Treating Breast cancer

Fighting breast Cancer

Reconstruction

Breast Cancer Reconstruction

Following a mastectomy, you have options to help you become comfortable with the changes in your body. They are all options, with benefits to each approach. What is best for you and your body may not be what is best for another woman.

If you are considering breast reconstruction, you should speak with your medical team before the mastectomy, even if you plan to have your reconstruction later on.

Reconstruction Methods 

There are a few of options for breast reconstruction, and which one you use will depend on your age, body type, and treatment plan.

Implants 

One possibility is to have breast implants. The breast is filled with silicone sacs of saline or silicone gel.

TRAM Flap, Latissimus Flap, or Gluteal Flap 
An alternative solution is to use tissue the surgeon removes from another part of your body, like the belly (TRAM), back (latissimus), or buttocks (gluteal). The surgeon sculpts this tissue into the shape of your breast.

 

Alternatives

Surgical Summary 

In addition to reconstructing the breast, the surgeon can add a nipple, change the shape or size of the reconstructed breast, and operate on the opposite breast as well for a better match. The plastic surgeon will be able to discuss with you the benefits and risks of each procedure, and help you decide what will make you feel the most natural.

Alternative to Breast Reconstruction 

One alternative to breast reconstruction is a removable prosthetic breast that is worn in the bra. This will preserve the shape and look of the breast without the surgical procedures.

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Chemoterapy

 
 

What Is Chemo?

Chemotherapy is a treatment method that uses a combination of drugs to either destroy cancer cells or slow down the growth of cancer cells.

  • Cytotoxic drugs (meaning “toxic to cells”) are usually given orally or through a vein (intravenously or “through the bloodstream”).
  • Chemotherapy is a systemic therapy, meaning that the drugs travel in the bloodstream throughout the entire body.

 

Chemotherapy for early and locally advanced breast cancer

After breast surgery (adjuvant chemotherapy)

For those with early breast cancer, chemotherapy is usually given after breast surgery (called adjuvant chemotherapy), but before radiation therapy.

Adjuvant chemotherapy helps lower the risk of breast cancer recurrenceby getting rid of cancer cells that might still be in the body.

Before breast surgery (neoadjuvant chemotherapy)

Chemotherapy is sometimes used before surgery (called neoadjuvant or preoperative chemotherapy).

In women with large tumors who need a mastectomy, neoadjuvant chemotherapy may shrink the tumor enough so a lumpectomy becomes an option.

In women with locally advanced breast cancer, neoadjuvant chemotherapy can reduce the size of the tumor in the breast and/or in the lymph nodes, and make it easier to surgically remove the cancer.

How Long The Treatment Lasts?

Chemotherapy usually lasts 3-6 months, but you have days or weeks off between treatments.

Your treatment schedule depends on the combination of drugs given.

And… Side Effects?

The majority of side effects occur during the course of treatment, but usually diminishes upon conclusion. However, there are some types of side effects know to last several months. The worst cases they can last years.

Chemo Side Effects lasts between 3 to 6 Months

Radiation Therapy

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Radiation Therapy Focus on trying to kill cancer cells

External Beam Breast

Cancer Radiation

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Side Effects

What Are The Side Effects Of Radiation?

Radiation therapy can have side effects, and these vary from person to person.

The most common side-effects are:

  • Sunburn-type skin irritation of the targeted area (which may range from mild to intense)
  • Red, dry, tender, or itchy skin
  • Breast heaviness
  • Discoloration, redness, or a bruised appearance
  • General fatigue

What should I do about side effects from breast cancer radiation?
If you experience difficulty from side effects, you should discuss them with your doctor, who may be able to suggest ways you can treat side effects and help yourself feel more comfortable. These problems usually go away over a short period of time, but there may be a lasting change in the color of your skin.

Here are some good general tips for dealing with the most common side effects of radiation:

  • Bras and tight clothes may rub your skin and cause soreness. You may want to wear loose-fitting cotton clothes during this time.
  • Gentle skin care also is important. You should check with your doctor before using any deodorants, lotions, or creams on the treated area.
  • You need to be aware that more intense treatment methods will tax your body. During radiation therapy, it is essential to take good care of yourself by getting extra rest and making good nutrition a priority.
  • Although resting is important, doctors usually advise patients to try to stay active too, unless it leads to pain or other problems. Routine exercise has been proven to reduce the degree of fatigue patients experience from radiation therapy.
  • You may wish to discuss with your doctor the possible long-term effects of radiation therapy. For example, radiation therapy to the chest may harm the lung or heart. Also, it can change the size of your breast and the way it looks. If any of these problems occur, your oncology team can tell you how to manage them.
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main Types Of Radiation Therapy:
Whole breast & Partial Breast

Hormone Therapy

Blockers vs Inhibitors

Before Menopause

After Menopause

If you have gone through menopause, the options include:

  • Aromatase inhibitor: This type of drug prevents the body from making a form of estrogen (estradiol). Examples are anastrazole, exemestane, and letrozole. Common side effects include hot flashes, nausea, vomiting, and painful bones or joints. Serious side effects include thinning bones and an increase in cholesterol. This is also a pill taken daily.
  • Tamoxifen: Hormone therapy is given for at least 5 years. Women who have gone through menopause receive tamoxifen for 2 to 5 years. If tamoxifen is given for less than 5 years, then an aromatase inhibitor often is given to complete the 5 years. Some women have hormone therapy for more than 5 years.

More research is underway to determine if there is a benefit in taking hormonal therapy for longer than 5 years. Some research studies have demonstrated that there may be benefits in switching from one hormonal therapy agent to another during the 5 year period. Your oncologist will discuss with you the most appropriate hormonal therapy regimen based on your breast cancer pathology and age. It is very important to take these pills every day as without adhering to the daily schedule and dosage as planned, you may not reap the benefit of these drugs. Overall, hormonal therapy can reduce risk of recurrence by 50%.
These drugs can be expensive. If you need financial help in paying for these medications contact the medical oncology nurse practitioner or social worker to receive assistance how to get the prescription at a discount.
Based on the side effects listed above, sexual dysfunction can occur. If you are experiencing a drop in libido, vaginal dryness resulting in pain during intercourse, make your oncologist aware as there may be some options for decreasing these side effects.

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Inhibitors and Blockers Options vary according to
Women's stage of life and age

Targeted therapy

What Is Targeted Therapy?

In addition to chemotherapy and hormone therapy, there are newer, more effective treatments that can attack specific breast cancer cells without harming normal cells. Currently, these targeted methods are commonly used in combination with traditional chemotherapy. However, targeted drugs often have less severe side effects than standard chemotherapy drugs.

How do breast cancer targeted therapies work?
Breast cancer targeted therapy uses drugs that block the growth of breast cancer cells in specific ways. For example, targeted therapy may block the action of an abnormal protein (such as HER2) that stimulates the growth of breast cancer cells.  For example, Trastuzumab (Herceptin®) or lapatinib (TYKERB®) may be given to a woman whose lab tests show that her breast tumor has too much HER2.

Monoclonal Antibiodes

Monoclonal Antibodies: Binding Agents For Cancer Cells

One type of targeted therapy currently being studied is monoclonal antibodies. These laboratory-manufactured proteins bind with certain cancers.

Herceptin: Targeting HER2-Positive Receptors

Monoclonal antibody drugs such as Herceptin (also known as Trastuzumab) target HER2-positive tumors. If cancer cells are positive for the HER2/neu receptors that means there is an overabundance of receptors on the cancer cell for the growth-stimulating HER2 protein.

The tumor acts almost like a magnet for growth hormones, and when the tumor cells connect with growth hormone cells, the cancer can quickly grow and multiply. Herceptin helps shrink these HER2-positive tumors by finding the cells, binding with them, and blocking the action of the receptor.

This drug is given through a vein. It may be given alone or with chemotherapy. Side effects that most commonly occur during the first treatment include fever and chills.

Other possible side effects include weakness, nausea, vomiting, diarrhea, headaches, difficulty breathing, and rashes. These side effects generally become less severe after the first treatment. Herceptin also may cause heart damage, heart failure, and serious breathing problems. Before and during treatment, your doctor will check your heart and lungs.

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Herceptin

How is Herceptin administered and what are the likely side effects?

This drug is given through a vein. It may be given alone or with chemotherapy. Side effects that most commonly occur during the first treatment include fever and chills.

Other possible side effects include weakness, nausea, vomiting, diarrhea, headaches, difficulty breathing, and rashes. These side effects generally become less severe after the first treatment. Herceptin also may cause heart damage, heart failure, and serious breathing problems. Before and during treatment, your doctor will check your heart and lungs.

Lapatinib: blocking abnormal proteins that signal cancer cells to multiply

This tablet, taken by mouth, helps stop or slow the spread of cancer cells. Lapatinib is given with chemotherapy or after other methods have not worked to slow the cancer.

Side effects can include nausea, vomiting, diarrhea, tiredness, mouth sores, and rashes. It can also cause red, painful hands and feet. Before treatment, your doctor will check your heart and liver. During treatment, your doctor will watch for signs of heart, lung, or liver problems.

As with all medical treatments, if you experience unusual changes in your health during targeted therapy, notify your doctor immediately.

Bevacizumab: Reducing the cancer cells’ blood supply

Another targeted therapy, Bevacizumab, prevents tumors from making new blood vessels that could feed the tumor, essentially cutting off the cancer cells from all nutrients.

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The risk of developing lymphedema
continues for the rest of your life.

Nutrition

Taking Care Of Yourself During Treatment And Beyond

It’s important for you to take very good care of yourself before, during, and after cancer treatment.

  • Taking care of yourself includes eating well and staying as active as you can.
  • Do your best to eat the right amount of calories to maintain a good weight.
  • Adequate protein can help to keep up your strength.

What if I don’t feel well enough to eat much of anything?
Eating well may actually help you feel better and have more energy. Sometimes, especially during or soon after treatment, you may not feel like eating. Some treatments can leave you feeling tired and uncomfortable. Or you may find that some foods don’t taste as good as they used to.

In addition, the side effects of treatment (such as poor appetite, nausea, vomiting, or mouth blisters) can make it hard to eat well. On the other hand, some women treated for breast cancer may have a problem with weight gain.

Your doctor, a registered dietitian, or another healthcare provider can suggest ways to help you meet your nutrition needs and remain as close to a healthy weight as you can.

Physical Care

Is It Okay To Continue To Exercise During Breast Cancer Treatments?

Yes, as long as your doctor okays your physical activity. Many women find that they feel better when they stay active. Walking, yoga, swimming, and other activities can keep you strong and increase your energy. Exercise may reduce nausea and pain and make treatment easier to handle. It also can help relieve stress. Whatever physical activity you choose, be sure to talk to your doctor before you start.

Also, if your activity causes you pain or other problems, be sure to let your doctor or nurse know.

Mayo clinic Nutrition and Fitness Guides

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Nutrition and Physical Fitness are very important factors
on surviving breast cancer

Follow Up

What Happens When My Cancer Treatment Rounds Are Complete?

You’ll need regular check-ups after treatment for breast cancer. Check-ups help ensure that any changes in your health are noted and treated if needed. If you have any new health problems between checkups, you should contact your doctor.

What Happens At Breast Cancer Follow-Up Appointments?

Your doctor will check for return of the breast cancer. Also, check-ups help detect health problems that can result from cancer treatment.

Check-ups usually include an exam of the neck, underarm, chest, and breast areas. Since a new breast cancer may develop, you should continue to have regular mammograms. You probably won’t need a mammogram of a reconstructed breast or if you had a mastectomy without reconstruction. Your doctor may order other imaging procedures or lab tests.

What Kinds Of Problems Need To Be Reported To My Physician During The Breast Cancer Follow-Up Phase?

You should report any changes in the treated area or in your other breast to your doctor right away.

Follow Up Care

Oncologist, Dr. Antonio Wolff, MD

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Articles Sources

Cancer research UK – Treatments

breastcancer.org – Treatment and Side effects

Cancer.net – Breast Cancer  Types Of Treatments

Breast Cancer Care – Going through Breast Cancer Treatment

Maurer Foundation for Breast Health Education – Search: Treatments

American Cancer Society –Treating Breast Cancer

innovation.org – Treatment Approaches

National Health Services UK – Breast Cancer Treatments

Susan G. Komen – Breast Cancer Treatment: Introduction

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