Early breast cancer is curable but it is important to remember that each patient is an individual. Your specialist must tailor the treatment according to how your cancer is presenting.
There are fundamental treatment principles that should be adhered to such as: who should receive chemotherapy, who should receive radiation therapy and what different surgical options are available for each patient. The size of the tumour, the type of cancer, the size of the breast, the position of the tumour, the general health and psychological make-up of the patient all help determine which treatment options are utilized and in what order they are employed.
Once a cancer has been diagnosed there is no harm in taking a few days to discuss the different treatment options – there is no need to jump to a decision. Breast cancer is not an emergency. It is important to get treatment early but you can take time to explore your options. The average doubling time of breast cancer cells is 40 days; the cancer did not arrive yesterday and will not be gone tomorrow. So: go for a second opinion, speak to people you or your friends know who have had breast cancer, ask your doctor if you could speak to some of their other patients.
How do we Fight Back?
The treatment of breast cancer involves three lines of attack: surgery, radiotherapy and oncology.
These are often used in various combinations with each other, as decided by your “breast team”, the team of doctors treating your breast cancer.
Oncology
(chemotherapy and hormone manipulation)
An oncologist uses medication to fight cancer cells. This treatment is fundamental even when the breast cancer is diagnosed early and is still confined to the breast. Hormone and/or chemotherapy after surgery is known as adjuvant therapy. When such therapy is given before the surgery it is known as neo-adjuvant therapy, primary medical treatment or induction chemotherapy.
Chemotherapy drugs target growing cells and are therefore very efficient in killing fast-growing cancer cells. The drugs are administered every few weeks and the treatment period may take several months. Some drugs are taken by mouth and some are administered via intravenous drips.
Why do so many women get chemotherapy?
Compare chemotherapy to toilet bowl cleaner! You look at your toilet bowl and, even though it looks clean, you still put in the toilet cleaner, just in case. It is the same with chemotherapy. After surgery we use it to sterilize the body – not because we think that you have cancer elsewhere – it is just in case. This has led to the concept of adjuvant therapy.
Hormone therapy targets certain endocrine sensitive cancers. All breast cancers that show positive oestrogen and progesterone receptors should receive cancer hormone block therapy, irrespective of the age or menopausal status of the patient.
Hormones control normal body functions, they also target certain cancer cells. This is particularly true of hormones such as oestrogen. Some cancer patients are treated with drugs, which either contain hormones or inhibit the action of hormones. Hormone drugs are safer to use (their side effects are rarely serious) and they are often better tolerated than chemotherapy.
Radiation (DXT)
High energy x-rays are used to destroy any cancer cells that may remain in the surrounding tissue. Radiotherapy is effective in the local control of breast cancer. DXT decreases the incidence of local recurrence and may improve overall survival in certain patients. Radiotherapy will prevent local recurrence after breast conserving surgery and is therefore standard treatment after breast conserving surgery. In medial tumours (inner half of the breast) where there is a chance of internal mammary node involvement (glands under the ribs) the radiotherapist not only irradiates the remaining breast tissue – they may also add an additional blast to the internal mammary nodes.
Written by Dr Carol-Ann Benn