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About Breast Cancer Treatments

In general breast cancer treatments are either local (surgery and radiotherapy) or systemic (hormone therapy, chemotherapy, Herceptin). Local treatments just treat the tissue removed (surgery) or irradiated. Systemic treatments go through the whole body and treat any cancer cells that may have spread.

The usual sequence of breast cancer treatments is to remove all the disease we know about first (with surgery). This is often supplemented with radiotherapy to the breast or chest. Most, but not all ladies also require one or a combination of systemic treatments.

Systemic treatments can also treat local disease and are sometimes used to make local disease smaller such that it is easier to remove. This is called neo-adjuvant therapy.

Radiotherapy

This is a course of treatment over 3 weeks. It involves attending the hospital every day of the week (Monday to Friday) and getting a short dose of radiation to the breast or chest area. Each hospital visit only takes about 40 minutes.

Radiotherapy is almost always used after breast-conserving surgery for breast cancer and often used after breast-conserving surgery for DCIS.
It is also used after mastectomy and to treat lymph nodes in some women.

Side-effects of Radiotherapy


Many women have very few side-effects from radiotherapy and it is hard to tell that they have had it. Other women are left with obvious radiotherapy changes to the tissue that was treated.

The main side effects are sunburn-like skin changes, discolouration of the skin and thickening of the skin in the region where the radiotherapy was given. In addition, many women feel tired during radiotherapy and for a while afterwards. Quite commonly the radiotherapy area feels quite tender afterwards - this is often permanent.

Some women are more at risk from radiotherapy side effects than others. Women with very large breasts are one such group, hence breast reduction is often discussed in these cases. In addition, some side-effects can be minimised by liberal and frequent application of moisturiser to the radiotherapy area. If you have had radiotherapy this should become a lifelong habit.

Chemotherapy

Chemotherapy is a way of treating breast cancer, even if it has (or potentially has) spread to other parts of the body. The other common way of doing this is hormone therapy.

Chemotherapy is also occasionally given prior to surgery to try and shrink larger breast cancers such that they become more easy to operate on and remove. This can sometimes make preserving the breast an option rather than mastectomy.

Chemotherapy is as a course of treatment usually given every 3 or 4 weeks over 3 to 6 months. Different regimens of treatment are used depending on the extent and type of breast cancer and your general fitness. Chemotherapy is usually given as an outpatient but does take most of the day. You are usually attached to a drip for a while so that the chemotherapy can go directly into the bloodstream.

There are a few common side effects with chemotherapy:

  • A metallic taste in your mouth

  • Temporary hair loss

  • Tiredness

  • Induction of the menopause

  • Sore mouth

  • Nausea

There are many ways nowadays to try and minimise the impact of these side effects. If you require chemotherapy you will be referred to an expert who will advise you. Your breast care nurse will also spend time going over the details of how best to cope with chemotherapy. Another good website for further information is www.breastcancercare.org.uk where you will find useful fact sheets

Herceptin

It is only suitable for a small minority (about 15 - 20%) of women with breast cancer. To be suitable your your cancer must have the Her-2 receptor. Like chemotherapy and hormone therapy it treats breast cancer that has (or potentially has) spread to other parts of the body.

It is an outpatient treatment given every 1 - 3 weeks by a drip directly into the bloodstream.

Treatment lasts about a year although duration of treatment is currently debated.

Common side effects are:

  • Flu-like symptoms

  • Nausea

  • Diarrhoea

  • Current guidance suggests that women receiving Herceptin should also be monitored for uncommon side effects on the heart with a regular heart scan (echocardiogram).

At the time of writing we only have evidence to say that Herceptin is effective in women who are also having chemotherapy.

Further information is available at www.breastcancercare.org.uk where there are useful fact sheets

Hormone Therapy

Hormone therapy is a way of treating breast cancer, even if it has (or potentially has) spread to other parts of the body. The other common way of doing this is chemotherapy.

Hormone therapy is only suitable for women with hormone sensitive breast cancer. It is usually given to such women after surgery (and after chemotherapy if you are also having that). Occasionally hormone therapy is used as a pre-surgical treatment to try and shrink a breast cancer such that it becomes easier to remove with surgery. In women who are not fit for surgery, hormone therapy may be a good 'second best' option and may be able to control the cancer for amny years without surgery.

There are different ways of giving hormone therapy principally depending on whether or not you have gone through the menopause or not.

For women who have not yet gone through the menopause.

  • In this situation, hormone therapy usually consists of giving a hormone therapy tablet (Tamoxifen).

  • In certain cases, the menopause is also induced.

Ways of inducing the menopause are:

  • Removing the ovaries surgically (this is called oophorectomy and is usually performed by keyhole surgery with a one night stay in hospital).

  • Giving radiotherapy to the ovaries.

  • Having a monthly injection (Zoladex).

The first 2 methods induce the menopause permanently and the third method induces the menopause only while you are having the injections. The third method is usually the most suitable one for young women who are many years before the natural menopause.

Either of the first two methods would be suitable for women who are within a few years of the natural menopause.

  • For women who are pre-menopausal at the time of starting treatment for breast cancer, the current standard for hormone therapy is Tamoxifen for 5 years.

  • For women who are post-menopausal at the time of starting treatment for breast cancer, the current standard for hormone therapy is taking an aromatase inhibitor (Arimidex or Letrozole) for 5 years.

  • For pre-menopausal women who have had the menopause permanently induced, a discussion will be had about the pros and cons of Tamoxifen versus an aromatase inhibitor.

  • For women who go through the menopause naturally whilst taking hormone therapy, a discussion will be had about changing from Tamoxifen to an aromatase inhibitor.

  • In some cases it is recommended that hormone therapy continue beyond 5 years.

  • All women having hormone therapy take a tablet once a day. Hormone therapy tablets are usually taken for 5 years and some women may be recommended to take them for longer. Some women may be recommended to switch from one tablet to another after 5 years. For higher risk women the option for extending hormone therapy beyond 5 years has been shown to be associated with less risk of cancer recurrence.

The different tablets have different side-effects and the choice of which to use and how long to use it is tailored to your individual situation.

Side-effects of Hormone Therapy

Hormone therapy is a treatment that a lot is known about in terms of side-effects. There is therefore a long list of possible (mostly rare) side-effects.

However some side-effects are common:

  • Menopausal-type symptoms

  • Hot flushes

  • Night sweats

  • Slight weight gain

  • Generalised joint ache (aromatase inhibitors)

  • Gynaecological symptoms - Vaginal dryness

  • Cognitive effects

In addition, of the less common side-effects important ones are: Tamoxifen is associated with a small risk of thrombosis Aromatase inhibitors are associated with a small risk of osteoporosis (you will have a bone density scan before starting an aromatase inhibitor).

A full list of side-effects can be read on an information sheet that will be given to you. Alternatively visit www.breastcancercare.org.uk and read the fact sheets.

 

Dr. Tasmia Tahmid

We offer patients the benefits of all major treatment methods including surgery, medical oncology and radiation oncology for Breast Cancer.
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