There are many treatment options for women with breast cancer. The choice of treatment depends on your age and general health, the stage of the cancer, whether or not it has spread beyond the breast, and other factors.

If tests show that you have cancer, you should talk with your doctor and make treatment decisions as soon as possible. Studies show that early treatment leads to better outcomes.

People with cancer often are treated by a team of specialists. The team will keep the primary doctor informed about the patient’s progress. The team may include a medical oncologist who is a specialist in cancer treatment, a surgeon, a radiation oncologist who is a specialist in radiation therapy, and others.

Before starting treatment, you may want another doctor to review the diagnosis and treatment plan. Some insurance companies require a second opinion. Others may pay for a second opinion if you request it.

Treatment and Research - What is Staging?

Once breast cancer has been found, it is staged. Staging means determining how far the cancer has progressed. Through staging, the doctor can tell if the cancer has spread and, if so, to what parts of the body. More tests may be performed to help determine the stage. Knowing the stage of the disease helps the doctor plan treatment.

Staging will let the doctor know

• the size of the tumor and exactly where it is in the breast
• if the cancer has spread within the breast
• if cancer is present in the lymph nodes under the arm
• if cancer is present in other parts of the body

Here are the stages of breast cancer

Stage 0 — This is very early breast cancer that has not spread within or outside the breast. Doctors often refer to this type of cancer as in situ or non-invasive cancer.

Stage I and stage II also are early stages of breast cancer. Stage I means that the tumor has not spread beyond the breast. In stage II, the tumor may be larger and may have spread to the lymph nodes.

Stage III is called locally advanced cancer. Here the tumor has spread beyond the breast to lymph nodes or to other tissues near the breast.

Stage IV is metastatic cancer. In this stage the cancer has spread beyond the breast and the underarm lymph nodes to other parts of the body, most often the bones, lungs, liver, or brain.

The choice of treatment is based on many factors. For stage I, II or III cancers, the main goals are to treat the cancer and reduce the chance it will come back, either at the place where the tumor first occurred or elsewhere in the body. For stage IV cancer, the goal is to improve symptoms and prolong survival.

Treatment and Research - Standard Treatments

There are a number of treatments for breast cancer, but the ones women choose most often — alone or in combination — are surgery, radiation therapy, chemotherapy, and hormone therapy.

Here is what the standard cancer treatments are designed to do:

• Surgery takes out the cancer.
• Hormone therapy keeps cancer cells from getting the hormones they need to survive and grow.

• Radiation therapy uses high-energy beams to kill cancer cells and shrink tumors.
• Chemotherapy uses anti-cancer drugs to kill cancer cells.

Treatment for breast cancer may involve local or whole body therapy. Doctors use local therapies, such as surgery or radiation, to remove or destroy breast cancer in a specific area. Whole body, or systemic, treatments like chemotherapy, hormonal, or biological therapies are used to destroy or control cancer throughout the body. Some patients have both kinds of treatment.

If you have early-stage breast cancer, one common treatment available to you is a lumpectomy combined with radiation therapy. A lumpectomy is surgery that preserves a woman’s breast.

In a lumpectomy, the surgeon removes only the tumor and a small amount of the surrounding tissue. The survival rate for a woman who has this therapy plus radiation is similar to that for a woman who chooses a radical mastectomy, which is complete removal of a breast.

If you have breast cancer that has spread locally — just to other parts of the breast — your treatment may involve a combination of chemotherapy and surgery. Doctors first shrink the tumor with chemotherapy and then remove it through surgery. Shrinking the tumor before surgery may allow a woman to avoid a mastectomy and keep her breast.

In the past, doctors would remove a lot of lymph nodes near breast tumors to see if the cancer had spread. Some doctors are also using a method called sentinel node biopsy. Using a dye or radioactive tracer, surgeons locate the first or “sentinel” lymph node closest to the tumor, and remove only that node to see if the cancer has spread.

If the breast cancer has spread to other parts of the body, such as the lung or bone, you might receive chemotherapy and/or hormonal therapy to destroy cancer cells and control the disease. Radiation therapy may also be useful to control tumors in other parts of the body.

Treatment and Research - Latest Research

Several new technologies offer hope for making future treatment easier for women with breast cancer. Using a special tool, doctors can today insert a miniature camera through the nipple and into a milk duct in the breast to examine the area for cancer. In the future, doctors may use this tool to deliver treatment.

Researchers are testing another technique to help women who have undergone weeks of conventional radiation therapy. Using a small catheter — a tube with a balloon tip — doctors can deliver tiny radioactive beads to a place on the breast where cancer tissue has been removed. This can reduce the therapy time to a matter of days.

New drug therapies also are on the horizon. Findings from several clinical trials show that the chemotherapy drug paclitaxel combined with the drugs cyclophosphamide and doxorubicin can help women with tumors that have spread to other parts of the body.

This mix of drugs may increase the length of time you will live or the length of time you will live without cancer. It may someday prove useful for some women with localized breast cancer after they have had surgery.

New research shows women with early-stage breast cancer who took the drug letrozole, an aromatase inhibitor, after they completed five years of tamoxifen therapy significantly reduced their risk of breast cancer recurrence.

Also, other new research found a test that can predict both the risk of breast cancer recurrence and who is most likely to benefit from chemotherapy such as letrozole. Herceptin® is another drug commonly used to treat women who have a certain type of breast cancer. This drug slows or stops the growth of cancer cells by blocking Her-2, a protein found on the surface of some types of breast cancer cells.

Approximately 20 percent of breast cancers produce too much Her-2. These “Her-2 positive” tumors tend to grow faster and are generally more likely to return than tumors that do not overproduce Her-2.

Cancer treatments like chemotherapy can be systemic, meaning they affect whole tissues, organs, or the entire body. Herceptin®, however, is the first drug used to target only a specific molecule involved in breast cancer.

Results from two recent clinical trials show that those patients with early-stage Her-2 positive breast cancer who received Herceptin® in combination with chemotherapy had a 52 percent decrease in risk in the cancer returning compared with patients who received chemotherapy treatment alone.

In an attempt to further specialize breast cancer treatment, The Trial Assigning Individualized Options for Treatment, or TAILORx, was recently initiated by NCI. This study will enroll 10,000 women to examine whether appropriate treatment can be assigned based on genes that are frequently associated with risk of recurrence of breast cancer.

The goal of TAILORx is important because the majority of women with early-stage breast cancer are advised to receive chemotherapy in addition to radiation and hormonal therapy, yet research has not demonstrated that chemotherapy benefits all of them equally.

TAILORx seeks to examine many of a woman’s genes simultaneously and use this information in choosing a treatment course, thus sparing women unnecessary treatment if chemotherapy is not likely to be of substantial benefit to them.

Several methods show promise in reducing the risk of breast cancer. In October 1998, the U.S. Food and Drug Administration, or FDA, approved the drug tamoxifen to lower the chance of cancer in high-risk women.

The approval of tamoxifen followed a clinical trial sponsored by the National Cancer Institute that included more than 13,000 pre-menopausal and post-menopausal women. All of the women were considered at high risk for breast cancer.

One group of women took the drug tamoxifen and another took a placebo — an inactive pill that looked like tamoxifen. The results of the study showed a 49 percent decrease in breast cancer among women who took tamoxifen.

Tamoxifen does have side effects. The most serious in some women are an increased risk of endometrial cancer, uterine sarcoma, and an increased risk of blood clots. Women at high risk for breast cancer may want to consult their doctor to see if tamoxifen may help them.

The Study of Tamoxifen and Raloxifene (STAR) is a more recent clinical trial sponsored by the National Cancer Institute. STAR enlisted nearly 20,000 women to compare tamoxifen to the drug raloxifene for effectiveness in reducing of breast cancer risk.

Raloxifene, marketed as Evista®, has been approved for use to lower the risk of and treat osteoporosis.

Initial results of the STAR trial show that raloxifene works as well as tamoxifen in reducing breast cancer risk for postmenopausal women at increased risk of the disease. Both drugs decrease risk by about 50 percent.

In addition, women enrolled in STAR who were assigned to take raloxifene had fewer uterine cancers, blood clots, and cataracts than those taking tamoxifen.

However, taking raloxifene raised the risk of blood clots and fatal strokes in women already at risk.

Originator: NCI Source: www.cancer.gov

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Most cancers in their early, most treatable stages do not cause any symptoms. That is why it’s important to have regular tests to check for cancer long before you might notice anything wrong.

When breast cancer is found early, it is more likely to be treated successfully. Checking for cancer in a person who does not have any symptoms is called screening. Screening tests for breast cancer include, among others, clinical breast exams and mammograms.

During a clinical breast exam, the doctor or other health care professional checks the breasts and underarms for lumps or other changes that could be a sign of breast cancer. A mammogram is a special x-ray of the breast that often can detect cancers that are too small for a woman or her doctor to feel.

Several studies show that mammography screening has reduced the number of deaths from breast cancer. However, some other studies have not shown a clear benefit from mammography.

Scientists are continuing to examine the level of benefit that mammography can produce. For the time being, the National Cancer Institute recommends the following:

• If you are a woman in your 40s, you should have mammography screening every one to two years.

• If you are a woman age 50 and older, you should have mammography screening every one to two years.
• If you are a woman who is at higher than average risk for breast cancer, you should seek expert medical advice about whether to begin screening before age 40 and how often to have screening mammography.

Between 5 and 10 percent of mammogram results are abnormal and require more testing. Most of these follow-up tests confirm that no cancer was present.

If needed, the most common follow-up test a doctor will recommend is called a biopsy. This is a procedure where a small amount of fluid or tissue is removed from the breast to make a diagnosis. A doctor might perform fine needle aspiration, a needle or core biopsy, or a surgical biopsy.

With fine needle aspiration, doctors numb the area and use a thin needle to remove fluid and/or cells from a breast lump. If the fluid is clear, it may not need to be checked out by a lab.

For a needle biopsy, sometimes called a core biopsy, doctors use a needle to remove tissue from an area that looks suspicious on a mammogram but cannot be felt. This tissue goes to a lab where a pathologist examines it to see if any of the cells are cancerous.

In a surgical biopsy, a surgeon removes a sample of a lump or suspicious area. Sometimes it is necessary to remove the entire lump or suspicious area, plus an area of healthy tissue around the edges. The tissue then goes to a lab where a pathologist examines it under a microscope to check for cancer cells.

Doctors are studying another type of surgical biopsy that removes less breast tissue. It is called an image-guided needle breast biopsy, or stereotactic biopsy. If approved for general use, it would become an important surgical tool.

Eighty percent of U.S. women who have a surgical breast biopsy do not have cancer. However, women who have breast biopsies are at higher risk of developing breast cancer than women who have never had a breast biopsy.

Other techniques used to find cancer include a new way of reading mammograms called digital mammography. Magnetic resonance imaging, or MRI, and ultrasound are two other techniques which researchers think might detect breast cancer with greater accuracy.

Originaotr: NCI  Source: www.cancer.gov

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