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How is breast cancer treated?

Breast cancer is best treated by a multidisciplinary team of health professionals including a surgeon, an oncologist, a radiologist, a pathologist, genetic counsellor, dietician, social worker, and physiotherapist. Each patient’s treatment is tailored according to the patient as an individual and the specific characteristics of the patient’s cancer.

Important patient factors to consider when choosing optimal treatment include:

• patient’s preference
• the age and fitness of the patient
• history of previous cancers and cancer therapy
• family history of breasts cancer and other cancers
• menopausal status of the patient

Important tumour factors include:

• the size of the tumour and whether the surgeon feels it is operable
• whether the cancer has spread to the lymph nodes
• the type of breast cancer
• the grade of the breast cancer
• the hormone status of the tumour (ER/PR)
• whether the tumour has a mutation called the Her 2 mutation

The first part of treatment for breast cancer is usually surgery. The goal of surgery is to remove the tumour in the breast, test the draining lymph nodes for cancer, and remove any affected lymph nodes. Surgical options for the breast include a lumpectomy, in which the cancerous area of tissue in the breast is removed with a margin of normal tissue surrounding it and a mastectomy, in which the entire breast is removed. The decision between a lumpectomy and a mastectomy depends on a number of factors including the size of the cancer in relation to the size of the patient’s breasts, whether there is just one area with cancer or multiple areas, any family history which makes the patient higher risk for recurrence of cancer, and whether the patient is willing to have radiotherapy which is usually required after a lumpectomy.

If there is no obvious spread to lymph nodes, the draining lymph nodes can be tested with a sentinel node biopsy. If the sentinel node biopsy shows spread to nodes, an axillary lymph node dissection is required. This is an operation which removes the lymph nodes in the axilla (underneath the arm-pit).

Other treatments for breast cancer may include radiotherapy, chemotherapy, Her-2 inhibitors, and endocrine therapy. These treatments are given to reduce the chances of the cancer coming back in the breast, lymph nodes and in the rest of the body.

Chemotherapy uses drugs which are designed to disrupt the life cycle of any cancer cells which may be left behind or circulating in the body.  The decision for whether chemotherapy is needed depends on the patient’s age and fitness as well as the risk of the cancer returning which is assessed for each individual patient.

Her -2 inhibitors belong to a group of drugs called targeted treatment. The way that they work is to target and inactivate a specific mutation in breast cancer cells, the Her 2, mutation. This mutation, when it is present in breast cancer causes increased growth and spread of breast cancer. The Her 2 mutation is tested for in all breast cancer patients.

Radiation therapy uses X-rays to treat cancer. When used for breast cancer, these X-rays are directed on the breast and sometimes on the lymph nodes, in order to prevent the cancer from coming back in these areas.  Radiotherapy is almost always needed after a lumpectomy and sometimes needed after a mastectomy.

Some breast cancers are fuelled by oestrogen and progesterone. Endocrine therapy includes treatment which either decrease the production of these hormones in the body or decrease the ability of these hormones to cause growth. These drugs are in a tablet form and usually are given for five years.

Breast cancer care is not only focused on curing the cancer but also maintaining quality of life. There are a number of lifestyle changes which can help patients in this regard. A healthy diet with adequate intake of fruits, vegetables, and whole grains and limited intake of highly saturated fats and sugars is ideal. Keeping active with regular moderate exercise helps the immune system and boosts mood. Relaxing activities such as yoga and meditation are also recommended.

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