Breast Cancer – Treatment Options and Prognosis

Medically Reviewed by Dr. K on 25 March 2021

Breast Cancer Treatment

If the scans reveal breast cancer, you and your doctor will formulate a treatment plan to eradicate the cancer, reduce the chances of it returning, and prevent it from spreading beyond the breast. Following the diagnosis, treatment usually begins within a few weeks.

The size and location of the tumour, the effects of lab tests on cancer cells, and the stage of the disease will all influence your treatment. Your doctor would normally take into account your age, overall wellbeing, and thoughts regarding the treatment options before making a decision.

Local treatments

These treatments target cancer cells in a particular region, such as the breast, and remove, destroy, or control it. There are some of them:

Surgery

  • Breast-conserving surgery. just the cancerous section of the breast, as well as any surrounding tissue, is removed by the surgeon. The amount they take out is determined by factors such as the tumor’s size and position. You may even find it referred to as:
    • Lumpectomy
    • Quadrantectomy
    • Partial mastectomy
    • Segmental mastectomy
  • Surgery to remove lymph nodes. Your doctor can remove lymph nodes from underneath your arm and see whether cancer has spread there. This surgery is divided into two types:
    • Sentinel lymph node biopsy. One or a few lymph nodes where cancer is more likely to grow are removed by the surgeon.
    • Axillary lymph node dissection. There are more nodes in this case, but normally less than 20.
  • Mastectomy. The whole breast, as well as much of the breast tissue and often surrounding tissues, is removed by a surgeon. Mastectomies come in a variety of forms:
    • Simple or total mastectomy. The surgeon will remove your entire breast, but spare your underarm lymph nodes unless they are located inside breast tissue.
    • Modified radical mastectomy. Your entire breast, as well as your underarm lymph nodes will be removed by the surgeon.
    • Radical mastectomy. Your entire breast, underarm lymph nodes and up to your collarbone, alongside the chest wall muscles underneath your breast, are removed by the surgeon.
    • Partial mastectomy. The cancerous breast tissue and any surrounding tissue are removed by the surgeon, typically more than with a lumpectomy.
    • Nipple-sparing mastectomy. The surgeon removes all of the breast tissue except your nipple.
    • Contralateral prophylactic mastectomy. If you have cancer in one breast and are at a high risk of developing cancer in the other, you may want both breasts removed.

Radiation. Radiation treatment will depend on what previous surgery you had on your breast, as well as the extent of cancer spread, size of the tumour and your age, and overall well being. There are options for one type of radiotherapy or a combination of others:

  • External beam radiation. This type is produced by a machine that is external to your body. It’s usually administered 5 days a week for 5 or 6 weeks. The below are examples of external beam radiation:
    • Hypofractionated radiation therapy. Larger doses are administered with fewer treatments, usually just three weeks.
    • Intraoperative radiation therapy (IORT). This method involves receiving a single significant dose of radiation in the operation room immediately after breast preservation surgery (before the surgical wound is closed).
    • 3D-conformal radiotherapy. Special devices provide radiation to the tumour site. Treatments will be provided twice a day for five days.
  • Internal radiation (brachytherapy). In this type, the doctor injects a radioactive substance into the body for a brief period of time.
    • Interstitial brachytherapy. The doctor places many thin, hollow tubes known as catheters into the breast near the cancerous area. They remain in place for a few days. Every day, doctors inject them with radioactive pellets for a short period.
    • Intracavitary brachytherapy. For women with breast cancer, this is the most common type of brachytherapy. A tiny catheter is used by the doctor to insert a device into the breast. The device is expanded and remains in position during the procedure. The other end of the cord protrudes from the breast. The doctor inserts radiation sources (usually pellets) into the system using a tube. As an outpatient, you’ll normally get this twice a day for five days. The doctor collapses and removes the unit after the last operation.

 

Systemic treatments

They eliminate or destroy cancer cells in the body. The following therapies are available:

  • Chemotherapy. These medications may be taken as tablets or inserted into a vein. If you have advanced breast cancer, it may be your main option. You will have it either before (neoadjuvant chemotherapy) or during treatment (adjuvant chemotherapy).
  • Hormone therapy. Certain hormones stimulate the growth of certain cancers. These drugs block hormones from binding to cancer cells, halting their development.
    • Aromatase inhibitors:
      • Anastrozole (Arimidex)
      • Exemestane (Aromasin)
      • Letrozole (Femara)
    • Fulvestrant (Faslodex)
    • Tamoxifen (Nolvadex, Soltamox, Tamoxen)

  • Targeted drugs. These medications halt the changes that cause cells to proliferate uncontrollably.
    • Abemaciclib (Verzenio)
    • Everolimus (Afinitor)
    • Lapatinib (Tykerb)
    • Neratinib (Nerlynx)
    • Olaparib (Lynparza)
    • Palbociclib (Ibrance)
    • Pertuzumab (Perjeta)
    • Ribociclib (Kisquali)
    • Talazoparib (Talzenna)
    • Trastuzumab (Herceptin)
    • Trastuzumab emtansine (Kadcyla)

Immunotherapy. These are medications that help the immune system fight cancer, for example, Atezolizumab (Tecentriq).

Management if you’re at high risk

If you have a risk factor for breast cancer, speak to the doctor about what you should do to improve your chances. There are some of them:

  • Genetic testing: Assess for changes that increase risk
  • Increasing doctor appointments and screening tests.
  • Medications: raloxifene, tamoxifen, and aromatase inhibitors
  • Surgical removal of breast or ovaries

 

Breast Cancer Outlook

Your prognosis after breast cancer is determined by a number of factors, including the stage of cancer at the time of diagnosis.

Nearly every woman with breast cancer lives for at least 5 years after being diagnosed. 91% of women with cancer that has spread to surrounding tissue live at least 5 years longer, and 84% live at least 10 years longer.

The 5-year survival rate for a woman with breast cancer that has spread to surrounding lymph nodes is 86%. Around 27% of women with cancer that has spread to other parts of their bodies survive for at least another 5 years.

The mortality rates of black people are around 9% lower than those of white women.

The median 5-year survival rate for men with breast cancer is 84%. If the cancers are only in their breast, 96% of men should expect to survive for at least another 5 years. If the cancer has spread to surrounding lymph nodes, the 5-year survival rate is 83%, and 22% if it has spread farther in a man’s body.

Sources

Referenced on 25.3.2021

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  12. Cancer.net: “Breast Cancer Diagnosis,” “Breast Cancer: Introduction,” “Breast Cancer: Statistics.”
  13. Mayo Clinic: “Breast cancer prevention: How to reduce your risk.”
  14. Association of Directors of Anatomic and Surgical Pathology: “Breast Cancer,” “Breast Cancer In-Situ.”
  15. Clinical Cancer Investigation Journal: “Low-grade adenosquamous carcinoma of the breast: A case report and review of literature.”
  16. National Cancer Institute: “Cancer Stat Facts: Female Breast Cancer.”
  17. International Journal of Surgery: “Low-grade adenosquamous carcinoma of the breast: A diagnostic and clinical challenge."
  18. American Cancer Society: “Immunotherapy for Breast Cancer.”
  19. Mayo Clinic: “Breast cancer.”
  20. Cancer.net: “Breast Cancer in Men: Statistics.”
  21. https://www.webmd.com/breast-cancer/understanding-breast-cancer-basics

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