Breast Cancer Treatment Essay

Invasive ductal carcinoma is the most common type of breast cancer, it begins in the cells that line the milk duct in the breast, then the cancer penetrates the channel wall and grows into nearby breast tissue, at this stage it can spread to other parts of the body through the lymphatic system and the bloodstream. Given in this case, the patient has invasive ductal carcinoma through the biopsy taken, and since the solid mass is immobile with a diameter of 2-3 cm, 5 cm from the nipple, is felt in the upper outer quadrant of the right breast, the lymph node in the armpit is imperceptible, and there is no spread In the body, according to the TNM staging system, the system that describes the amount and spread of cancer in a patient’s body. T describes the size of the tumor and any spread of cancer into nearby tissue; N describes the spread of cancer to nearby lymph nodes; and M describes metastasis. Accordingly, the patient in this case is in Stage 2A: T2, N0, M0.

In this case, we will start with a topical treatment.

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Stage 2 cancers are treated with either breast preservation surgery (BCS; sometimes called lumpectomy or partial mastectomy) or mastectomy. Proximal lymph nodes will also be examined, either by sentinel lymph node biopsy (SLNB) or axillary lymph node dissection (ALND). Women with BCS are treated with radiotherapy after surgery as radiation is discussed as a treatment option after surgery. In this case, we will start with a lumpectomy and then dissect the axillary lymph node.

The goal of lumpectomy is to remove cancer or other abnormal tissue while maintaining the appearance of your breast. Studies indicate that lumpectomy followed by radiation therapy is as effective in preventing a recurrence of breast cancer as the removal of the entire breast (mastectomy) for early-stage breast cancer. here we recommend lumpectomy because the biopsy has shown that the cancer is believed to be small and early stage. A lumpectomy may also be used to remove certain noncancerous or precancerous breast abnormalities.

we do not recommend lumpectomy for breast cancer if you: Have a history of scleroderma, have a history of systemic lupus erythematosus, have two or more tumors in different quadrants of your breast that cannot be removed with a single incision, which could affect the appearance of your breast, have previously had radiation treatment to the breast region, have cancer that has spread throughout your breast and overlying skin since lumpectomy would be unlikely to remove cancer completely, have a large tumor and small breasts, which may cause a poor cosmetic result, and don't have access to radiation therapy. But in this case, all of these barriers are not present, so a lumpectomy is a correct and proper option.

The goal of axillary lymph node which is a surgical procedure that incises the axilla to identify, examine, or remove lymph nodes. Axillary dissection has been the standard technique used in the staging and treatment of the axilla in breast cancer. Patients presenting with symptomatic early breast cancer have a 30-40% chance of having positive axillary nodes and a 20-25% chance if presenting through a screening program. Staging of the axilla is an important step in the treatment of breast carcinoma. Axillary lymph node status is a significant prognostic pathologic variable in patients with operable primary breast cancer, and it remains the most powerful predictor of recurrence and survival.

starting with a Lumpectomy to remove cancerous breast tissue along with a rim of normal tissue surrounding it called a surgical margin. The procedure preserves the rest of the breast as well as the sensation in the breast. If you have invasive breast cancer and are younger than 70 years of age, a lumpectomy is always followed by radiation treatments to the breast the patient is 42 years old so we will start with radiation therapy, External beam radiation therapy is offered after breast-conserving surgery for stage 2 breast cancer. All of the breast and the lymph nodes under the arm and near the collarbone are treated. Radiation after lumpectomy is to kill any cancer cells that might remain. Adding radiation after a lumpectomy reduces the risk that cancer will return to the affected breast. Lumpectomy combined with radiation therapy is often referred to as breast conservation therapy. This type of treatment is as effective as having all the breast tissue removed (mastectomy). In special situations where the risk of recurrence is very low.

After lumpectomy, radiation treatment options might include:

Radiation to the entire breast. One of the most common types of radiation therapy after a lumpectomy is external beam radiation of the whole breast (whole-breast irradiation).

Radiation to part of the breast. Radiation therapy to part of the breast (partial-breast irradiation) may be an option for some early-stage breast cancers. This technique directs internal or external radiation to the area around where the cancer was removed.

Complementary and Alternative Medicine (CAM) is becoming increasingly popular among cancer patients, in particular those with breast cancer. It represents one of the fastest-growing treatment modalities in the United States. CAM encompasses a wide range of modalities including special diet and nutrition, mind-body approaches, and traditional Chinese medicine.

• CAM treatment 1: Special diet

A healthy diet is an important part of cancer treatment. However, some people with breast cancer may start on a special diet in place of taking anticancer drugs. You should avoid foods that are:high-fat, salt-cured, smoked, or pickled. You should also double up on fruits, vegetables, and plant-based foods.

• CAM treatment 2: Antioxidant supplements

Antioxidants lower your risk of cancer by helping protect your body from damage caused by free radicals. Certain grains, fruits, and vegetables are rich in dietary antioxidants, including:

beta carotene, lycopene, vitamin A, vitamin C, vitamin E. These antioxidants may be found in the following foods: goji berries, wild blueberries, dark chocolate, pecans, and kidney beans. They’re also available through dietary supplements. However, research is mixed on whether antioxidant supplements are safe to use during cancer treatment.

• CAM treatment 3: Mind, body, and soul therapies

Mind-body practices are meant to improve your mind’s positive impact on the rest of your body. Each therapy targets your mind, body, and soul using meditative techniques and creative activities that help enhance your quality of life.

• CAM treatment 4: Massage therapy

Massage therapy is known to boost immunity and ease anxiety, pain, and fatigue. One 2003 study by Trusted Source found that in women who had breast cancer, massage therapy helped reduce not only anxiety and pain but also the need for pain medication. Another study Trusted Source released around that time found that massage therapy and progressive muscle relaxation helped increase protective white blood cells in women with stage 1 and stage 2 breast cancer.

• CAM treatment 5: Acupuncture

Acupuncture is a central part of traditional Chinese medicine that may help relieve symptoms of breast cancer and the side effects of treatment. Acupuncture requires a practitioner to place sterile, hair-thin needles into acupuncture points — specific points on your skin — and then gently move them to stimulate your nervous system.

Research Trusted Source has shown that acupuncture can help: relieve fatigue, control hot flashes, reduce vomiting, reduce pain, and help decrease nausea.

Fighting cancer typically involves more than one treatment. Most of the time, the disease requires a multidisciplinary approach or a combination of therapies. Treatment plans often involve a primary therapy—generally surgery or radiation therapy—in addition to an adjuvant or neoadjuvant therapy. In a nutshell, these are therapies, like chemotherapy or hormone therapy, delivered before or after the primary treatment, to help increase the treatment’s chance of success and decrease the risk of recurrence.

Neoadjuvant and adjuvant therapies are often used to treat breast, colon, and lung cancers, and may include chemotherapy, hormone therapy, radiation therapy, immunotherapy, and targeted therapy. The two therapies differ largely in when they are given and why. Neoadjuvant therapies are delivered before the main treatment, to help reduce the size of a tumor or kill cancer cells that have spread. Adjuvant therapies are delivered after the primary treatment, to destroy remaining cancer cells.

Most often, neoadjuvant and adjuvant therapies are recommended when a patient with early-stage cancer undergoes surgery or radiation therapy and we believe that in this condition she may benefit from additional systemic treatments, In this condition we have localized breast cancer, and the first-line treatment in this case is surgery, but to improve the chances that the surgery works as well as it can, we give chemotherapy three or four months before surgery, or three to four months after surgery, then there is a significant improvement in prognosis and a decreased risk of recurrence with doing either an adjuvant or neoadjuvant approach.”

Neoadjuvant and adjuvant therapies benefit many, but not all, cancer patients. The type and stage of a patient’s cancer often dictate whether she is a candidate for additional treatment. Neoadjuvant therapy may also serve as a tool for determining the patient’s response to treatment. If the tumor responds to chemotherapy before surgery, you know that the patient is more than likely to do well.”

It’s important to know, though, that neoadjuvant and adjuvant therapies may cause side effects, such as the nausea and fatigue that often accompany chemotherapy. That’s why they’re commonly recommended for otherwise healthy cancer patients when the expected benefits outweigh the potential risks.

What types of adjuvant therapies are used for breast cancer?

Most adjuvant therapies are systemic: they use substances that travel through the bloodstream, reaching and affecting cancer cells all over the body. Adjuvant therapy for breast cancer can include chemotherapy, hormonal therapy, the targeted drug trastuzumab (Herceptin), radiation therapy, or a combination of treatments.

• Adjuvant chemotherapy uses drugs to kill cancer cells. Research has shown that adjuvant chemotherapy for early-stage breast cancer helps to prevent the cancer from returning.

• Hormonal therapy deprives breast cancer cells of the hormone estrogen, which many breast tumors need to grow. A commonly used hormonal treatment is the drug tamoxifen, which blocks estrogen’s activity in the body. Studies have shown that tamoxifen helps prevent the original cancer from returning and also helps to prevent the development of new cancers in the other breast.

• Trastuzumab is a monoclonal antibody that targets cancer cells that make too much of, or overexpress, a protein called HER2. When cancer cells overexpress HER2 protein, they are said to be HER2-positive. Approximately 20 percent of all breast cancers are HER2 positive. Clinical trials have shown that targeted therapy with trastuzumab in addition to chemotherapy decreases the risk of relapse for women with HER2-positive tumors.

• Radiation therapy is usually given after breast-conserving surgery and may be given after a mastectomy. For women at high risk of recurrence, doctors may use radiation therapy after mastectomy to kill cancer cells that may be left in tissues next to the breast, such as the chest wall or nearby lymph nodes.

What types of Neoadjuvant therapies are used for breast cancer?

• Neoadjuvant chemotherapy. If your treatment plan includes chemotherapy, neoadjuvant chemotherapy may be an option as a first treatment. However, for some women, neoadjuvant chemotherapy may change their surgical options. Neoadjuvant chemotherapy may be able to shrink a larger tumor enough so lumpectomy plus radiation therapy becomes an option instead of mastectomy like in this case.

• Neoadjuvant hormone therapy, may change a woman’s surgical options. It may be able to shrink a large tumor enough so lumpectomy plus radiation therapy becomes an option instead of mastectomy like in this case. Neoadjuvant hormone therapy is only used to treat hormone receptor-positive (ER-positive and or PR-positive) breast cancers. Some women with low-grade tumors or invasive lobular breast cancer may be offered neoadjuvant hormone therapy instead of chemotherapy. Survival is the same whether you start taking hormone therapy before surgery or after surgery.

The BRCA gene test is offered to those who are likely to have an inherited mutation based on a personal or family history of breast cancer or ovarian cancer. The BRCA gene test isn't routinely performed on people at average risk of breast and ovarian cancers.

While BRCA1 and BRCA2 gene mutations may increase your odds of developing breast cancer, your odds of having either mutation are pretty small. An estimated 0.25% of the general population carries a mutated BRCA gene or about one out of every 400 people.

For some people, though, the chances of having a BRCA gene mutation are much higher. Genes are inherited, which is why knowing your family history is important when determining breast cancer risks. If one of your parents has a BRCA mutation, you have a 50% chance of inheriting the mutated gene. Odds can also vary depending on a person’s ethnicity. For example, people of Ashkenazi Jewish descent have a 2.5% chance of inheriting a BRCA mutation, or about 10 times the rate of the general population.

Genetic counseling is recommended for tested breast cancer gene mutations. So we determine whether genetic testing would make sense based on family history and risk factors. Since many genetic tests only look for one specific gene mutation. The genetic test itself simply involves taking a small sample of blood or saliva, which is sent to a lab for analysis. Results can take several weeks or months.

Ideally, in a family that might carry a gene mutation, a family member who has breast or ovarian cancer will have the BRCA gene test first. If this individual agrees to genetic testing and doesn't carry the BRCA gene mutation, then other family members may not benefit from genetic testing. However, there might be other genetic tests to consider. In this case, based on the information given, the patient does not have a family history of breast cancer, so genetic tests are not very useful in this case. Nevertheless Genetic testing results are not always clear-cut:

A test result can be positive, meaning that the patient does carry the gene mutation.

A negative test result indicates that they do not have that particular known gene mutation. It does not, however, rule out the possibility of having mutations in other genes. It also does not rule out the possibility of developing breast cancer. Most breast cancer cases are not hereditary, so everyone should still have an early detection plan.

Genetic test results can also be uncertain or ambiguous. An ambiguous test result means that a mutation has been found in the gene, but it is not yet known whether that particular mutation has any effect on the chances of developing breast cancer.

Genetic testing can be scary. The results also can impact other family members such as siblings and offspring; when someone tests positive for a gene mutation, their siblings and offspring will have a 50% risk of also testing positive.

Preoperative testing before the lumpectomy, In the weeks or days before surgery, we need to take tests to make sure the body can handle the anesthesia and the operation.

A chest X-ray and electrocardiogram (EKG) will show whether your lungs and heart are working properly. Blood tests will check your blood counts, your liver and kidney function, and your risk of bleeding or infection. A urine test can find out about your kidney function and look for infections.

Sometimes other tests, such as CAT scans, are given to check for tumor location and size. A CAT scan can also determine whether a tumor is involved with other parts of the body. Also, we ask about having diabetes, high blood pressure, heart disease, or other conditions that could affect surgery.