Once the breast cancer has been detected and classified, the doctors establish the treatment protocol that is, as much as possible, adapted to the patient.
In all cases, the treatment protocol is discussed by a group of specialists in different medical fields (surgeons, oncologists, radiologist and radiotherapists) and varies according to the type of cancer, its (location, its) stage and the general condition of the patient. In most of the cases, surgery is the first-line treatment for non-metastatic breast cancer. It is performed in 80% of the cases, whenever the condition of the patient permits.
1. Tumorectomy or lumpectomy (the removal of the tumour) is the least invasive surgical treatment: the tumour is removed, but the mammary gland is preserved to the maximum. This is called conservative surgery, and it happens in 75% of the cases. It is sufficient to use this technique if the cancer is at an early stage. Generally, this takes a one-day surgery, meaning that the patient does not sleep in the hospital but goes home on the day of the operation.
2. 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.
3. Today, the sentinel lymph node technique allows avoiding 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, not the whole chain of lymph nodes is removed, and the patient can thus avoid such serious consequences as the potential lymphedema of (the accumulation of the lymph in) the arm affected by the operation.
4. Radiotherapy is also almost always part of the treatment protocol for breast cancer, particularly after a conservative surgery. The goal of radiotherapy is to destroy any tumorous cells that may have remained after the operation by targeted radiation.
Following a surgery and a radiotherapy, other types of treatments are usually required. These are general treatments with the aim of being able to affect every part of the body.
1. Chemotherapy is often prescribed. This treatment targets the body cells in the process of division, especially the cancerous ones. This is an intravenous treatment that is most often administered at a day clinic.
2. The biggest disadvantage of chemotherapy is that while they attack cancerous cells, they also attack any rapidly dividing cell. Chemotherapy has numerous serious side effects such as hair loss, as well as nail and skin problems…
3. In some cases, chemotherapy is prescribed before the surgery (this is called neo-adjuvant chemotherapy) in order to reduce the size of the tumour before the operation. Then it is often repeated after the surgery, sometimes in combination with for example radiotherapy or targeted therapy.
4. Hormone therapy is prescribed in nearly three-quarters of cases of breast cancer. It allows for blocking the action of hormones 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 (the recurrence of the illness). Hormone therapy is most often prescribed for a duration of 5 years.
5. Targeted therapies are a way to treat many types of cancer, including breast cancer, in the future. Their underlying principle is to restrain the development of the tumour.
For example, the medicine ‘trastuzumab’ prevents the functioning of HER2 receptors that are overexpressed on the surface of HER2+ cancer cells. It also blocks the division process of
and the development of cancer cells. By definition, this treatment is, therefore, effective only for patients whose tumour is HER2+. There are also other targeted therapies already,
and the researchers are working on several other tracks.