- The Different Treatments -
The Different Treatments
Once the breast cancer has been detected and classified, the doctors establish the treatment protocol that is best suited to the patient.
The treatment protocol is always discussed by a group of specialists from different medical fields (surgeons, oncologists, radiologists and radiotherapists) and varies according to the type of cancer, its stage of development and the patient’s overall health.
In most cases, surgery is the first-line treatment for non-metastatic breast cancer. It is performed in 80% of cases, where the patient’s condition allows.
- Tumorectomy or lumpectomy is the least invasive surgical treatment: the tumour is removed, but the mammary gland is preserved as much as possible. This is called conservative surgery, and it happens in 75% of cases. It is sufficient to use this technique if the cancer is at an early stage. Generally, it involves a single day of surgery, meaning that the patient does not sleep in the hospital but goes home on the day of the operation.
- Mastectomy: the whole breast tissue is removed, while the pectoral muscles remain unaffected. The whole breast tissue may need to be removed if the tumour is too big, or if there are more than one tumorous centres or precancerous lesions in the breast. This surgery is more demanding and generally requires hospitalisation for 2-3 days.
- The sentinel lymph node technique avoids removing all of the ganglia in a certain area if not all of them are affected. If the tumour is small, the surgeon removes it together with the first ganglion that touches the lymph node draining the tumour. This is the first thing to do when the tumour cells are circulating in the lymphatic system. When this is done, the entire chain of lymph nodes is removed. This is called ganglionic or axillary lymphadenectomy. If the sentinel node is healthy, it is not necessary to remove the whole chain of lymph nodes and the patient can thus avoid such serious consequences as potential lymphedema (the accumulation of the lymph) in the arm affected by the operation.
- Radiotherapy is also almost always part of the treatment protocol for breast cancer, particularly after conservative surgery. The goal of radiotherapy is to destroy any tumour cells that may have remained after the operation, using targeted radiation.
Following surgery and radiotherapy, other types of treatment are usually required.
These are general treatments, which are intended to reach all areas of the body.
- Chemotherapy is often prescribed. This treatment targets cells in the body which are in the process of dividing, especially the cancerous ones. This is an intravenous treatment that is most often administered at a day clinic.
- The biggest disadvantage of chemotherapy is that whilst it attacks cancerous cells, it also attacks any rapidly dividing cell. Chemotherapy has numerous serious side effects such as hair loss and nail and skin problems.
- In some cases, chemotherapy is prescribed before surgery (this is called neo-adjuvant chemotherapy) in order to reduce the size of the tumour before the operation. It is then often repeated after the surgery, sometimes, for example, in combination with radiotherapy or targeted therapy.
- Hormone therapy is prescribed in nearly three-quarters of cases of breast cancer. It is used to stop hormones from acting on tumour cells that overexpress hormonal receptors for oestrogen and progesterone (i.e. on the surface of which these receptors are overrepresented). In the majority of cases, this hormone therapy is administered as an ‘adjuvant’ therapy, that is to say, after other treatments such as surgery. It aims to limit the risk of recidivism (recurrence of the illness). Hormone therapy is most often prescribed for a duration of 5 years.
- Targeted therapies present a possibility to treat many types of cancer, including breast cancer, in the future. The idea: stop the tumour from developing.
For example, the medicine trastuzumab prevents the functioning of HER2 receptors that are overexpressed on the surface of HER2+ cancer cells. It also stops cancer cells dividing and developing. This treatment is therefore only effective for patients whose tumour is HER2+. Other targeted therapies also exist and researchers are working on several others.