Treatments

– Chemotherapy may be recommended before breast cancer surgery (neoadjuvant) or after surgery (adjuvant):

• Neoadjuvant (or primary systemic) breast cancer chemotherapy is used before surgery to reduce the size of large breast tumors and to destroy cancer cells. This type of chemotherapy often makes breast-conserving surgery possible. It also helps our cancer doctors determine the effect a regimen is having on the breast tumor.
• Adjuvant breast cancer chemotherapy is used after surgery or radiation therapy to eliminate any remaining cancer cells that may not have been removed during breast cancer surgery and/or radiation therapy. It also may prevent the disease from spreading to other parts of the body.

– Before chemotherapy, solid tumors may undergo genomic testing to determine whether they are likely to respond to specific chemotherapeutic drugs, thereby avoiding unnecessary toxicity to you.

– During chemotherapy, patients will be monitored and may receive physical exams, blood tests, CT scans, MRI scans and X-rays.

– Radiation therapy uses high-powered beams of energy, such as X-rays and protons, to kill cancer cells. Radiation therapy is typically done using a large machine that aims the energy beams at your body (external beam radiation). But radiation can also be done by placing radioactive material inside your body (brachytherapy).

– External beam radiation of the whole breast is commonly used after a lumpectomy. Breast brachytherapy may be an option after a lumpectomy if you have a low risk of cancer recurrence.

– Doctors may also recommend radiation therapy to the chest wall after a mastectomy for larger breast cancers or cancers that have spread to the lymph nodes.

– Breast cancer radiation can last from three days to six weeks, depending on the treatment. A doctor who uses radiation to treat cancer (radiation oncologist) determines which treatment is best for you based on your situation, your cancer type, and the location of your tumor.

– Side effects of radiation therapy include fatigue and a red, sunburn-like rash where the radiation is aimed. Breast tissue may also appear swollen or firmer. Rarely, more-serious problems may occur, such as damage to the heart or lungs or, very rarely, second cancers in the treated area.

For a mastectomy, your surgeon removes the breast and nearby lymph nodes to see if the cancer has spread. Some women choose to have breast reconstruction during the same surgery.

With lumpectomy, a surgeon removes the lump from your breast. He or she also removes nearby lymph nodes (the little oval-shaped organs that are part of your immune system) to see if the cancer has spread. The surgery takes an hour or two, and most women spend the day at the hospital, but there is usually no need to stay overnight.

– Targeted drug treatments attack specific abnormalities within cancer cells. As an example, several targeted therapy drugs focus on a protein that some breast cancer cells overproduce called human epidermal growth factor receptor 2 (HER2). The protein helps breast cancer cells grow and survive. By targeting cells that make too much HER2, the drugs can damage cancer cells while sparing healthy cells.

– Targeted therapy drugs that focus on other abnormalities within cancer cells are available. And targeted therapy is an active area of cancer research.

– Your cancer cells may be tested to see whether you might benefit from targeted therapy drugs. Some medications are used after surgery to reduce the risk that the cancer will return. Others are used in cases of advanced breast cancer to slow the growth of the tumor.

– Immunotherapy uses your immune system to fight cancer. Your body’s disease-fighting immune system may not attack your cancer because the cancer cells produce proteins that blind the immune system cells. Immunotherapy works by interfering with that process.

– Immunotherapy might be an option if you have triple-negative breast cancer, which means that the cancer cells do not have receptors for estrogen, progesterone or HER2. For triple-negative breast cancer, immunotherapy is combined with chemotherapy to treat advanced cancer that is spread to other parts of the body.

– Hormone therapy — perhaps more properly termed hormone-blocking therapy — is used to treat breast cancers that are sensitive to hormones. Doctors refer to these cancers as estrogen receptor positive (ER positive) and progesterone receptor positive (PR positive) cancers.

– Hormone therapy can be used before or after surgery or other treatments to decrease the chance of your cancer returning. If the cancer has already spread, hormone therapy may shrink and control it.

– Treatments that can be used in hormone therapy include:

• Medications that block hormones from attaching to cancer cells (selective estrogen receptor modulators)
• Medications that stop the body from making estrogen after menopause (aromatase inhibitors)
• Surgery or medications to stop hormone production in the ovaries.
• Hormone therapy side effects depend on your specific treatment, but may include hot flashes, night sweats and vaginal dryness. More serious side effects include a risk of bone thinning and blood clots.

– The two most common types of breast cancer hormone therapy are:

• Selective estrogen receptor modulators (SERMs): These drugs bind to estrogen receptors in the breast cancer cells to block estrogen from reaching cancer cells, preventing their growth. Tamoxifen is a commonly used hormone therapy designed to prevent breast cancer recurrence. This drug is also used for some women who are at high risk for developing breast cancer.
• Aromatase inhibitors: These breast cancer hormone therapy drugs block estrogen production by binding to the enzyme responsible for producing estrogen (the aromatase enzyme). Once estrogen production is halted, the cancer cells starve from lack of estrogen, which prevents them from growing and dividing.

– Clinical trials are a key testing ground for determining the effectiveness and safety of new treatments and drugs for many diseases, including cancer. As part of our commitment to providing new and innovative treatments, our doctors may recommend that you consider enrolling in carefully selected breast cancer clinical trials, if you meet specific criteria, to offer you access to treatment options that would otherwise be unavailable to you.

– Each patient is considered for a clinical trial on an individual basis and may qualify at any stage of disease or treatment. Talk to your doctor about whether a breast cancer clinical trial is a good option for you and ask about the risks and various requirements involved.

– Hair Loss

• You may lose some or all your hair within about two to four weeks of starting chemotherapy. New treatments may help with hair loss, so ask your doctor about that if it is a big concern for you. Your hair will grow back starting around a month to a month and a half after your last chemotherapy treatment.

– Nausea

• Most women feel sick and exhausted for a day or two after each chemotherapy treatment. It is different for everybody, and you must try the first round or so of chemotherapy before you know for sure. If you feel queasy, your doctor can give you a prescription for medicine to treat the nausea.

– Tiredness

• You may feel tired after chemotherapy and radiation therapy. Most of those side effects go away a few weeks after therapy ends.

– Skin Changes

• On or around the skin where you have been treated with radiation, you may get some redness or peeling, kind of like a sunburn. Your doctor will tell you the best way to treat these skin changes.