Treatment of Breast Cancer

Once the diagnosis of breast cancer is established, the choice of initial treatment depends upon the stage or extent of disease. The treatment of breast cancer must be individualized and is based upon several factors

Step 1

Treatment of Early stage breast cancer:

Early stage breast cancer includes stage I (tumor size 2 cm or spread to lymph nodes of the same side as the cancerous breast). A tumor >5 cm without involvement of any lymph nodes is also considered early stage cancer.

Two surgical options are available for treating Early stage breast cancer: removal of the full breast (mastectomy) and removal of the cancerous tissue only also referred to as breast conserving therapy. This should be followed by radiation therapy.

Step 2

The need for additional drug therapy depends on the type of the tumor. After removal, the cancerous tissue is analyzed to see whether it was sensitive to female hormone estrogen, in which case the tumors need estrogen to grow and thrive. This is usually done by confirming the presence of estrogen hormone receptors in the cancerous cells.

Accordingly a woman may have hormone receptor-negative breast cancer or hormone receptor positive breast cancer. The clinical implication of knowing this is that the receptor negative group is unlikely to be benefited by medications that lower the levels or block the actions of estrogen whereas the other group would be ideal for anti-estrogen treatment. Some of the anti-estrogen drugs that are used include:
tamoxifen (Nolvadex) and goserelin (Zoladex).

Step 3

Irrespective of the receptor status, chemotherapy with following drugs may be administered in selected patients: cyclophosphamide, methotrexate, 5-fluorouracil, paclitaxel, docetaxel and doxorubicin.

Step 4

Recently, Trastuzumab (Herceptin), which is an antibody against tumor cells, has been used in selected patients with good results.

Step 5

Breast reconstruction is an important option for women who undergo mastectomy.

Step 6

Stage III disease (extensive bilateral lymph nodal disease, direct tumor extension to the chest wall or skin) or inflammatory breast cancer and stage IV disease (metastatic breast cancer) are treated with surgery, radiation therapy, chemotherapy, endocrine therapy, trastuzumab or some combination of these options