Breast cancer management
Breast cancer management takes different approaches depending on physical and biological characteristics of the disease, as well as the age, over-all health and personal preferences of the patient.
Management of breast cancer is undertaken by a multidisciplinary team, including medical-, radiation-, and surgical- oncologists, and is guided by national and international guidelines.
[3] TNM staging, in combination with histopathology, grade and genomic profiling, is used for the purpose of prognosis,[4] and to determine whether additional treatment is warranted.
The three major subgroups are: Additional classification schema are used for prognosis and include histopathology, grade, stage, and genomic profiling.
Studies indicate that for patients with a single tumor smaller than 4 cm, a lumpectomy with negative surgical margins may be as effective as a mastectomy.
Advances in SLN mapping over the past decade have increased the accuracy of detecting Sentinel Lymph Node from 80% using blue dye alone to between 92% and 98% using combined modalities.
Women who are carriers of a BRCA mutation have an increased risk of both breast and ovarian cancers and may choose to have their ovaries removed prophylactically as well.
In the case of external beam radiotherapy, X-rays are delivered from outside the body by a machine called a Linear Accelerator or Linac.
Radiation therapy eliminates the microscopic cancer cells that may remain near the area where the tumor was surgically removed.
A newer approach, called 'accelerated partial breast irradiation' (APBI), uses brachytherapy to deliver the radiation in a much shorter period of time.
APBI delivers radiation to only the immediate region surrounding the original tumor[16][17][18] and can typically be completed over the course of one week.
Radiation therapy is usually not indicated in patients with advanced (stage IV disease) except for palliation of symptoms like bone pain or fungating lesions.
This approach allows physicians to treat only part of the breast in order to spare healthy tissue from unnecessary radiation.
In addition, conventional radiotherapy can also deliver similar dose distributions utilizing modern computer dosimetry planning and equipment.
[21] Within the past decade, a new approach called accelerated partial breast irradiation (APBI) has gained popularity.
Targeted intraoperative radiotherapy (TARGIT)[24] is a method of delivering therapeutic radiation from within the breast using a portable X-ray generator called Intrabeam.
[25] The TARGIT-A trial results found that the difference between the two treatments was 0.25% (95% CI -1.0 to 1.5) i.e., at most 1.5% worse or at best 1.0% better with single dose TARGIT than with standard course of several weeks of external beam radiotherapy.
[26] In the TARGIT-B trial, as the TARGIT technique is precisely aimed and given immediately after surgery, in theory it could be able provide a better boost dose to the tumor bed as suggested in phase II studies.
About a third of the 66 participants—women with metastatic breast cancer that had developed resistance to standard estrogen-lowering therapy—a daily dose of estrogen could stop the growth of their tumors or even cause them to shrink.
[47] However, they are now rarely if ever used due to their virilizing side effects, such as voice deepening, hirsutism, masculine muscle and fat changes, increased libido, and others, as well as availability of better-tolerated agents.
[49] Pertuzumab may work synergistically with trastuzumab on the expanded EGFR family of receptors, although it is currently only standard of care for metastatic disease.
Medical imaging is frequently used in breast cancer management to make crucial diagnostic decisions throughout the treatment process.
[52] Drugs and radiotherapy given for cancer can cause unpleasant side effects such as nausea and vomiting, mouth sores, dermatitis, and menopausal symptoms.
There is a study, first to show sustained benefits in sleep quality from gabapentin, which Rochester researchers already have demonstrated alleviates hot flashes.
Complementary medicines that contain phytoestrogens are not recommended for breast cancer patients as they may stimulate oestrogen receptor-positive tumours.
[63] Although traditional recommendations limited exercise, a new study shows that participating in a safe, structured weight-lifting routine can help women with lymphedema take control of their symptoms and reap the many rewards that resistance training has on their overall health as they begin life as a cancer survivor.
It recommends that women start with a slowly progressive program, supervised by a certified fitness professional, in order to learn how to do these types of exercises properly.
Patients undergoing some weeks of treatment usually experience fatigue caused by the healthy tissue repairing itself and aside from this there can be no side effects at all.
However many breast cancer patients develop a suntan-like change in skin color in the exact area being treated.
Studies suggest APBI may reduce the side effects associated with radiation therapy, because it treats only the tumor cavity and the surrounding tissue.
