Natural Health and Herbal Remedies Blog

BREAST CANCER: TREATMENT

The treatment of breast cancer has changed dramatically over the last fifty years. Extensive surgery used to be routine, and was generally quite disfiguring. The trend now is for less extensive surgery, combined with other cancer treatments, like radiotherapy and chemotherapy.

Assessing the stage of the cancer is important in not only giving some idea of prognosis, but also in planning treatment, as the suggested options vary depending on the size of the tumour and the level of spread.

Staging involves collating information from different sources to determine:

• the size of the tumour

• whether or not there is spread to axillary nodes

• whether or not there is evidence of distant spread (metastases).

Apart from the investigations already outlined, specific tests to check for distant spread will usually be undertaken if any of the preliminary tests have proven malignancy. A chest x-ray, blood tests for liver function and blood count, and often a bone scan and liver ultrasound will be performed, as breast cancer tends to spread to the chest, liver and bone.

Examination of the excisional biopsy will give information regarding the size and type of the cancer, and whether the lump has been fully removed, along with an adequate margin of normal tissue around it.

The surgeon will usually operate on the axilla (armpit), removing as many lymph nodes as possible. The reason for this is that breast cancer tends to spread to these nodes, and finding out whether spread has occurred or not is a useful staging procedure to plan management.

Treatment options can also depend on other factors, apart from the staging. The wishes and health of the woman, whether she is pre- or post-menopausal, and where in the breast the tumour is situated are important. The aim of treatment may be to cure the cancer (the usual aim with earlier stage disease), or palliation. Palliation means relieving symptoms, and this would be the aim of treatment if the chances of cure were thought to be extremely small, as is usually the case with more advanced breast cancer.

Most treatment options involve surgery. Surgeons tend towards more conservative surgery where this is possible.

The term total mastectomy is used to describe an operation in which all the breast tissue is removed. The skin overlying the breast tissue, together with the breast and surrounding fat are removed, and the skin is closed with sutures. These days die muscles under the breast are usually left in a routine mastectomy, as this helps to improve function of the arm, and is less disfiguring than the more extensive operations performed in the past (radical mastectomy).

Variations on the garden-variety mastectomy include leaving the skin, nipple and areola, or inserting a prosthesis at the initial operation to allow for early reconstruction. This may be done in the hope of a better cosmetic result, but individual factors may mean that some women are nor suitable for these variations, which are called partial mastectomies.

Operations which remove less than the total breast tissue are commonly performed. These are called sub-total mastectomies, or segmentectomies (removing a segment of breast), or lumpectomies, or clear local excision, depending on how much tissue is removed. Some of these operadons can be performed without much alteration to the breast shape and size, and are often chosen by women for their cosmetic result These less disfiguring operadons may give the same success rates as the more extensive operations, as they are usually combined with other therapies, like radiotherapy and chemotherapy.

Very early cancer, with no evidence of invasion into the surrounding breast tissue, is potentially curable with surgery alone. Removal of the breast tissue by mastectomy (partial or total) may be all the treatment recommended.

If the tumour shows spread into the breast tissue, removal of the breast tissue by some degree of mastectomy would usually be recommended. The axilla would also be operated on, and the nodes removed in what is known as axillary dissection.

If a less than total mastectomy is performed, radiotherapy to the remaining breast tissue will usually be recommended. Radiotherapy involves exposing the remaining breast to specific forms of x-rays that have a damaging effect on cancer cells.

If the lymph nodes show evidence that the cancer has spread, then chemotherapy may be suggested. If the woman is not yet menopausal, the chemotherapy will usually be in the form of cancer-treating medication, similar to those used in other cancers. A course of several doses would be given. Anti-cancer medications are known for their tendency to produce unpleasant side-effects, like nausea. There are several different specific types, and the ones usually used for breast cancer may give some short-term problems, but they are usually fairly well tolerated, as far as chemotherapy goes.

If the woman has already become menopausal, it is likely that she will be offered a different kind of medication. This is a drug called Tamoxifen, and it has an anti-oestrogen action, which has been shown to be of benefit in treating breast cancer in post-menopausal women. It is not like the other general anti-cancer drugs, and is said to produce very few side-effects.

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