Women with breast cancer have many treatment options. These are surgery, chemotherapy, radiotherapy, hormone therapy and biological therapy.
The most important factor in determining the method of treatment is the stage of the disease (see: “Treatment by stage” at the end of this file).
Many women receive more than one treatment. In addition, they may receive treatment at any stage of the disease to relieve their body’s pain and other signs of cancer, alleviate the side effects of treatment, and overcome their emotional problems. This treatment is called supportive treatment.
Cancer treatment is either local treatment or systemic treatment.
Local treatment: Surgery and radiotherapy are local treatments. The aim of these treatments is to eliminate the cancer in the breast. When breast cancer spreads to other parts of the body, local treatment can be used to control the disease in those areas.
Systemic therapy: Chemotherapy, hormone therapy and biological therapy are systemic treatments; They enter the blood and control, or destroy, cancer throughout the body. Some women with breast cancer receive systemic therapy to shrink the tumor before radiotherapy or surgery. It also happens that systemic therapy is administered after surgery and/or radiotherapy to prevent the cancer from coming back. Systemic treatments may also be done for cancer that has spread.
Patients want to know how the treatment will change their lifestyle, how they will look during and after treatment. The doctor is the most appropriate person to explain the treatment options, the side effects of the treatment and the expected results to the patient.
Each patient can work with their doctor to create a treatment plan that will match their needs and personal values.
The patient may ask their doctor to answer the following questions before treatment begins
What are the treatment options? Which one would you recommend? Why?
What are the expected benefits of each treatment?
What are the risks and possible side effects of each treatment?
How does treatment affect a woman’s usual activities?
Would a clinical research study be appropriate?
How much will the treatment cost? Are the expenses of this treatment covered by the health insurance?
Of course, patients do not have to ask all these questions at once. It is always possible for them to direct their questions to their doctors.
Operation
Surgery is the most common treatment for breast cancer. There are many types of surgery (see pictures below). The doctor should explain to the patient the benefits and risks of any type of surgery and how it will change the woman’s appearance.
Surgery in which the breast is preserved: The operation in which only the cancer is removed, the tumor is removed, but the breast is not removed is called breast-conserving surgery (lumpectomy, segmental mastectomy, or partial mastectomy). The surgeon usually removes the guard lymph node with special methods to determine whether cancer cells have entered the lymph system with a separate incision and is scanned for metastasis. If present, the lymph nodes are removed from the armpit. This procedure is called Sentinel (guard) lymph node biopsy, the removal of lymph nodes in the armpit is called axillary lymph node dissection. After surgery in which the breast is not removed, radiotherapy is applied to destroy any cancer cells that may remain in the breast.
Mastectomy: The operation in which the breast is removed with or without axillary lymph nodes is called mastectomy. After surgery, patients can receive radiotherapy, if necessary.
Studies have concluded that breast-removal surgery (with radiotherapy) and mastectomy are equally successful in the treatment of stage I and II breast cancer.
Sentinel lymph node biopsy is a new method to look for cancer cells in lymph nodes. With this method, which has been applied by us since 1998, the specially trained surgeon does not remove many lymph nodes under the armpit, but only one or a few lymph nodes (sentinel glands). Necessary explanations about the ongoing studies on this method are included in the “Research on treatment” file.
1 – Breast conserving surgery
In the operation where the breast is not removed, the surgeon removes the tumor in the breast and some disease-free tissue around it. Lymph nodes in the armpit can also be removed.
2 – Simple mastectomy surgery
In total mastectomy, the surgeon removes the entire breast. The operation in which the armpit lymph nodes are not removed is called Simple Mastectomy, and the operation in which the armpit lymph nodes are removed is called Modified Radical Mastectomy.
3 – Modified Radical Mastectomy surgery
In modified radical mastectomy, the surgeon may perform the entire breast, most or all of the lymph nodes in the armpit.
gets. The smaller of the two chest muscles can also be removed to facilitate the removal of the lymph nodes.
Before the operation, the woman may ask her doctor the following questions.
What type of surgery might be available for me?
Which one do you find suitable? What are the risks of the surgery you find suitable?
Will my lymph nodes be removed? How many of them? Why?
How will I feel after the operation? How long will I need to stay in the hospital?
Do I need to learn to take care of the incision or myself when I go home? Sir, what does “incision” mean?
Where on my body, what kind of scars will there be?
If I decide to have breast reconstruction, how and when can the surgery be performed? Can you recommend me an experienced plastic surgeon? see: Breast reconstruction
Do I need to do special exercises to regain the strength and freedom of movement of my arm and shoulder? Will I do the exercises under the direction of a physiotherapist or a nurse?
When can I return to my usual daily activities? Is there anything I absolutely shouldn’t do during the healing process?
Is there anyone I can contact who has had the same surgery?
Radiotherapy
Also called radiation therapy/therapy, it is high energy beams used to kill cancer cells.
In general, it is applied after surgery in which the tumor is removed and the breast is not removed. Sometimes it is also applied after mastectomy, depending on the size of the tumor and other factors. The radiation destroys any breast cancer cells that may have remained in the area.
Radiotherapy may also occasionally be used before surgery (radiotherapy alone, or in combination with chemotherapy or hormone therapy) to destroy cancer cells and shrink tumors. This approach is mostly used in cases where the breast tumor is large or cannot be easily removed with surgery.
Doctors use 2 types of radiotherapy in the treatment of breast cancer.
External radiation: Radiation comes from the machine. For external radiation therapy, a patient with breast cancer goes to a hospital or clinic. The duration of treatment is usually 5 weeks, with 5 sessions per week.
Internal radiation (implant radiation): The radiation comes from the radioactive material inside the thin plastic tubes placed inside the breast. A hospital stay is required for implant radiation. Implants stay in the breast for several days. After removal, the patient is discharged.
A patient may need to receive both radiotherapy.
The patient may want to ask the following questions to his doctor before radiotherapy.
Why do I need this treatment?
What are the benefits, risks, and side effects of this treatment? Will it affect my skin?
Are there any long-term side effects?
When will treatment start and when will it end?
How will I feel during the treatment?
How should I take care of myself before, during and after treatment?
Can I continue my usual daily activities during the treatment period?
What will my breast look like at the end of the treatment?
What is the probability of recurrence of the tumor? Sir, does it mean the possibility of forming a new tumor?
How often should I be monitored after treatment?
Chemotherapy
Chemotherapy is the use of drugs to kill cancer cells. In chemotherapy for breast cancer, several drugs are often used together. The drugs are given as pills or by intravenous injection. In both ways, the drugs mix with the blood and circulate in the body.
Most patients receive chemotherapy without staying in the hospital, in the doctor’s office, or at home. There may also be patients who want to stay in the hospital during chemotherapy.
hormone therapy
Hormone therapy prevents cancer cells from getting the natural hormones (estrogen and progesterone) needed for growth. If laboratory tests show that the breast tumor has hormone receptors, the patient may be given hormone therapy.
Like chemotherapy, hormone therapy can affect cells throughout the body.
Hormone therapy is performed with the use of medication or surgery.
Medicine
The doctor may prescribe a medicine that will block the natural hormone; for example, Tamoxifen, which blocks estrogen, or an anti-hormone drug that prevents the body from producing female hormones.
Operation
A non-menopausal woman may have surgery to have her ovaries removed. The main source of estrogen in the body is the ovaries. After menopause, surgery is not required as the ovaries’ hormone production naturally decreases.
biological therapy
Biological therapy uses the body’s natural ability (the immune system) to fight cancer. Some women with metastatic breast cancer receive biologic therapy with the use of a medicine called Trastuzumab (Herceptin). This is a lab-made monoclonal antibody that can attach to cancer cells.
Herceptin is given to women who have a breast tumor who has an excess of the protein called HER2 in laboratory testing. By blocking Her2, Herceptin can slow or stop the growth of cancer cells.
Herceptin is injected into a vein. It is given alone or in combination with chemotherapy.
Biological therapy, like chemotherapy and hormone therapy, affects cancer cells throughout the body.
The patient may ask his doctor to answer the following questions before undergoing systemic therapy (chemotherapy, hormone therapy, biological therapy).
Why do I need this treatment?
What drugs will I use? What is the function of drugs?
If I need hormone therapy, would it be better for me to have my ovaries surgically removed or to use medication?
When will the treatment start and when will it end?
What are the expected benefits of treatment?
What are the risks and possible side effects of the treatment? Is there anything I can do to alleviate the side effects of treatment? Which side effect should I tell you? Will there be any long-term side effects?
Where will I go for treatment? Will I be able to drive home after each treatment session? Do I need to stay in the hospital during treatment?
How will the treatment affect my daily activities?
Is a clinical research study suitable for me?
What kind of care will I need after the treatment?
Treatment options by stage
A woman’s treatment options vary according to the stage of her disease and the following factors.
The ratio of the size of the tumor to the size of the breast,
Results of laboratory tests (such as whether the growth of cancer cells is dependent on hormones)
Whether the woman has gone through menopause
General health status of the woman
Commonly used treatments for each stage
Clinical trials may be an option at any stage of breast cancer. (For clinical studies, see the “Success of cancer research” file)
Stage 0
Lobular carcinoma in situ (LCIS) or ductal carcinoma in situ (DCIS) in stage 0 breast cancer
LCIS: Patients with LCIS usually do not need additional treatment after surgery. Instead, follow-up is recommended. Tomoxifen can be used in patients with positive estrogen receptors to reduce the risk of developing breast cancer. However, LCIS in one breast increases the risk of cancer in both breasts. Therefore, it may be recommended to remove both breasts to prevent new cancer formation in patients with LCIS. (Bilateral Prophylactic Mastectomy surgery) In this surgery, armpit lymph nodes are not removed.
DCIS: Most patients with DCIS receive radiotherapy following breast-conserving surgery. However, some may choose to have a total mastectomy. The lymph nodes in the armpit are usually not removed. Women with DCIS can use tamoxifen to prevent the formation of invasive breast cancer.
Stage I, Stage II and Stage III A
Combined treatment can be applied to women with breast cancer stage I, II and III A. Especially in stages I and II, either the breast is not removed, only the tumor is removed and radiotherapy is applied after the surgery, or a mastectomy is performed. In both approaches, usually axillary lymph nodes can also be removed.
There are 23-44 lymph nodes in the armpit. If cancer cells are found in more than three axillary lymph nodes, or if the tumor in the breast is large, radiotherapy is also used after mastectomy.
Factors taken into account in the decision of which treatment to apply (Surgery in which the breast is not removed, only the tumor is removed, followed by radiotherapy or mastectomy?):
Tumor size, location, and stage
size of the breast
Certain features of cancer
The patient’s feelings about whether or not to have the breast removed
The patient’s anxieties and possible fears about the application of radiotherapy
Whether the patient is in a position to go to the radiotherapy center
From time to time, chemotherapy may be administered prior to surgery, especially for patients in stage II or III A. Neo to this treatment
Stage III B and III C
Women in stage III B (including inflammatory breast cancer), or stage IIIC are usually given chemotherapy.
If chemotherapy shrinks the tumor, an additional treatment may be given afterwards. These:
Mastectomy: The surgeon removes the lymph nodes from the breast and armpit. After the operation, radiotherapy can be applied to the breast and armpit.
Surgery in which the breast is not removed: Only the tumor is removed, the breast is not removed. Usually the lymph nodes in the armpit are also removed. After the operation, radiotherapy can be applied to the breast and armpit of the woman.
Radiotherapy instead of surgery: There are cases where the patient is not operated but is treated with radiotherapy.
The doctor may additionally administer chemotherapy, hormone therapy, or both. Systemic treatment prevents recurrence of the disease in the breast or elsewhere.
Stage IV
In stage IV, hormone therapy, chemotherapy or both are applied. Biological therapy can also be added to these. Radiation can be used to control tumors in certain parts of the body. These treatments may not completely cure the disease, but they may make the patient live longer.
Many patients receive supportive treatment that slows the progression of the disease along with anticancer treatments. Some may only receive supportive treatment to control symptoms.
Supportive treatment supports the patient to feel well both physically and emotionally. The aim of this type of treatment is to control the patient’s pain and other symptoms and to reduce the side effects of treatment (such as nausea).
recurrent breast cancer
Recurrent breast cancer is cancer that comes back after treatment. Treatment for recurrent cancer depends on the location and size of the cancer and the previous treatment the patient has received.
If the cancer has recurred in the breast that was not removed, that breast is removed. If the cancer occurs in different parts of the body, treatment may include chemotherapy, hormone therapy, or biological therapy.
Radiotherapy can control cancer that occurs in the chest wall or in certain parts of the body.
Supportive treatment is the most important part of the treatment plan. While many patients receive anti-cancer treatment, they also receive supportive treatment to slow the progression of the disease and alleviate its symptoms. Some receive only supportive treatment to reduce pain, nausea, and other symptoms and improve their quality of life.
Women with breast cancer can talk to their doctors about participating in clinical trials and research studies to prevent recurrence and new ways of treatment. These studies are available for breast cancer of all stages. The Success of Cancer Research section, information about ongoing treatment trials
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