Treatment for Carcinoma of Breast
Every breast cancer patient should preferably be seen by a Surgeon, Medical Oncologist, Radiation Oncologist and Plastic Surgeon before anything is done. Then a treatment plan has to be made and implicated by each member of the team. Different strategies have to be explained an discussed with the patient and her input has to direct the course of treatment.
This is a very difficult thing for the patients to do. Imagine a woman being just diagnosed with breast cancer. The anxiety and depression levels are so high at the onset,. However, this is the most important time for a group effort to treat her problem. In best case scenario, the first physician who sees her will arrange for all her care, but unfortunately, this is not the case for every patient. Some patients suffer from inefficiencies of our healthcare system and receive less than adequate care. There are two important aspects to the treatment and control of the breast cancer
Local control and treatment of the breast itself
Systemic Control of the illness.
1- Local Control is achieved by surgery, whereby surgeon will attempt to remove the tumor as well as some normal tissue around the tumor. The extent of surgery on the breast will depend on the size and location of tumor as well as the size of the breast. Another aspect of surgery is removal of the lymph glands from the area under the arm on the same side as cancer is diagnosed. The findings, and status of these lymph glands, in respect to cancer involving them, is the most important determining factor for further care of patients. Some complementary laboratory tests are also performed on the cancer tissue in order to determine the presence or absence of receptor molecules to Estrogen (ER) or Progesterone (PR) (female sex hormones) as well as genetic and chromosome studies.
Mastectomy is complete removal of one breast and some surrounding tissues. This is done under general anesthesia and in a hospital setting.
Lumpectomy is partial removal of the breast tissue that contains the cancer, whereby most of the breast architecture is preserved. Since some cancer cells may be left behind with this procedure, the reminder of the breast has to be treated with radiation to achieve similar results as with Mastectomy.
2- Systemic Control is achieved by Chemotherapy or Hormonal treatments. Whether or not there is a need for chemotherapy is a question that is best answered by Medical Oncologist. He has to determine the risk of recurrence of the cancer and gauge the benefits and side effect of this treatment. The determination of the necessity for Chemo or hormonal therapy is dependent on the following factors
Patient's age and her general condition
Size of the original tumor
Involvement of the Lymph glands by the cancer
Presence or absence of hormone receptors on tumor cells as well as HER2 status
Genetic and Chromosome abnormalities in the cancer tissue
Other factors, such as microscopic findings in the cancer tissue
Extent of the cancer, whether it has spread to other organs.
Following is a list of common rules and guidelines to assess the needs for Chemo or hormone therapy:
Rule # 1: The younger the patient, the more aggressive the treatment, with the goal being to cure the disease. This is achieved by using aggressive chemotherapy.
Rule # 2: Hormone treatment for patients with positive hormone receptor tumors, ER+, PR+
Rule # 3: All women under age of 70, who are in good state of health, with any stage of breast cancer, regardless of extent of initial disease should be considered for adjuvant hormone therapy or chemotherapy for aggressive disease. Systemic treatment of each patient has to be tailored to her specific situation. '
Rule # 4: All with Her2/Neu positive tumors should be treated with Herceptin, either as part of adjuvant therapy or for treatment of metastatic disease.
