Breast Cancer Treatment Introduction

Doctor's Opinion Many patients find it helpful to make a list of questions before seeing the doctor.

The treatment choices for each woman depend on the size and location of the tumor in her breast, the results of lab tests (such as hormone receptor tests), and the stage or extent of the disease. A doctor also considers the woman's age, general health, the size of her breasts, and whether she is in menopause when making recommendations about a treatment plan for her. A woman considers these recommendations based on a range of personal factors as well.

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 care. They are likely to have many questions and concerns about their treatment options. Most patients also want to know how they will look after treatment and whether they will have to change their normal activities. The doctor is the best person to answer such questions as what treatment choices are, how successful it is expected to be, what the risks and side effects may be, and how much it is likely to cost.

Types of treatment

Treatments for breast cancer are either local or systemic. Local treatments remove, destroy, or control the cancer cells in one certain area. Surgery and radiation therapy are local treatments. Systemic treatments are used to destroy or control cancer cells throughout the entire body. Chemotherapy and hormonal therapy are systemic treatments. A patient may have one treatment or a combination of different treatments.

Goals of treatment

Different types of treatments have different goals. Below is a list of various treatments and how they may be used.

• Surgery: Surgery is used to remove the tumor from the breast. Sometimes only the tumor is removed and the breast is left intact. Sometimes the entire breast is removed. Surgery is also used to see if the cancer has spread to the lymph nodes under the arm. This information can help the patient and her doctors make important decisions about other treatments that may be helpful. Surgery may also be used to reconstruct a breast mound after the breast is removed. These three ways of using surgery are sometimes done as one operation or may be done separately.

• Radiation therapy: The goal of radiation therapy is to kill cancer cells using x-rays and other types of radiation. This treatment can be used to shrink a tumor before surgery, , to kill cancer cells that may remain in the breast or chest area after surgery, or to treat tumors in other areas of the body. Radiation therapy is usually given daily, Monday through Friday, for several weeks.

• Chemotherapy: Chemotherapy is used to kill cancer cells with medicines that can go throughout the body. It may be used to shrink a tumor before surgery, to kill cancer cells that may remain in the body after local treatments, or to treat tumors that have already developed in other areas of the body. Chemotherapy is usually given in cycles, with treatments given every three to four weeks over several months. Treatment of breast cancer that has spread will usually involve hormone therapy and/or chemotherapy with or without trastuzumab (Herceptin), depending on whether or not the cancer cells overexpress the HER-2 protein.

• Hormonal Therapy: Hormonal therapy is used to stop the growth of cancer cells that rely on hormones. Hormonal therapy may be used to decrease the chances of cancer returning or a new cancer developing after surgery. It can also be used to treat cancer that has spread. Hormonal therapy may include the use of any of the following agents: anastrozole (Arimidex®), fulvestrant (Faslodex®), letrozole (Femara®), tamoxifen (Nolvadex®). These maybe given as a daily pill or as an injection with treatment continuing for several years or as long as it appears to be working, if it is being given for active disease.

Doctors are finding new ways to treat breast cancer. These new methods are tested in clinical trials. Before beginning treatment, a woman may want to ask her doctor if there are any clinical trials she should consider.

Questions to Ask About Treatment

At first, the information you receive about treatment options may seem overwhelming. It is important that you take the time to gather as much information as possible about your disease and its treatment, and to discuss the issues with your doctors, nurses, and loved ones. Your doctor is the best person to answer your questions about treatment.

Many people find it helpful to make a list of their questions before seeing their doctor. To make it easier to remember what the doctor says, you may want to take notes or ask if you can use a tape recorder. It might also help to have a family member or friend with you to take part in discussion, to take notes, or just to listen.