Factors evaluated include:
● Stage of your cancer (localized vs. advanced)
● Pathological and molecular profiling
● Your general health and treatment goals
Your doctor will discuss the recommended treatment plan with you and, together, you and your doctor will decide on the approach that is right for you. It may include one or a combination of several of the following types of treatment:
● Systemic therapy: (chemotherapy, including targeted therapy, and endocrine therapy)
● Radiation therapy
● Rehabilitation including lymphedema prevention and management, exercise and survivorship programs
● Clinical trials
Link to Cancer.gov.
Surgery is usually the first step in the treatment of breast cancer. The goal of breast cancer surgery is removal of the cancerous mass, plus a margin of healthy tissue to prevent microscopic cancer cells (cell you cannot see with the eye) from being left behind. There are several procedures used to remove breast tumors that your breast surgeon will review with you. They include:
● Lumpectomy: Removal of a cancerous mass with a margin of healthy tissue all around (also known as breast conserving surgery, or BCS). This surgery, plus the addition of radiation, has been shown to have equal or better survival outcomes when compared to mastectomy. The following may be used with lumpectomy surgery.
○ Radioactive (breast) seed localization (RSL): A tiny radioactive seed the size of a grain of rice is placed in the breast to accurately locate spots in the breast that cannot be felt. RSL may be inserted into the breast to target spots or localize cancers prior to a lumpectomy.
○ Wire localization: An alternative for localization used when RSL is not feasible.
● Mastectomy: Removal of the entire breast and surrounding breast tissue. Most women will choose to consider immediate (or sometimes delayed) reconstruction with mastectomy.
● Lymph node assessment: Evaluation of lymph nodes to measure the extent of breast cancer to plan treatment effectively.
● Sentinel node Biopsy: A procedure which involves injecting dye and/or a small amount of radioactive dye near the breast tumor, helping to locate the lymph node that where tumor cells would first spread. It is used to evaluate if cancer cells have spread to the lymph nodes. If these nodes are negative no further surgery is done.
● Axillary lymph node dissection: If a tumor is identified in the lymph nodes, removal of most lymph nodes found in the axilla region may be considered.
● Reconstruction: A new breast may be formed using remaining skin and muscle after a mastectomy. Reconstructive techniques may use the patient’s own tissue to reconstruct, or the placement of implants. There are different types of reconstruction, so please discuss with your surgeon which option may be right for you.
● Neoadjuvant treatment: Systemic treatment given before surgery to help reduce the size of the tumor.
The decision to use systemic therapy is based on many factors such as the stage of the breast cancer, how sensitive it is to hormones, HER2 status, and a patient’s overall condition. A test called Oncotype DX® is sometimes used to predict chemotherapy benefit. Your medical oncologist will have this discussion with you. Systemic therapies are drugs that go throughout the body to control, slow or cure your cancer. They include chemotherapy, targeted therapies and endocrine therapy. Systemic therapy may be used alone or in combination with surgery or radiation.
Chemotherapy drugs are used to fight and kill cancer cells. Chemotherapy is associated with side effects, but there are many medications today to help reduce these. Chemotherapy is sometimes given by intravenous infusion (an IV, through a vein in your arm or port) or it may be taken orally as a pill. Most patients have a series of treatments over several weeks or months, often including drug-free periods to allow your body to recover.
Chemotherapy can be used in several ways:
● To decrease the risk of spread of cancer
● Prior to surgery, to shrink a tumor so it is easier to remove
● After surgery, to ensure that no cancer cells remain after the tumor has been removed
● As a palliative therapy, to reduce pain and other symptoms of advanced cancer
● As maintenance therapy
Targeted therapies work differently from standard chemotherapy. They are typically oral medications that work by “targeting” specific DNA abnormalities within the cancer cells. The target is chosen after a thorough a analysis of a patient’s tumor specimen. Herceptin, which targets HER2, was one of the first targeted therapies. These are truly personalized cancer medicines.
Oral or injectable medications may be used to block hormones that may be adding to cancer growth.
Radiation therapy, the precise and controlled use of radiation to kill cancer cells, can provide effective treatment for cancer. Here at WCHN, our highly skilled radiation oncologists use advanced technology that adapts to your breathing cycle. This ensures accuracy and protects nearby tissue as high doses of radiation therapy are delivered to your cancer. Our techniques include:
External beam radiation
External beam radiation delivers a beam of high-energy x-rays to a patient’s tumor site and is the most common treatment used post lumpectomy. External beam radiation gets its name from the fact that the beams come from an external source (a machine called a linear accelerator) and are directed at the site of the tumor. The whole breast is irradiated, typically over 6 weeks, but in certain cases breast radiation delivery can be done in 4 weeks.
Accelerated partial breast irradiation (APBI)
This form of breast radiation therapy delivers focused radiation specifically to the part of the breast where the tumor was removed. Most often, partial breast irradiation is completed with a breast brachytherapy technique.
Clinical trials are research studies that evaluate the safety and effectiveness of new methods or drugs to treat cancer, or procedures to diagnosis or screen for cancer. Participation is always voluntary. WCHN research program is part of a premier regional cancer network that includes Danbury, New Milford and Norwalk Hospitals. Clinical trials at WCHN come from a wide variety of sources, including the National Cancer Institute (NCI), pharmaceutical companies, nearby university cancer centers, as well as well as those developed at the WCHN. Our goal is to offer you the most promising emerging treatments available.