Breast Cancer Treatment

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[edit] Breast Cancer Treatment

When a woman feels a breast lump or when routine mammograms show a suspicious lesion, it is usually removed by surgical excision (lumpectomy) or else a number of breast biopsies are done and the material is sent to the pathologist for histological analysis. If the breast biopsy sample is positive for breast cancer, the staging tests are done with blood tests, CT or MRI scans.

Stage I and II breast cancer: In 1991 there has been a consensus conference among oncologist.

It was decided that a breast conserving excision of the tumor (lumpectormy) followed by radiation therapy to the surgical site would be an appropriate method for treating the majority of women with stage I and II breast cancer.

This treatment has been shown to provide equivalent survival as the more radical and disfiguring total mastectomy and axillary dissection. The value of postsurgical radiation of the surrounding tissue and the axillary region has been shown in a study with 8 years follow-up. Two comparable groups of stage I and II breast cancer patients were either treated with radiotherapy following surgery or not. The radiotherapy treated group had a local recurrence of only 10% after 8 years, the untreated group had a 39% local recurrence. Radiotherapy provided a 29% survival advantage, which is considered quite significant. It is generally assumed that residual microscopic breast cancer tissue, left behind in normal looking lymph glands, likely is eradicated with the radiotherapy.

Stage III breast cancer, where there is local metastatic involvement of the axillary lymph glands, has to be treated with a combined treatment modality to improve survival. This consists of chemotherapy (fluorouracil, doxorubin and cyclophosphamide) followed by surgery and radiotherapy. In future there might be further cycles of chemotherapy to control reoccurrences. Using this combined approach impressive 5-year survival rates have been achieved. The more localized stage IIIA patients have a 5-year survival of 71%-84%, with further spread of breast cancer in stage IIIB patients the survival rate drops to 33% to 44%.

With stage IV patients only combination chemotherapy can be used as a treatment form. But as the immune system often is severely compromised, there are limitations as to how aggressive the oncologist can be with the cytotoxic chemicals.

Paclitaxel(brand name: Taxol), derived from the needles and bark of the Pacific yew tree, Taxus brevifolia, is a mitotic spindle poison and interferes with cell division. It has been shown in studies that it is effective in slowing cancer growth in advanced ovarian and breast cancer. This medication is being combined with various chemotherapeutic agents to extend the advanced stage IV patient's lives by a few months, but in some cases it has even lead to long term remissions.

There has been an extensive worlwide analysis ( a "metaanalysis")of several breast cancer trials, which revealed the following guidelines regarding survival and cancer remissions (Ref. 1 and 3):

• 10 year follow-up studies are more desirable, but show similar survival benefits as 5-year survival studies. In other words a good therapy shows up already at 5 years, but is even more impressive at 10 years.
• Using triple chemotherapy the annual survival rate for breast cancer increases by 15% every year, even for women above the 50 year age mark. Triple chemotherapy consists of cyclophosphamide, methotrexate and fluorouracil , which is started 4 weeks following surgery for 6 months, after which a pause 6 months will follow. This is alternated until remission is achieved.
• Estrogen receptor positive tumors (the pathologist checks for the estrogen receptors on the surface of the cancer cells on the material removed by the surgeon when requested) are treated with tamoxifen (brand names: Tamofen, Nolvadex, Tamone). In a group of stage IV breast cancer patients after 2 years of tamoxifen therapy with 20 mg daily there was a 21% survival improvement (overall 33% survival) over 10 years, which compares to 11% overall survival over 10 years for estrogen receptor negative tumors.
• Patients with similar breast cancers, but negative axillary lymph glands versus patients with positive axillary lymph glands in the control group, show a twofold better survival rate!
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References:

The following references were used apart from my own clinical experience:

1. Cancer: Principles &Practice of Oncology, 4^th edition, by V.T. De Vita,Jr., et. al J.B. Lippincott Co.,Philadelphia, 1993. Vol.2: Chapter 48.

2. The Merck Manual, 7^th edition, by M. H. Beers et al., Whitehouse Station, N.J., 1999. Chapter 177.

3. Cancer: Principles&Practice of Oncology. 5th edition, volume 1. Edited by Vincent T. DeVita, Jr. et al. Lippincott-Raven Publ., Philadelphia,PA, 1997. Chapter 36: 1541-1616.

4. BS Herbert et al. Breast Cancer Res 2001;3(3):146-149.

5. BS Herbert et al. J Natl Cancer Inst 2001 Jan 3;93(1):39-45.

6. Conn's Current Therapy 2004, 56th ed., Copyright © 2004 Elsevier

7. Ferri: Ferri's Clinical Advisor: Instant Diagnosis and Treatment, 2004 ed., Copyright © 2004 Mosby, Inc