Breast cancer is a disease that occurs as a result of cell malignancy in the breast tissue. Relatively fatal, breast cancer accounts for the second-highest incidence of cancer mortality amongst women as per CDC data. According to 2017 statistics, the probability of cases is about 125 per 100,00 women. Fortunately, there is an 89.1% survival rate in breast cancer, implying that getting the diagnosis does not signify the road's end.
There are many treatment options for cancer, ranging from local and systemic treatment to treatment by disease progression. Local treatment targets the tumor only and will have only mild effects on the rest of the body. On the other hand, systemic approaches involve drug therapy, usually given orally or by direct introduction into the systemic circulation. However, most treatment plans take into account the type and stage of cancer.
Local Treatment Approaches
Surgical intervention in breast cancer can either preserve part of the breast or remove all of it. The conservational way is lumpectomy or partial mastectomy and only removes the part of the breast with the tumor. If the cancer is very severe, removing the entire breast tissue through a process known as mastectomy is the main course of action. In some cases, depending on disease progression, a double mastectomy is the best solution.
Radiotherapy is the go-to treatment, particularly after one has gone through a mastectomy or conservation surgical procedure. This approach can either be external or internal. Internal irradiation involves introducing beaming radiation onto the breast from an external source and is the most common radiotherapy technique.
Internal irradiation is known as brachytherapy and is a more selective approach. The radiation device has a radioactive source that works over short periods. Brachytherapy is a more rapid alternative to external irradiation, with its only drawback being the likelihood of causing local side effects.
This approach utilizes oral or intravenous medication to combat the cancerous infection. Chemotherapy is usually an adjunct, meaning that it is a combination of therapeutic techniques such as surgery or radiotherapy.
Chemotherapy use before surgery helps shrink particularly malignant tumors and is alternately known as neoadjuvant therapy. After surgery, these drugs prevent the chances of disease recurrence or spread to other organs in a treatment known as adjuvant therapy.
In some cases, the diagnosis of cancer happens at a very advanced stage. In such a case, chemotherapy is the primary course of action. If cancer has gone through metastasis and spread to other parts of the body, surgical intervention is out of the question. At the same time, radiotherapy may not be as effective, leaving chemotherapy as the way forward.
Hormone therapy is an approach that utilizes the difference between male and female sexual differences. Breast cancer growth is dependent on female sex hormones, with estrogen and progesterone frequently coming up in these cases. The cancer cells can attach to these hormones, thereby promoting their growth. Hormone therapy targets and blocks this attachment in breast cancer.
Because of the many breast cancer sub-types, some breast tumor variants do not have any receptor sites for these hormones. In the case where these receptors are absent, this approach will not work. It is essential to test for the presence of receptors beforehand before proceeding with this therapeutic approach.
Hormone therapy can be used before and after surgery as well as in cases of relapse.
This treatment approach attempts to block or down the growth of cancer cells. These drugs have the advantage of being able to target specific cancer growth proteins such as the HER-2 protein, gene mutations that promote cancer, and triple-negative variants. Below are some of the targeted therapies:
HER2 Protein Positive Breast Cancer
Monoclonal Antibodies help stop cancer progression. A monoclonal antibody linked with a chemotherapeutic agent helps target the agent to cancer cells. Kinase signaling inhibitors help slow down cancer growth.
Hormone Receptor-Positive Cancer
These drugs block the action of various proteins that play a significant role in cancer growth and progression. These proteins include cyclin-dependent kinases, mTOR protein, and PI3K protein.
Gene Mutation Target Therapy
A gene mutation of the BRCA gene increases the probability of developing breast cancer in women. These drugs inhibit DNA repair in the cells, leading to cancer cell death.
Triple-Negative Breast Cancer
In this cancer, progesterone and estrogen receptors are absent while there is very little HER2b protein. These drugs are usually a combination of a monoclonal antibody and a chemotherapy agent.
This therapeutic approach stimulates the individual's immune system and enables it to identify and destroy cancerous cells. The most available immune therapy techniques are mainly immune checkpoint inhibitors. These drugs act at points in the immune system called checkpoints that enable them to identify cancer cells.
Other treatment Options
Treatment by Stage
Depending on its pathology, the most common cancer classification ranges from stage 0 to stage IV in order of increasing severity. Earlier stages such as 0 and I are benign and easily manageable. Stages II and III are more spread over the breast, and their primary location is around the breast and lymph nodes. Stage IV is advanced and, in most cases, goes through metastasis and is irreversible.
Knowing the stage is crucial for treatment because, at some point, breast cancer becomes either untreatable or inoperable. The treatment is usually a variant of most of the options discussed above in some format or other.
Treatment of Triple-Negative Malignancy
In some breast cancer cases, the three proteins and their receptors associated with them are either absent or in insignificant numbers. In this case, systemic chemotherapy is the only option, with the added disadvantage of having a high probability of relapses. In some cases where this condition prevails, immune therapy and radiotherapy are also viable alternatives.
Inflammatory Breast Cancer
In rare instances, the cancer progression may cause cutaneous inflammation on and around the breast. This inflammation only appears at either stage III or IV if a combination of therapies can manage the disease.
Targeted therapy, immune therapy, and chemotherapy are some of the alternatives in addition to surgical intervention or radiation therapy, depending on disease progression.
Pregnancy is always a sensitive period and brings many complications as far as treatment of any condition goes. The challenge is that the mother must be taken care of while ensuring that the growing fetus gets no harm. Surgery and a certain degree of chemotherapy are relatively safe in the second and third trimesters of the pregnancy as they have little impact on the fetus.
However, immune, radiation and targeted therapies are harmful to the fetus at any pregnancy stage. After the 35th week of pregnancy, chemotherapy at this stage may alter the mother's blood count in a way that may lead to complications during birth. After birth, breastfeeding during chemotherapy impairs recovery and may harm the baby as the drugs pass out through breast milk.
If you have breast cancer, it is good to be aware of all the treatment options. Depending on disease progression, you should thoroughly consult and get all the perspectives, including second opinions on therapeutic approaches. An oncologist will help you set therapeutic goals as well as discuss safety concerns such as side effects.
In any case, whether you want to seek treatment or live with the condition, it does not do any harm to have all the necessary information. This article has given some of the best alternatives available currently, but because research is continually changing, having professionals guide you through the treatment and recovery process brings out the best of these approaches.