Monkey Butter's blog: "Breast Cancer"

http://www.rd.com/content/breast-cancer-treatment/ Through continuing research into new treatment methods, women now have more treatment options and greater hope for survival than ever before. Treatment options depend on the size and location of the tumor, the results of lab tests (including hormone receptor tests), and the stage (or extent) of the disease. To develop a treatment plan, doctors also consider a woman's age and menopausal status, her general health, and the size of her breasts. Many women want to learn all they can about their disease and their treatment choices so that they can take an active part in decisions about their medical care. They are likely to have many questions and concerns about treatment. A doctor is the best person to answer these: what the treatment choices are, how successful a treatment is expected to be, and how much it is likely to cost. Most patients also want to know how they will look after treatment and whether they will have to change their normal activities. Also, a patient may want to talk with her doctor about taking part in a clinical trial, a human research study, of new treatment methods. The National Cancer Institute's Cancer Information Service at 1-800-4-CANCER is another way to gather up-to-date treatment information, including information about current clinical trials. Cancer information specialists can provide thorough, personalized answers to questions about treatment. They can suggest other sources of information and support. They can also talk with callers about questions to ask the doctor. Planning Treatment Before starting treatment, a woman may want a second opinion about a diagnosis and treatment plan. Some insurance companies actually require a second opinion; others may cover a second opinion if the patient requests it. It may take a week or two to arrange to see another doctor. Studies show that a brief delay (up to several weeks) between biopsy and treatment does not make breast cancer treatment less effective. There are a number of ways to find a doctor for a second opinion: A patient's doctor may refer her to one or more specialists. Specialists who treat breast cancer include surgeons, medical oncologists, plastic surgeons, and radiation oncologists. Sometimes these doctors work together at cancer centers or special centers for breast diseases. The Cancer Information Service can tell callers about treatment facilities, including cancer centers and other NCI-supported programs, in their area. Patients can also get the names of specialists from their local medical society, a nearby hospital, or a medical school. The Official ABMS Directory of Board Certified Medical Specialists lists doctors along with their specialty and their background. Women can also search the American Board of Medical Specialties' Web site for specialists in their area. Methods of Treatment Methods of treatment for breast cancer can be local or systemic. Local treatments are used to remove, destroy, or control the cancer cells in a specific area. Surgery and radiation therapy are local treatments. Systemic treatments, which include chemotherapy and hormonal therapy, are used to destroy or control cancer cells throughout the body. Women may have just one form of treatment or a combination. Different forms of treatment may be administered at the same time or one after another. Surgery is the most common treatment for breast cancer. There are several types. The doctor can explain each in detail, discuss and compare the benefits and risks, and describe how each will affect the patient's appearance. An operation to remove the breast (or as much of the breast as possible) is called a mastectomy. Breast reconstruction may be performed at the same time as the mastectomy, or later on. An operation to remove the cancer but not the breast is called breast-sparing surgery or breast-conserving surgery. Lumpectomy and segmental mastectomy (also called partial mastectomy) are types of breast-sparing surgery. They usually are followed by radiation therapy to destroy any cancer cells that may remain in the area. In most cases, a surgeon also removes lymph nodes under the arm to help determine whether cancer cells have entered the lymphatic system. In lumpectomy, a surgeon removes the breast cancer and some normal tissue around it. Often, some of the lymph nodes under the arm are removed. In segmental mastectomy, a surgeon removes the cancer and a larger area of normal breast tissue around it. Occasionally, some of the lining over the chest muscles below the tumor and some of the lymph nodes under the arm are removed as well. In total (simple) mastectomy, a surgeon removes the entire breast. Some of the lymph nodes under the arm may also be removed. In modified radical mastectomy, the surgeon removes the whole breast, most of the lymph nodes under the arm, and often the lining over the chest muscles. The smaller of the two chest muscles is also taken out to help in removing the lymph nodes. In radical mastectomy (also called Halsted radical mastectomy), the surgeon removes the breast, the chest muscles, all of the lymph nodes under the arm, and some additional fat and skin. For many years, this operation was considered the standard for women with breast cancer, but it is very rarely used today and only in cases of advanced cancer in which the cancer has spread to the chest muscles. Radiation therapy (also called radiotherapy) is the use of high-energy rays to kill cancer cells and stop them from growing. The rays may come from radioactive material outside the body and be directed at the breast by a machine (external radiation). The radiation can also come from radioactive material placed directly in the breast in thin plastic tubes (implant radiation). Some women receive both kinds of radiation therapy. For external radiation therapy, women go to the hospital or clinic each day. When this therapy follows breast-sparing surgery, the treatments are administered 5 days a week for 5 to 6 weeks. At the end of that time, an extra "boost" of radiation is sometimes given to the place where the tumor was removed. The boost may be either external or internal (using an implant). Patients stay in the hospital for a short time for implant radiation. Radiation therapy, alone or with chemotherapy or hormone therapy, is sometimes used before surgery to destroy cancer cells and shrink tumors. This approach is most often used in cases in which the breast tumor is large or not easily removed by surgery. Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy for breast cancer is usually a combination of drugs. The drugs may be given by mouth or by injection. Either way, chemotherapy is a systemic therapy because the drugs enter the bloodstream and travel throughout the body. Chemotherapy is administered in cycles: a treatment period followed by a recovery period, then another treatment, and so on. Most patients have chemotherapy in an outpatient part of the hospital, at the doctor's office, or at home. Depending on which drugs are given and the woman's general health, however, she may need to stay in the hospital during her treatment. Hormonal therapy is used to keep cancer cells from getting the hormones they need to grow. This treatment may include the use of drugs that change the way hormones work or surgery to remove the ovaries, which produce female hormones. Like chemotherapy, hormonal therapy is a systemic treatment; it can affect cancer cells throughout the body. Treatment Choices A woman's treatment options depend on a number of factors. These include her age and menopausal status; her general health; the size, location, and stage of the tumor; whether a doctor can feel lymph nodes under her arm; and the size of her breast. Certain features of the tumor cells (such as whether they depend on hormones to grow) are also considered. The most important factor is the stage of the disease. The stage is based on the size of the tumor and whether the cancer has spread. Below are brief descriptions of the stages of breast cancer and the treatments most often prescribed for each stage. Stage 0 is sometimes called noninvasive carcinoma or carcinoma in situ. Lobular carcinoma in situ, or LCIS, refers to abnormal cells in the lining of a lobule. These abnormal cells seldom become invasive cancer. However, their presence is a sign that a woman has an increased risk of developing breast cancer. This risk of cancer is increased for both breasts. Some women with LCIS may choose to take a medication called tamoxifen to try to prevent breast cancer, or they may take part in studies of other promising new preventive treatments. Others may not receive any treatment, but return to their doctors regularly for checkups. Still others may have surgery to remove both breasts to try to prevent cancer from developing. Ductal carcinoma in situ, also called intraductal carcinoma or DCIS, refers to cancer cells in an area of abnormal tissue in the lining of a duct that have not invaded the surrounding breast tissue. If DCIS lesions are left untreated, over time cancer cells may break through the duct and spread to nearby tissue, becoming an invasive breast cancer. Patients with DCIS may have a mastectomy or may have breast-sparing surgery followed by radiation therapy. Underarm lymph nodes are not usually removed. Women with DCIS may want to talk with their doctors about the possible usefulness of treatment with tamoxifen. Stage I and stage II are early stages of breast cancer, but in these stages the cancer has invaded nearby tissue. Stage I means that cancer cells have not spread beyond the breast and the tumor is no more than about an inch across. Stage II means one of the following: the tumor in the breast is less than 1 inch across and the cancer has spread to the lymph nodes under the arm; the tumor is between 1 and 2 inches and may or may not have spread to the lymph nodes under the arm; or the tumor is larger than 2 inches but has not spread to the lymph nodes under the arm. Women with early stage breast cancer may have breast-sparing surgery followed by radiation therapy as their primary local treatment, or they may have a mastectomy, with or without breast reconstruction (plastic surgery) to rebuild the breast. Sometimes radiation therapy is also administered to the chest wall after mastectomy. These approaches are equally effective in treating early stage breast cancer. The choice of breast-sparing surgery or mastectomy depends mostly on the size and location of the tumor, the size of the woman's breast, certain features of the cancer, and how the woman feels about preserving her breast. With either approach, lymph nodes under the arm usually are removed. Many women with stage I and most with stage II breast cancer have chemotherapy and/or hormonal therapy in addition to surgery or surgery and radiation therapy. This added treatment is called adjuvant therapy, which means that it is given to try to destroy any remaining cancer cells and prevent the cancer from recurring, or coming back. Stage III is also called locally advanced cancer. The tumor in the breast is large (more than 2 inches across), the cancer is extensive in the underarm lymph nodes, or it has spread to other lymph nodes or tissues near the breast. Inflammatory breast cancer is a type of locally advanced breast cancer. Patients with stage III breast cancer usually have both local treatment to remove or destroy the cancer in the breast and systemic treatment to stop the disease from spreading. The local treatment may be surgery and/or radiation therapy to the breast and underarm. The systemic treatment may be chemotherapy, hormonal therapy, or both; it may be given before or after the local treatment. Stage IV is metastatic cancer. The cancer has spread from the breast to other parts of the body. Women who have stage IV breast cancer receive chemotherapy and/or hormonal therapy to destroy cancer cells and control the disease. They may have surgery or radiation therapy to control the cancer in the breast. Radiation may also be useful to control tumors in other parts of the body. Recurrent cancer means the disease has come back in spite of the initial treatment. Even when a tumor in the breast seems to have been completely removed or destroyed, the disease sometimes returns because undetected cancer cells remained in the area after treatment or because the disease had already spread before treatment. Most recurrences appear within the first 2 or 3 years after treatment, but breast cancer can recur many years later. Cancer that returns only in the area of the surgery is called a local recurrence. If the disease returns in another part of the body, it is called metastatic breast cancer. Treatment for recurrent cancer varies.