Management of Breast Cancer (Treatment and Aftercare)

TREATMENT
Many women receive more than one type of treatment.

-Divided to either Local Therapy or Systemic Therapy
Local Therapy
- Remove, destroy cancer in the breast.
- Used to control disease in specific areas of metastasis occurs
Systemic Therapy
- Destroy/control cancer throughout the body.

Surgery
Breast sparing surgery
- Remove cancer(lump) but not the breast.
- Underarm lymph nodes are removed as well (axillary lymph node dissection)
- Usually coupled with radiation therapy after surgery to destroy remaining cancer cells.


Mastectomy
Simple (total) mastectomy
-removal of whole breast, some lymph nodes under arm removed removed.

Radical Mastectomy
-removal of whole breast, most/all of lymph nodes under arm
-often lining over the chest muscles is removed

Radiation Therapy (radiotherapy)
- high energy rays to kill cancer cells by damaging cell DNA,
hence loses ability to grow and divide
- cancer cells less organized, harder to repair compared to normal cells.
- may be performed before surgery to destroy cancer cells and shrink tumour.
- may be used after breast sparing surgery or mastectomy
to destroy cancer cells that remain in the area.

External radiation
Radiation from large machine, linear accelerator, outside body
Internal radiation (implant radiation)
Implants (thin plastic tubes, catheters) containing radioactive substance (pellets, seeds) put directly into breast.

Chemotherapy
- Anticancer drugs used to kill cancer cells
- A combination of drugs is used
- Drugs given as a pill or injection into a vein (IV) – enter bloodstream and travel through body
- Stops growth/multiplication of cancer cells - kill them
- Used to reduce size of breast tumour before surgery
- Used after surgery to destroy cancer cells that may have spread
- Possibility of killing normal cells which divide rapidly (eg. blood cells)

Classes of drugs
Alkylators
- Damage proteins that control growth in the genes of the tumour cell
(eg. cyclophosphamide)
Antimetabolites
- Act as false building blocks (bases in nucleotides) in a cancer cell’s genes, causing it to die as it gets ready to divide .
(eg. fluorouracil)
Antibiotics (against growth, not those that fight infection)
-potent inhibitors of gene replication
(eg. Adriamycin)
Antimiototic agents
-natural agents that rob cellular genes of the ability to reproduce themselves during division (stops mitosis)
(eg. vincristine fr periwinkle plant)
Antimicrotubule
-natural agents which interfere with cell structure, microtubules, during cell division.
(eg. Taxol (paclitaxel) fr yew tree)


Hormone Therapy
- For hormone-receptor-positive breast cancer
- some tumours need hormones(estrogen, progesterone) to grow
- uses drugs OR surgery to lower the amount of hormone in body OR block action of estrogen on body

Type of Hormonal therapy medicines
Aromatase inhibitors
-aromatase is enzyme that synthesizes estrogen
Selective Estrogen Receptor Modulators (SERMs)
- ability to selectively inhibit or stimulate estrogen like action in various tissues
(eg. Tamoxifen)
Estrogen Receptor Downregulators (ERDs)
- sit in estrogen receptors in breast cells, blocks effect of estrogen in breast tissues

Targeted Therapy (Biologycal Therapy)
- helps immune system fight cancer

Herceptin (trastuzumab)
-monoclonal antibody that binds to cancer cells
- for breast tumours that have too much of a specific protein (HER2),
Blocks ability of cancer cells to receive chemical signals that tell the cells to grow.

CARE AFTER TREATMENT

Breast Reconstruction
- Reasons for breast reconstruction
~ maintain self-esteem and confidence
~body image reinforcement
~appearance for professional reasons
~avoid inconvenience of mammary prosthesis
- Two types of breast reconstruction:
~using implants (saline or silicon or both)
~using either the stomach or back muscles

External Prostheses
- helps restore body image
- made of silicon gel
- may be worn inside bra and closely copies natural contours of breast

Follow Up Treatment
- to look after emotional wellbeing and support
- regular checkups (mammograms, clinical examinations)