Breast Cancer Treatment
Treatment for breast cancer depends on the stage of the disease and includes the following:
Breast Cancer Surgery
Surgery combined with radiation and/or chemotherapy is the most common treatment for breast cancer. The type of surgical procedure recommended to the patient depends on the stage of the disease. Mastectomy and lumpectomy are the most commonly performed procedures.
Radiation Therapy to Treat Breast Cancer
Radiation uses high-energy x-rays to destroy cancer cells. Treatment is delivered by a machine outside the body (called external radiation) or by radioactive "seeds" that are placed directly into the tumor (called brachytherapy). Breast cancer is usually treated using external radiation.
Radiation may be used to shrink the tumor before surgery (called neoadjuvant therapy) or may be used after surgery to destroy cancer cells that remain in the breast, chest wall, or underarm (called adjuvant therapy).
Radiation therapy is performed in a hospital or outpatient center. Each treatment lasts a few minutes and treatment is usually given 5 days per week, for 6 weeks. Side effects include fatigue, reddening of the skin, and swelling.
Chemotherapy to Treat Breast Cancer
Chemotherapy is a systemic treatment (travels throughout the body via the bloodstream) that often uses a combination of drugs to slow tumor growth and destroy cancer cells. Drugs may be administered orally or intravenously (through an IV). Chemotherapy is often used as adjuvant therapy to destroy breast cancer cells that have metastasized to the lymph nodes. It also is used to shrink the tumor prior to surgery (neoadjuvant therapy) and as primary treatment.
The combination most commonly prescribed to treat breast cancer is doxorubicin (Doxil) and cyclophosphamide (Cytoxin). Paclitaxel (Taxol, or the generic form, Paxene) is often prescribed after this combination treatment, when breast cancer has metastasized to the lymph nodes. It is also prescribed following breast cancer surgery. Other chemotherapy drugs include docetaxel (Taxotere) and gemcitabine (Gemzar).
Side effects are often severe and include the following:
- Hair loss (alopecia)
- Low blood cell count (e.g., anemia, neutropenia, thrombocytopenia)
Although hair loss (alopecia) related to breast cancer treatment usually is temporary, minimizing chemotherapy-induced hair loss can help improve the quality of life for many patients. In December 2015, the Food and Drug Administration (FDA) cleared for marketing the first cooling cap to reduce the frequency and severity of hair loss in women undergoing chemotherapy for breast cancer in the United States.
In this system, cooled liquid is circulated through a cap worn during chemotherapy. A second cap is worn over the cooling cap to hold it in place and act as an insulator. The goals are to: 1) constrict blood vessels in the scalp, reducing the amount of chemotherapy drugs that reach the hair follicles, and 2) decrease activity of the hair follicles, slowing down cell division and lessening the effect of the chemo drugs on the follicles.
The cooling cap may not work with all chemotherapy regimens. Side effects include headaches, chills, and neck/shoulder pain. In clinical trials, more than 66 percent of patients using the cooling cap reported losing less than half of the hair on their heads 3 to 6 weeks after finishing chemotherapy.
Ixabepilone (Ixempra) was approved by the FDA in October 2007 to treat advanced breast cancer that has not responded to other chemotherapy drugs. Ixempra is approved for use alone, or in combination with capecitabine (Xeloda). It should not be used in patients who have liver damage. Side effects of this drug include numbness and tingling in the hands and feet, bone marrow suppression, nausea, fatigue, and bone pain.