Breast Cancer: Treatment


Depending on the stage of the cancer, patients may have one or more of the following treatment options.

a. Chemotherapy

Chemotherapy drugs are given either before the surgery to shrink the tumor (neo-adjuvant therapy), or after the surgery, to keep the cancer from growing back (adjuvant therapy).

b. Chemoprevention/Hormonal Therapy

This approach involves the use of systemic agents to lower a patient’s risk of developing cancer by blocking the body’s natural production of hormones. Tamoxifen is approved for use in prevention, but is associated with some chronic side effects (including hot flashes and vaginal symptoms) and rare but serious side effects (including an increased risk of uterine cancer and blood clots). A similar drug, raloxifene, has fewer side effects and was approved by the FDA to reduce risk of breast cancer in high-risk postmenopausal women.
In addition, aromatase inhibitors, such as anastrozole, letrozole, and exemestane, are now standard hormonal therapies for postmenopausal women both for treatment and prevention. In addition to menopausal symptoms, the main side effects include joint symptoms and an increased risk of osteoporosis. These hormonal treatments are standardly given for a total of five years, however, newer studies indicate that extended therapy for up to 10 years is effective for preventing late relapse of breast cancer.

c. Targeted Therapies

This type of treatment attacks specific types of cancer cells with less harm to normal cells. Some types of targeted therapies help the immune system kill cancer cells or deliver toxic substances directly to cancer cells and kill them. These are called immunotherapy drugs.

Other targeted therapies block the action of certain proteins involved in the growth and spread of cancer cells. These are called monoclonal antibodies. An important targeted therapy for HER2-positive breast cancer is trastuzumab (Herceptin) and there are many new agents that can also target HER2.

Targeted therapy may have fewer side effects than other types of cancer treatment.

d. Radiation Therapy

With advanced radiation therapy techniques doctors can better target tumors while reducing the radiation to nearby healthy tissues. Here at HICCC our radiation oncology experts have the ability to provide “state of the art” treatments for breast disease.

Your radiation oncologist will design the optimal treatment plan for you with you that will provide you the best optimal results. Treatment delivery can be daily, weekly, every other day, and or single fraction.

If radiation treatment is recommended, a radiation oncologist will work with our radiation oncology team to create a course of treatment. At Columbia University Irving Medical Center treatment modalities available and most commonly used for this cancer are External Beam Radiation Therapy, 3D Conformal Radiotherapy, Intensity-modulated radiation therapy (IMRT), Partial Breast Irradiation and Intraoperative Radiation Therapy (IORT).

e. Surgery

Operations to remove the cancer may include the following:

Breast-conserving surgery This approach removes the cancer while leaving as much of the breast as possible. This includes lumpectomy (removal of the lump with some surrounding tissue at the margin of the tumor), quadrantectomy (removal of one quarter, or quadrant, of the breast), and segmental mastectomy (removal of the cancer as well as some of the breast tissue around the tumor and the lining over the chest muscles below the tumor).

Modified radical mastectomy In this operation, the surgeon removes the breast, lymph nodes under the arm, and the lining over the chest muscles. In some cases, part of the chest wall muscles will be removed as well. This may be followed by reconstructive surgery to reshape the breast.

Total mastectomy This surgery, also called simple mastectomy, removes the entire breast.

Lymph node removal Following surgery, the patient’s lymph nodes may be removed and a sample of tissue taken, to check if the cancer has spread. In what is called a sentinel lymph node biopsy, some of the lymph nodes in the tumor area are removed. In a radical lymph node dissection, most or all of the lymph nodes in the tumor area are removed. This procedure is also called a lymphadenectomy.

A common side-effect of breast cancer surgery is lymphedema, swelling in the arms, hands, fingers, shoulders or chest, caused by fluid retention in the body. Columbia surgeons have developed innovative protocols to prevent lymphedema following surgery for breast cancer.

Oncoplastic breast surgery Patients may also have concerns about how surgery might affect their appearance. Surgeons at Columbia’s Clinical Breast Cancer Program are fully versed in Oncoplastic Surgical techniques. These techniques are designed to give the patients excellent cosmetic results while maintaining sound oncologic principles following major resection from the breast cancers.

More information can be found here