Breast cancer treatment: guideline, methods, by stage, triple negative, metastatic. Depending on the type of cancer, the stage and grade, the size, and whether you have hormone-sensitive cancer, your doctor will determine your treatment options.
Your doctor will also consider your general health and personally preferred treatment options.
In most cases, women with breast cancer undergo surgery, and many also require additional treatment afterward, such as chemotherapy, hormone therapy, or radiation. Patients may also receive chemotherapy before surgery if needed.
Choosing a treatment for breast cancer is a complex process, and you may feel overwhelmed trying to decide what will work for you. If you think you need a breast specialist, you should consider obtaining a second opinion in a breast center or clinic. If you are unsure of your decision, you may want to talk to another woman.
Guideline
If a patient is experiencing symptoms that could indicate breast cancer, their general practitioner should refer them to specialized breast clinics. A screening mammogram is also offered every three years to women aged 47 to 73 years as part of the NHS Breast Screening Programme (NHSBSP).
Depending on your age, a referral may be needed from a screening assessment clinic. You may also need a referral from another cancer MDT or specialist.
Patients who are referred will not know the precise diagnosis at the time of referral, and many will be discovered to be cancer-free after referral. Essentially, primary healthcare professionals need to convey optimism to patients when they are referred with a breast lump because they naturally feel concerned.
Women of all ages who are concerned about breast cancer may require specialist knowledge and assistance. Primary healthcare providers should discuss the patient’s needs with them and respond appropriately. In order to reduce the time it takes for symptoms to manifest, primary care providers need to teach patients to be “breast aware.”
The first sign that a woman may have breast cancer is a lump in her breast. The lump should be examined by the patient’s primary healthcare provider if the patient permits it.
Any discrete, firm lump attached to the skin, whether or not it is tethered, should raise suspicion of malignancy in the provider’s mind. No matter how old the patient is, anyone who arrives in this manner should be referred immediately. Consider the history of the patient as well.
Methods
Following are the methods:
Surgery
The most common kind of treatment for breast cancer is surgery. Your operation will be determined by the type of breast cancer you have. In surgery following measures are taken:
- Removing the breast cancer (lumpectomy)
- Remove the entire breast (mastectomy)
- Removing a limited number of lymph nodes
- Removing several lymph nodes
- Removing both breasts
Chemotherapy, radiation, or, in rare situations, hormone or targeted therapies are generally used after surgery.
The type of breast cancer you have will determine the treatment you receive.
Your doctor will talk to you about the best treatment options. Chemotherapy or hormone therapy may be used as a first line of defence.
Radiotherapy
Using controlled doses of radiation, radiotherapy kills cancer cells. Cancer cells that have not been destroyed by other treatments are often destroyed by radiotherapy after surgery and chemotherapy.
In order to allow your body time to heal, radiotherapy will begin around a month after your surgery or chemotherapy.
You’ll likely get radiation sessions three to five days a week for three to five weeks.
Chemotherapy
The goal of chemotherapy is to eliminate fast-growing cells, such as cancer cells, through the use of medications. A doctor may recommend chemotherapy following surgery to reduce the chances of cancer recurring or spreading to other parts of your body if your cancer has a high risk of recurrence or spreading.
Occasionally, women with larger breast tumors undergo chemotherapy before surgery. Surgically removing a tumor requires reducing the growth to a level where it can be removed.
Also, chemotherapy is used in the treatment of cancers that have spread to other parts of the body. As a part of managing cancer and relieving its symptoms, chemotherapy may be prescribed.
Hormone therapy
Breast cancers with a strong hormonal response are treated with hormone therapy, or, perhaps more accurately, with hormone-blocking therapy. Cancers with estrogen receptors (ER positive) and progesterone receptors (PR positive) are referred to by doctors as estrogen receptor-positive and progesterone receptor-positive, respectively.
In order to reduce the risk of cancer recurrence, hormone therapy can be administered either before or after surgery or other treatments. When cancer has already spread, hormone therapy may be helpful in controlling it.
Targeted therapy drugs
As the name implies, targeted therapies treat cancer cells by targeting specific defects residing within them. The protein human epidermal growth factor receptor 2 (HER2), which is expressed by some breast cancer cells, is targeted by several targeted treatment medications.
Breast cancer cells rely on this protein to grow and survive. As the medications target cells that produce too much HER2, they can harm cancer cells while protecting healthy cells.
Cancer cells can be treated with medications that target various defects. A targeted therapy approach to cancer treatment is also gaining attention.
Immunotherapy
A possible treatment option for cancers with triple-negative hormone receptors, which lack estrogen, progesterone, or HER2 receptors, is immunotherapy. Triple-negative breast cancer that has spread to other areas of the body can be treated with immunotherapy and chemotherapy.
By Stage
Stage 0
Stage 0 cancers are not invasive (do not invade surrounding tissues) and are limited to the milk ducts.
Stage 0(DCIS) tumors are ductal carcinomas in situ.
Lobular carcinoma in situ (LCIS) used to be assessed as stage 0, but this classification has been changed since it is not cancer. However, it still indicates an increased risk of breast cancer.
Breast cancer that has spread only to the milk ducts of the breast is known as ductal carcinoma in situ (DCIS), which means cancer has not spread to the surrounding breast tissue.
Breast cancer classified as non-invasive or pre-invasive is called DCIS. It is important to note that, although DCIS cannot exist outside the breast, it is frequently treated since, if left untreated, certain DCIS cells can undergo alterations that may cause invasive breast cancer (which spreads).
With DCIS, a woman most commonly has the option of choosing between a breast-conserving surgery or a straightforward mastectomy. A mastectomy is recommended for women whose DCIS has spread across the breast. We are examining whether observing instead of surgery is a viable option for some women through clinical trials.
Stage I-III
Most women with stage I to III breast cancer are treated with surgery and radiation, often in combination with chemotherapy or other drug therapies either before (neoadjuvant) or after (adjuvant) surgery.
Stage I: The breast cancers in these cases are still relatively small and do not have many lymph nodes involved, or cancer has only spread to a very small number of sentinel lymph nodes (the first lymph node to which cancer spreads).
Stage II: A few nearby lymph nodes have been affected by these breast cancers, which have grown larger than stage I cancers.
Stage III: Usually, these tumors are larger or have spread to nearby tissues (the skin or muscle over the breast or they have spread to several lymph nodes nearby).
Triple negative Breast Cancer treatment
As well as not producing any or too little of the HER2 protein, TNBC is characterized by the absence of estrogen and progesterone receptors. Since HER2 is not present in cancer cells, hormone therapy and medicines targeting this protein cannot be effective; thus, chemotherapy (chemo) is the only systemic therapy that can be used.
Furthermore, TNBC exhibits a higher recurrence rate than other breast cancers in spite of the fact it responds to chemotherapy quite well at first.
- If the tumor is small, the surgeon may recommend a lumpectomy (breast-conserving surgery).
- The mastectomy and removal of lymph nodes may be required if there are lymph node involvements.
- Surgical removal of the tumor may be followed by radiation if cancer spreads to the lymph nodes or is large.
- If the cancer is in its early stage, chemotherapy (neoadjuvant chemotherapy) is used to shrink a large tumor before surgery (neoadjuvant chemotherapy) or after surgery (adjuvant chemotherapy) in order to reduce the risk of recurrence.
Metastatic Breast Cancer Treatment
In the case of metastatic cancer following treatments are used:
- During the progression of the disease to other parts of the body, chemotherapy may be the first course of action.
- Those with triple-negative breast cancer with a BRCA mutation who cannot be treated with standard chemotherapy may benefit from platinum-based chemotherapy medicines (cisplatin or carboplatin).
- Patients with triple-negative breast cancer and a BRCA mutation may benefit from PARP inhibitors (such as olaparib/Lynparza® and talazoparib/Talzenna®) since they target a critical enzyme involved in DNA repair.
- Immunotherapy drugs in combination with chemotherapy may be the first-line treatment for triple-negative breast cancer patients carrying the PD-L1 protein (such as atezolizumab/Tecentriq® or pembrolizumab/Keytruda®). An estimated one out of every five triple-negative breast cancers contain this protein.
- People who have received two different medication treatments may find sacituzumab/Trodlevy® govitecan-hziy to be an alternative to two different medications.
Read also: Inflammatory Breast Cancer; Metastatic Breast Cancer; Breast Cancer in Men
External resource: Cancer org
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