Top

Click the page navigation links below to go directly to the page section you're interested in.
Clicking on the [Top of Page] links will take you back here.

Destination Complete Elimination
Radiation Therapy
External beam radiation
Whole breast v. targeted therapy
Possible side effects
Internal Radiation (Brachytherapy)
Interstitial brachytherapy
Accelerated partial breast irradiation (APBI)
Systemic Breast Cancer Therapies
Chemotherapy
Basic types of chemotherapy
High dose chemotherapy with transplantation
Possible side effects and risks of chemotherapy
Hormonal therapy
Types of hormonal therapy
Immunotherapy
Drugs that target HER2/neu
Drugs that target tumor blood vessels
Bisphosphonates
Complementary and Alternative Therapies
Complementary therapies
Alternative treatments

Destination—Complete Elimination

After a tumor is removed from the breast, a number of possible treatments may follow to ensure the cancer has been completely eliminated. The treatments chosen will depend on the size and location of the tumor and the extent to which the cancer has spread. The whole point of these post-surgical treatments is to prevent the cancer from returning and to halt its spread.

[Top of page]

Radiation Therapy

Radiation therapy involves treatment with high-energy x-rays that are used to kill any cancer cells remaining in the breast, chest wall or underarm area. Both normal and cancer cells are affected by the radiation. But the normal cells can recover fast, while abnormal cancer cells are permanently damaged. Basically, radiation therapy can be delivered in two ways—through external beam radiation or internal radiation (brachytherapy).

[Top of page]

External beam radiation

External beam radiation is the most common type of radiation therapy for treating breast cancer. The procedure is painless and lasts only a few minutes. Radiation beams are focused from several angles onto the area affected by the cancer, much like when you get an x-ray.

[Top of page]

Whole breast v. targeted therapy

How much radiation is delivered depends on whether a lumpectomy or mastectomy was performed and whether or not lymph nodes were involved. After a lumpectomy, the entire breast receives radiation. Then an extra amount is delivered just to the area where the cancer was removed to prevent its return. Depending on the size and extent of the cancer, radiation may include the chest wall, underarm area, supraclavicular lymph nodes (above the collarbone) and internal mammary lymph nodes (beneath the breast bone). External radiation therapy usually isn't started until about a month after surgery. If chemotherapy is also prescribed, radiation therapy usually is delayed until chemotherapy ends. Patients who receive breast radiation after lumpectomy usually are treated in an outpatient center five days a week for a total time of about six weeks.

[Top of page]

Possible side effects

The main side effects of external beam radiation therapy are swelling and heaviness in the breast, sunburn-like skin changes in the treated area and fatigue. Your healthcare team may advise you to avoid exposing the treated skin to the sun, which can make the side effects worse. You also want to avoid using adhesive tape or bandages on the affected skin as well as heating pads or ice packs. Changes to the tissue and skin usually go away in 6 to 12 months.

[Top of page]

Internal Radiation (Brachytherapy)

With internal radiation, also known as brachytherapy, a radioactive source is placed safely and precisely within the breast tissue—rather than aiming beams from outside the body. One of the main advantages of brachytherapy is that it delivers high intensity radiation near the tumor site with less spillover to surrounding tissue and organs. Brachytherapy sometimes is used to apply extra radiation to the tumor site in addition to external beam radiation. But it's also increasingly being used and studied as a stand-alone radiation therapy after a lumpectomy. The tumor size, location and other factors influence who might benefit from either of the two basic types of brachytherapy— interstitial or intracavity /APBI.

[Top of page]

Interstitial brachytherapy

Interstitial brachytherapy involves inserting 10-to-20 thin, plastic tubes into the breast near the lumpectomy site. Then, a radioactive pellet is loaded into each tube. Using a detailed CT scan, a computer plots the precise placement of each pellet to ensure the target area receives an even dose of radiation. Ten treatments are given over five days, each treatment lasting about ten minutes. Patients are free to leave the radiation therapy facility between treatments and go about their everyday affairs.

[Top of page]

Accelerated partial breast irradiation (APBI)

Accelerated partial breast irradiation (APBI) is an important development in breast cancer treatment. Otherwise known as intracavity brachytherapy, It involves placing a small, deflated balloon attached to a thin tube into the space left by the lumpectomy. The balloon is then filled with saline and left in place throughout the treatment. A radioactive source (seed) is threaded into the balloon through the tube for a short time period during each treatment and then removed. An advanced computer system accurately controls seed placement to make sure only the tissue closest to the balloon is affected by radiation. Treatments are delivered twice a day for five days, at which time the balloon is deflated and removed. One leading APBI brachytherapy system, the CONTURA ® Multi-Lumen Balloon (MLB) Catheter , uses vacuum ports to remove excess fluid and air which allows close adherence within the lumpectomy cavity. This adherence provides for more uniform treatment of the surrounding tissue. The CONTURA® MLB Catheter also contains five separate lumens (tubes) inside the balloon that enable the doctor to shape the radiation dose toward the desired target area and away from the skin or chest wall. This ability to shape the dose allows doctors to treat more patients as they are not limited in the size or shape of the breast with relation to skin or chest wall distance.

After a lumpectomy, 6-to-7 weeks of external beam, whole-breast radiation therapy has been the standard of care. APBI changes this therapy approach in two major ways. For one thing, it shortens the treatment time from six weeks to just 5 days. Secondly, it reduces the treatment area from the entire breast to only the tissue surrounding the lumpectomy cavity. This is where most cancers are likely to recur. The goal is to use a less invasive and more focused treatment without compromising results. In clinical trials APBI has been shown to be as effective as whole breast irradiation.

Warning:  The safety and effectiveness of the Contura® MLB Catheter as a replacement for whole breast irradiation in the treatment of breast cancer has not been established. Please consult complete package labels and Information For Use for Indications, Contraindications, Warnings, Precautions, and Complications.

[Top of page]

Systemic Breast Cancer Therapies

Localized breast cancer treatments, such as surgery and radiation therapy, treat the breast area only. But if there's reason to believe cancer cells have traveled beyond the breast area, you need a systemic treatment. This means drugs are used to attack cancer cells in all parts of your body. Systemic treatment can be delivered through chemotherapy, hormonal therapy, immunotherapy or any combination of the three.

[Top of page]

Chemotherapy

Chemotherapy is treatment with cell-killing drugs that aim to destroy cancer cells. Most of these drugs are injected, but some can be taken orally. The drugs then travel through the bloodstream to reach cancer cells throughout the body. Generally, chemotherapy has proven most effective when more than one drug is used. Chemotherapy is delivered in cycles with each treatment period followed by a rest period. The chemotherapy drugs are administered at the beginning of the cycle, followed by a two-to-three-week rest period. The total time of chemotherapy is generally three to six months.

[Top of page]

Basic types of chemotherapy

Adjuvant chemotherapy—When systemic therapy is given after breast cancer surgery, even when there's no evidence of the cancer's spread, it's called adjuvant therapy. The goal of adjuvant therapy is to kill any undetected cells that have traveled from the breast, reducing the risk of breast cancer recurrence.

Neoadjuvant chemotherapy—Chemotherapy given before surgery is called neoadjuvant therapy. The aim is to shrink large cancers so they're small enough to be removed by lumpectomy instead of mastectomy. Another advantage of neoadjuvant chemotherapy is that doctors can see how the particular cancer responds to chemotherapy.

Chemotherapy for advanced breast cancer—Chemotherapy can also be used as the main treatment for women whose cancer has already spread outside the breast and underarm area. The length of these treatments depends on whether or not the cancer shrinks and how much.

[Top of page]

High dose chemotherapy with transplantation

Although very high doses of chemotherapy kill cancer cells, they also kill blood-making stem cells in the bone marrow. Damage to these cells lowers the white blood cell count, which can lead to infection or easy bleeding. One way to get around this is to first remove stem cells from the blood or bone marrow, deliver the high-dose treatment and then return the stem cells into the body via injection. The stem cells soon find their way back into the bone marrow, where they reestablish themselves and restore the body's ability to make new blood cells. Initially, this was thought to be a good way to treat advanced breast cancer. But several studies have shown that women who receive high-dose chemotherapy don't live any longer than women who receive standard chemotherapy and suffer more serious side effects, so research continues.

[Top of page]

Possible side effects and risks of chemotherapy

Chemotherapy drugs work by attacking cells that divide quickly, such as cancer cells. But other cells in the body also divide quickly, such as those in the bone marrow, mouth lining and hair follicles. These cells also can be affected by chemotherapy, leading to side effects. Some women have many side effects, others have few, and the side effects depend on the type of drugs, amount taken and treatment length. Some side effects are short term and usually go away when the treatment ends, such as:

• Hair loss
  
• Mouth sores
  
• Loss of appetite
  
• Nausea and vomiting
  
• Increased chance of infections
  
• Easy bruising or bleeding
  
• Fatigue

Other side effects can be long-term or even permanent including:

Menstrual changes—Premature menopause and infertility are potential permanent complications of some chemotherapy drugs. The older a woman is when receiving chemotherapy, the more likely this is to occur.

Heart damage—Some chemotherapy drugs can cause permanent heart damage if used for a long time or in high doses. For these drugs, your doctor will monitor your heart and stop the medication at the first sign of trouble.

Chemobrain—Many women who receive chemotherapy seem to have a slight decrease in mental functioning, such as problems with concentration and memory.

Feeling unwell or tired—Many women do not feel as healthy after receiving chemotherapy as they did before. They report body pain or aching, mild losses of physical functioning and fatigue.

[Top of page]

Hormonal therapy

Hormone therapy is another kind of systemic treatment used to reduce the risk of cancer recurrence after surgery (adjuvant therapy). The goal is to block the effects of estrogen or progesterone, or to lower the amounts of them in the body. This is because these two hormones promote the growth of about two-out-of-three breast cancers.

[Top of page]

Types of hormonal therapy

Tamoxifen—This is the most frequently used anti-estrogen drug and is taken daily in pill form. Taking tamoxifen after surgery cuts the risk of cancer recurrence in half for women who have early breast cancer with estrogen or progesterone receptors. The most common side effects include fatigue, hot flashes, vaginal discharge and mood swings.

Toremifene—This drug is closely related to tamoxifen and can be an option for postmenopausal women with breast cancer that has spread to other parts of the body (metastasized). Possible side effects are similar to those for tamoxifen.

Fulvestrant—This drug is often effective when breast cancer no longer responds to tamoxifen. It is only given to post-menopausal women and only is approved for treating advanced breast cancer. Hot flashes, mild nausea and fatigue are the major side effects.

Aromatase inhibitors—This group includes three drugs (letrozole, anastrozole and exemestane) that stop estrogen production, but only in postmenopausal women. These drugs work by blocking the enzyme aromatase. The most common side effect is joint stiffness or pain.

Ovarian ablation—Removing estrogens from premenopausal women can be done surgically by removing the ovaries, an operation called an oophorectomy. A similar effect can be achieved with luteinizing hormone-releasing hormone (LHRH) analogs, which block the ovaries from making estrogen.

Megestrol acetate—This drug is used for hormone treatment of advanced breast cancer, usually for women whose cancers do not respond to other hormone treatments. Its major side effect is weight gain.

Androgens—Male hormones may be considered after other hormone treatments for advanced breast cancer have failed. They're sometimes effective, but can promote masculine characteristics, such as an increase in body hair or deepening of the voice.

[Top of page]

Immunotherapy

Chemotherapy drugs work by attacking fast-growing cells in the body. This is effective against cancer cells, but it also damages other fast-growing cells the body needs. Immunotherapy works in a different way—by targeting only cancer cells. It builds up the immune system, which includes many kinds of white blood cells that circulate through the blood and attack invading cells. In essence, immunotherapy boosts the immune system's natural cancer-fighting ability.

[Top of page]

Drugs that target HER2/neu

Trastuzumab (Herceptin)—This drug attaches to the growth-promoting protein HER2/neu, which is present in breast cancer cells in about one out of five patients. Breast cancers with lots of this protein tend to grow and spread faster. Trastuzumab can help slow this growth and stimulate the immune system to attack the cancer. It is injected, usually once a week or as a triple dose every three weeks. Compared with chemotherapy, its side effects are relatively mild and include flu-like symptoms.

Lapatinib—This drug also targets HER2/neu and is given as a pill, usually along with chemotherapy. It is used when HER2-positive breast cancer is no longer helped by chemotherapy and trastuzumab. The most common side effects include flu-like symptoms and discomfort in the hands and feet (hand-foot syndrome).

[Top of page]

Drugs that target tumor blood vessels

Bevacizumab—This is another drug used in patients whose breast cancer has spread and it has shown positive results when used with chemotherapy. It targets vascular endothelial growth factor (VEGF), a protein that helps tumors form new blood vessels so they can get nutrients (angiogenesis). Common side effects include high blood pressure, low white blood-cell count and flu-like symptoms.

[Top of page]

[Top of page]

Complementary and Alternative Therapies

When you or someone you care about has cancer, you're likely to hear about treatments besides traditional Western medicine. It's only natural to have a lot of questions about how these treatments work and whether they're safe and effective. Most medical professionals use the term complementary to refer to medicines or methods that are used along with your regular medical care. Typically, these are presented as ways to reduce pain, increase comfort or improve quality of life. In contrast, alternative treatments often are proposed instead of standard medical treatment. As such, they require serious scrutiny and should be met with skepticism.

[Top of page]

Complementary therapies

Typically, complementary treatment methods aren't presented as cures for cancer, but rather as ways to help you feel better. Some methods are known to improve comfort and well being, while others really have not been tested. There are many complementary methods that you can safely use right along with your medical treatment to reduce side effects, ease pain and help you relax.

For example, many people find body therapies to be helpful, such as massage, Rolfing, therapeutic touch, yoga and acupuncture. A number of mind-body therapies also seem to help many women, such as support groups, meditation, relaxation, stress management and visualization. Of course, a strong social-support system, good nutrition and healthy doses of humor and laughter also go a long way.

It's also important to note that a number of herbal and nutritional therapies have been promoted for use by recovering breast cancer patients. For most of these, the facts aren't at all clear. So it's probably in your best interest to err on the side of caution. Few of these remedies have undergone scientific testing. And some even can be harmful.

[Top of page]

Alternative treatments

Alternative breast cancer treatments are those proposed for use instead of standard medical care. However, these alternatives have not been proven safe and effective in clinical trials. Some of these methods can even be dangerous or life threatening.

It's easy to understand why anyone with cancer would consider an alternative treatment. Who wouldn't want to do all she can to fight cancer? On top of this, some medical treatments like chemotherapy are rough. So along comes some promoter suggesting his method can cure your cancer without serious side effects, and who wouldn't want to believe it? The problem is, if it sounds too good to be true, it probably is.

Laetril is a case in point. Made from apricot pits, its promoters claimed it could cure cancer because cyanide found inside the pits killed cancer cells. But later scientific studies and patient experiences proved laetril to be worthless. Even worse, it could be harmful. Sometimes people became very sick from cyanide poisoning and there were even reports of deaths.

Yes, you have to be knowledgeable and consider your options, to be sure. But please talk to your doctor or nurse about any alternative methods you're thinking about. And above all, be especially skeptical about any treatment or method whose promoters:

• Promise a quick cure-all for all kinds of cancers.
  
• Tell you not to use standard medical treatments.
  
• Claim their cure is a secret that only they know how to administer.
  
• Require you to travel to another country.
  
• Attack Western science and medicine.
  
• Claim the government and medical community have conspired to suppress their product.
  
• Require payment in advance or promise a money-back guarantee.