Treatment of breast cancer is based on 4 main pillars:
- Radiation therapy
- Endocrine therapy
Which or how many pillars are required for successful treatment depends on many factors and differs from woman to woman. That means that cancer treatment is very individualized and can vary according to age, health status and especially from the tumor biology and stage.
After the information is gathered through various examinations, e.g. chest x-ray, abdominal ultrasound and a bone scan) a tumor board convenes to discuss the results and to make a further treatment recommendation. The tumor board consists of experts in the treatment breast cancer, i.e. gynecologists, oncologists, radiation therapists, pathologists, psycho-oncologists and radiologists. Other specialists are invited to the tumor board whenever needed. The tumor board makes a recommendation based on all available information as to which of the treatment modalities would be of benefit for cure or for improvement. This is only a recommendation, a treatment is done only with patient consent.
CHEMOTHERAPY is given generally in an ambulatory setting, usually as an infusion over a few hours. The i.v. medications are given every three weeks, called a cycle. Most regimens have 6-8 cycles, i.e. 18 – 24 weeks of therapy. However, there are many different regimens and it is not possible to make an exact statement to how many cycles, the cycle frequency or to the possible length of treatment. Chemotherapy is very individualized so specific information will be given prior to treatment.
RADIATION THERAPY is done after breast conserving treatment and is sometimes recommended after mastectomy. Radiation therapy is performed to reduce local recurrence of cancer in the remaining breast tissue, chest wall or in the lymphatic tissue. The recommendation is made at the time of the tumor board. A typical treatment takes about 5 weeks, 5 days per week for a few minutes at a time. Newer forms of radiation therapy have made serious side effects more seldom. The risks and benefits as well as side effects will be discussed with the radiation therapist before treatment begins.
The ENDOCRINE THERAPY is an anti-hormone therapy and consists of medications that either modify the estrogen receptor on cells to block the effects of estrogen or by inhibiting estrogen production. Tamoxifen is a selective estrogen receptor modifier and been used very successfully for a long time in the treatment of estrogen receptor positive breast cancer. A newer medication group are the aromatase inhibitors. They block estrogen production by inhibiting a specific enzyme in the estrogen synthesis pathway. These medications are not strong enough to overpower the ovarian production of estrogen, therefore are recommended only after menopause.