Following the shock of being told you have breast cancer is the confusion involved when you try to sort out and understand the complicated treatment process. Here are some common issues that patients have to face.
Why do I have to take medications?
The ability of cancer cells to travel to distant organs in the body is what sets them apart from normal cells. These cells are too small to be detected by any blood test or scan and can grow undetected, leading to a recurrence of the cancer.
Medication, such as chemotherapy, hormone therapy, or biological therapy, as well as radiation, can help kill the dormant cells. On average, patients who receive the recommended adjuvant therapy will fare better than those who do not receive it, leading to a better cure rate. This therapy may be done before or after surgery, and the drugs used will be tailored to the specific kind of breast cancer cell.
What are the types of breast cancer and the characteristics to know?
A meeting with the medical oncologist will usually involve a discussion about the particular type and characteristics of the patient’s cancer. Important features include the lymph node status, the size of the cancer, the grade, the estrogen receptor and progesterone receptor status, the Her-2/neu status and sub-types revealed through genomic tests.
Lymph nodes, which act as filters all over the body, can trap cancer cells. In breast cancer, the relevant lymph nodes are located under the arm. These particular nodes are important because a breast cancer that has spread to these lymph nodes is more likely to have also spread to other areas of the body. The size of the cancer is also directly related to the likelihood that the cancer has spread. These two features, the number of lymph nodes with cancer and the size of the cancer, are what determines the patient’s “stage.” The stage is a number from 1 to 4 and is used to describe how advanced a cancer is. The stage should not be confused with the “grade” of the cancer, a separate number used to predict the aggressiveness of the cancer based on the appearance of the cells in the microscope.
Breast cancers can also be characterized by the presence or absence of the estrogen receptor, the progesterone receptor and the Her-2/neu receptor. Whether the cancer tests positive or negative for each of these receptors will reveal which medication will likely work best. Sophisticated genetic-based tests can also help predict which cancers are likely to relapse and which patients can benefit from chemotherapy.
What are the choices for treatment?
Once armed with all of this information, it is still a complicated task to decide who needs adjuvant therapy, and if so, which therapy should be given. The decision can be simplified by asking three basic questions. 1) What are the chances of cure with surgery alone? 2) What are the chances of cure if adjuvant therapy is given? 3) What are the dangers and side effects of the therapy?
There are currently three classes of drugs available to improve the outcome of women with breast cancer. The categories include hormonal therapy, chemotherapy and biologic therapy. Some, none or all of these could be recommended.
Hormonal therapy (which is the opposite of hormonal replacement therapy) includes antiestrogens such as tamoxifen or drugs known as aromatase inhibitors (there are three of these on the market). Hormonal therapy is offered to women whose cancers are estrogen receptor positive or progesterone receptor positive. The decision to use chemotherapy is complex but is typically recommended for more advanced or aggressive cancers. The most common biologic therapy is a drug called trastuzumab (known as Herceptin) given to women with Her-2/neu positive breast cancer. Each of these therapies, when given to the appropriate patient, improves the cure rate.
Some women have to decide between a mastectomy and a lumpectomy. Assuming the cancer is completely removed, it is well established that the cure rates are the same with either operation. Many women think that having a lumpectomy means having to get chemotherapy, or having a mastectomy means avoiding chemotherapy. This is not correct, as the decision to give adjuvant medications is based on the characteristics of the cancer, not which operation removed it.
Another important treatment involves the use of radiation therapy. Radiation treatments are administered under the care of a radiation oncologist. Radiation is delivered by a machine which aims the cancer-killing x-rays at a particular part of the body. Examples of patients who have better outcomes because of radiation therapy includes those with larger tumors, those treated with lumpectomy and certain patients with cancer that has spread to the lymph nodes.
Help Understanding Options
As medical oncologists, we understand the complexities around cancer treatment can be overwhelming for patients. With multiple types of cancers, a variety of treatment options and
constantly evolving research and strategies, it may seem like there are too many options – and the stakes are very high. That’s why we work with each person to help them understand their individual case and the best options available. It’s a conversation we welcome, with the patient and their family members, because fighting cancer is not something that is done alone.
To learn more about Cape Fear Cancer Specialists – NHRMC Physician Group, visit www.capefearcancerspecialists.org
Visit nhrmcphysiciangroup.org for a comprehensive listing of providers, locations and contact information.