chances of a cure will be.

Women and their doctors can then balance these benefits against the chance of side effects and come to a decision about whether they have the extra treatment or not.

Advanced breast cancer

Advanced breast cancer is cancer that has spread to other parts of the body or cancer that has come back after treatment. This is also known as secondary breast cancer.

With some advanced cancers, treatment can be given with the aim of destroying all the remaining cancer cells and bringing about a cure. More often, where the disease has spread, it is given to shrink and control the cancer and try to prolong a good quality of life. Women may be offered different treatments, including:

Surgery
Radiotherapy
Chemotherapy
Monoclonal antibody therapy (Herceptin)
Hormone therapy
Complementary or alternative therapies

Many women with advanced breast cancer would respond to any of several treatments. However, other women respond better to some treatments than others. A specialist will look at many factors before recommending any treatment. These include:

Where the cancer has spread. If the cancer has come back to the breast or if it has spread to the bone or parts of the brain, surgery may be an option. If the cancer has spread to the lymph nodes, bones or skin then hormone treatment is often tried although chemotherapy may be used if the cancer is growing very quickly or if the hormone therapy stops working. If the cancer has spread to the liver or lungs, then chemotherapy is often tried first. Radiotherapy works well if the cancer has spread to the bones, parts of the brain, eyes, lymph nodes or locally near the original cancer.
Whether or not the cancer cells have special proteins on their surfaces called hormone receptors. Cancers where the majority of cells have these receptors are more likely to respond well to hormone therapy.
Whether or not women have reached the menopause.
How rapidly the cancer is growing.
What treatment was used for the cancer when it was first diagnosed.
Whether or not the cancer cells have special receptors, known as HER2 receptors, on their surfaces. If this is the case, a new treatment called herceptin may be useful.

Doctors will discuss how much each woman can expect to be helped by treatment and what might happen if she had no extra treatment. Women and their doctors can then balance the benefits against the chance of side effects and come to a decision about whether they have the extra treatment or not.