Breast cancer

Breast cancer is cancer of breast tissue. Worldwide, it is the most common form of cancer in females, affecting approximately 10% of all women at some stage of their life in the Western world. Although significant efforts are made to achieve early detection and effective treatment, about 20% of all women with breast cancer will die from the disease, and it is the second most common cause of cancer deaths in women.

Treatment

The mainstay of breast cancer treatment is surgery, with possible adjuvant chemotherapy and/or radiotherapy.

Related Topics:
Surgery - Chemotherapy - Radiotherapy

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Depending on the staging and type of the tumour, just a lumpectomy (removal of the lump only) may be all that is necessary or removal of larger amounts of breast tissue may be necessary. Surgical removal of the entire breast is called mastectomy.

Related Topics:
Lumpectomy - Mastectomy

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Standard practice requires that the surgeon must establish that the tissue removed in the operation has margins clear of cancer, indicating that the cancer has been completely excised. If the tissue removed does not have clear margins, then further operations to remove more tissue may be necessary. This may sometimes require removal of part of the pectoralis major muscle which is the main muscle of the anterior chest wall.

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During the operation, the lymph nodes in the axilla are also considered for removal. In the past, large axillary operations took out 10-40 nodes to establish whether cancer had spread - this had the unfortunate side effect of frequently causing lymphedema of the arm on the same side as the removal of this many lymph nodes affected lymphatic drainage. More recently the technique of sentinel lymph node dissection has become popular as it requires the removal of far fewer lymph nodes, resulting in fewer side effects.

Related Topics:
Lymph nodes - Axilla - Lymphedema - Sentinel lymph node dissection

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At present, the treatment recommendations follow a pattern. This pattern may be adapted as every two years a worldwide conference takes place in St. Gallen, Switzerland to discuss the actual results of worldwide multi-center studies. Depending an clinical criteria (age, type of cancer, size, metastasis) patients are roughly divided to high risk and low risk cases which follow different rules for therapy. The following list is a compilation af possibilities:

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• after a breast conserving therapy (lumpectomy, quadrant-resection), the high local recurrence risk (~40%) is reduced by radiation therapy to the breast
• if the lymph nodes are positive, the high mortality risk (30-80%) is reduced by systemic treatment (either anti-hormones or chemotherapy).
• in younger patients, the most useful systemic therapy is chemotherapy (usually older regimens such as CMF, FAC, AC and/or Taxol) and now the FDA approved regimen TAC (Taxotere, Adriamycin, Cytoxan) or FEC for 3 cycles followed by Taxotere for 3 cycles. Another standard regimen includes dose dense AC (Adriamycin and cyclophosphamide) followed by Taxol. This is given on a two week cycle with growth factor support, e.g. pegfilgrastim.
• in older patients with estrogen receptor positive tumors, the most useful systemic therapy is anti-hormone therapy (tamoxifen, aromatase inhibitors, GnRH-analogues)
• chemotherapy has increasing side effects as the patient's age passes 65
• in patients with estrogen receptor negative tumours, the most useful systemic therapy is chemotherapy
• in patients with estrogen receptor positive tumours, the most useful systemic therapy is hormone therapy with medications such as tamoxifen or an aromatase inhibitor (in postmenopausal women)
• two large clinical trials published in the summer of 2005 demonstrated that patients with positive nodes and Her2/neu positive breast cancer should be treated with trastuzamab (brand name Herceptin) in addition to traditional chemotherapy

For some early tumours, systemic treatments may not be recommended if the tumor is hormone receptor negative. Radiation therapy is recommended in all patients who had lumpectomy, however radiation therapy after mastectomy is recommended only if four or more lymph nodes are involved with cancer. Radiation therapy is usually not indicated in patients with advanced (stage IV disease) except for palliation of symptoms like bone pain.

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The emotional impact of cancer diagnosis, symtoms, treatment, and related issues can be severe. Most larger hospitals are associated with cancer support groups which can help patients cope with the many issues that come up in a supportive environment with other people with experience with similar issues.

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On-line cancer support groups are also very beneficial to cancer patients, especially in dealing with uncertainty and body-image problems inherent in cancer treatment.

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