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Breast cancer - Diagnosis
and Treatment
Diagnosis
Breast self-examination
(BSE): Breast self examination
is an effective way to determine early breast cancer. Survival
at 5 years was 75% in women performing BSE and 57% in
non-performers.
Mammograms-
Mammography is a useful adjunctive diagnostic measure when used
in patients with clinically suspicious or high-risk breasts.
About 25% of breast cancers diagnosed in mass screening
programs are detected by mammography alone. A negative
mammogram in a patient with a palpable mass should not
dissuade a biopsy or an fine needle aspiration cytology (FNAC)
or biopsy.
Breast ultrasound
can rapidly and accurately determine if a mass is a simple
cyst. If so, it is benign and no further work up is necessary.
Biopsy:
Biopsy is done to provide cells or tissue in order to establish
a definitive diagnosis. Biopsy can be done in several
different ways:
Treatment for Breast Cancer
Four types of standard
treatment are used:
Surgery
Most patients with breast cancer
have surgery to remove the cancer from the breast. Some of the
lymph nodes under the arm are usually taken out and looked at
under a microscope to see if they contain cancer cells. Type of
surgery depends on the stage of the disease and type of tumor.
Lumpectomy:
A surgical procedure to remove a tumor (lump) and a small
amount of normal tissue around it.
Partial mastectomy:
A surgical procedure to remove the part of the breast that
contains cancer and some normal tissue around it. This
procedure is also called a segmental mastectomy. Patients who
are treated with breast-conserving surgery may also have some
of the lymph nodes under the arm removed for biopsy.
Total mastectomy:
A surgical procedure to remove the whole breast that contains
cancer. This procedure is also called a simple mastectomy. Some
of the lymph nodes under the arm may be removed for biopsy at
the same time as the breast surgery or after. This is done
through a separate incision.
Modified radical mastectomy:
A surgical procedure to remove the whole breast that contains
cancer, many of the lymph nodes under the arm, the lining over
the chest muscles, and sometimes, part of the chest wall
muscles.
Radical mastectomy:
A surgical procedure to remove the breast that contains cancer,
chest wall muscles under the breast, and all of the lymph nodes
under the arm. This procedure is sometimes called a Halsted
radical mastectomy.
Even if the doctor removes all of
the cancer that can be seen at the time of surgery, the patient
may be given radiation therapy, chemotherapy, or hormone
therapy after surgery to try to kill any cancer cells that may
be left. Treatment given after surgery to increase the chances
of a cure is called adjuvant therapy.
If a patient is going to have a
mastectomy, breast reconstruction (surgery to rebuild a
breast?s shape after a mastectomy) may be considered. Breast
reconstruction may be done at the time of the mastectomy or at
a future time.
Radiation therapy-
Radiation therapy is a cancer
treatment that uses high-energy x-rays or other types of
radiation to kill cancer cells. There are two types of
radiation therapy. External radiation therapy uses a
machine outside the body to send radiation toward the cancer.
Internal radiation therapy uses a radioactive substance
sealed in needles, seeds, wires, or catheters that are placed
directly into or near the cancer. The way the radiation therapy
is given depends on the type and stage of the cancer being
treated.
Chemotherapy
Chemotherapy is a cancer treatment
that uses drugs to stop the growth of cancer cells, either by
killing the cells or by stopping the cells from dividing. The
way the chemotherapy is given depends on the type and stage of
the cancer being treated. Mostly chemotherapeutic drugs are
given in cycles either alone or in combinations. Some of the
common chemotherapeutic drugs include -
Chemotherapy combinations for non-metastatic
breast cancer
-
AC T
- Adriamycin (chemical name: doxorubicin) with
cyclophosphamide (brand name: Cytoxan), with or without Taxol
(chemical name: paclitaxel)
-
CMF
- cyclophosphamide, methotrexate,
and fluorouracil ("5-FU" or 5-fluorouracil)
-
CAF
- cyclophosphamide, Adriamycin, and fluorouracil ("5-FU" or
5-fluorouracil)
-
CEF
- cyclophosphamide, Epirubicin (similar to Adriamycin), and
fluorouracil ("5-FU" or 5-fluorouracil)
-
FAC
- fluorouracil ("5-FU" or 5-fluorouracil), Adriamycin, and
cyclophosphamide.
All the drugs used for
chemotherapy have varying degree of unpleasant side effects.
Hormone therapy (adjuvant
therapy)
Hormone therapy is a cancer
treatment that removes hormones or blocks their action and
stops cancer cells from growing. The presence of some hormones
can cause certain cancers to grow. If tests show that the
cancer cells have places where hormones can attach (receptors),
drugs, surgery, or radiation therapy are used to reduce the
production of hormones or block them from working. Hormone
therapy with tamoxifen is often given to patients with early
stages of breast cancer and those with metastatic breast cancer
(cancer that has spread to other parts of the body). Hormone
therapy with tamoxifen (selective estrogen receptor
modulating drug) is most common.
Anastrozole (Arimidex),
letrozole (Femara), exemestane (Aromasin) are aromatase
inhibitors which can be used for treatment of homone
receptor positive breast cancer specially in post menopausal
women . Fulvestrant (Faslodex) an Estrogen receptor
downregulators(ERDs) was recently approved by FDA for
treatment of breast cancer. Women taking tamoxifen
should have a pelvic examination every year to look for any
signs of cancer. Any vaginal bleeding, other than menstrual
bleeding, should be reported to a doctor as soon as possible.
Immune therapy
- Trastuzumabis (Herceptin ) is
the only immune treatment currently available for breast
cancer. Herceptin works only against breast cancers that make
too much of the HER2/neu, or HER2, protein. These cancers are
called "HER2 positive." About one out of every four breast
cancers is HER2 positive. It is considered an immune treatment
because it helps the immune system fight the cancer.
A combination of different
therapies is often used for treating breast cancer. For
example - Surgery may combined with radiotherapy and
chemotherapy or hormone therapy |
