Treating breast cancer
The ways and methods of treating cancerous growths that originate in the breast.
What is the treatment?
The extent of the cancerous growth within the breast, whether it has spread to other parts of the body, and whether it is oestrogen-sensitive are the main considerations when deciding on the most appropriate course of treatment. Once a full assessment has been made, your doctor will discuss your treatment options with you. Treatment of breast cancer may include surgery, radiotherapy, chemotherapy, hormone therapy, or, most frequently, a combination of these. Counselling may help you to come to terms with cancer, and some complementary therapies can be used to promote a sense of well-being.
Surgery for breast cancer
Surgery is normally the first stage of breast cancer treatment. There are many possible types of operation used to treat breast cancer (see Surgery for breast cancer).
If the tumour is small, a lumpectomy (sometimes also called a wide local excision) may be performed, in which the tumour and a small area of surrounding tissue are removed. A larger tumour is treated by a quadrantectomy, in which about a quarter of the breast tissue is removed.
In some cases, all of the tissue from the affected breast is surgically removed in a procedure known as a mastectomy. Some women choose to have a mastectomy because they think that this is the only way to make sure all of the tumour has been removed but medical studies have shown that this operation is not necessary for treating most single, small breast tumours.
During surgery, a number of lymph nodes from the armpit on the same side as the affected breast may be removed. These lymph nodes are examined to look for signs of cancer. If the lymph nodes are found to be free of cancerous cells, the cancer is unlikely to have spread from the tumour site.
Surgery will affect the appearance of your breast. If one breast looks smaller after surgery, you may want to have the other breast reduced to the same size (see Breast reduction). After a mastectomy, some women have a breast reconstruction. This operation can either be performed at the same time as the mastectomy or at a later date.
Radiotherapy for breast cancer
Treatment with radiotherapy is given to almost all women after lumpectomy, regardless of the size of the tumour. It may also be used after mastectomy if a large tumour is removed or if the cancer is fast-growing or has spread to the lymph nodes. Treatment usually begins 1 month after surgery and is given 5 days a week for a period of about 6 weeks. The aim is to destroy any cancer cells that may remain after surgery.
Tumours that are oestrogen-sensitive usually respond to drugs that block the action of oestrogen, whereas cytotoxic chemotherapy is often effective for all types of tumour.
Tamoxifen (see Sex hormones and related drugs) inhibits the effects of oestrogen so that the tumour becomes smaller or does not grow as quickly. Tamoxifen is usually taken for 5 years. The drug is also effective in preventing breast cancer in women at increased risk. There are newer forms of hormone therapy (using drugs called aromatase inhibitors) that may be used for women who cannot take tamoxifen and for those who have advanced breast cancer.
Cytotoxic chemotherapy involves using combinations of drugs that destroy rapidly dividing cancerous cells. Treatment is usually given at intervals of 3-4 weeks over a period of 4-6 months. In most cases, cytotoxic chemotherapy is used in addition to surgery. These drugs can also kill normal cells, and commonly cause side effects such as hair loss and mouth ulcers.
Complementary therapies and treatement
Women with breast cancer may choose to complement conventional treatments with other therapies, such as relaxation exercises, meditation, homeopathy, or acupuncture. These therapies should not be regarded as alternatives to conventional treatment. If you are considering using complementary therapies, you should consult your doctor. Counselling, in which people are encouraged to express their feelings, may also be helpful in coping with cancer.
What is the prognosis?
If breast cancer is diagnosed before it has spread to other body organs, treatment is more likely to be successful and the cancer is less likely to recur after treatment. Combining drug treatment with surgery has been found to improve the chances of long-term survival.
Following treatment, you will have follow-up examinations with your doctor and regular mammograms to check for recurrence of the disease. About 1 in 4 women treated for breast cancer has a recurrence within 5 years. Cancer may recur close to the site of the original tumour or in a different area. Any recurrence requires further treatment.
About 7 in 10 women who receive treatment for breast cancer in its early stages survive for 10 years or more.
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