BodyHealth

An Overview of Breast Cancer Treatment Options and 5 Stages of Breast Cancer Treatment Plans

All about the survival rate after breast cancer treatment. What to expect?

Breast cancer develops when abnormal cells multiply uncontrollably in breast tissue. Early detection is vital, as the result of cancer is highly variable depending on the extent and stage of the disease. It isn’t a silent killer. It is usually detected in its early stages if there is proper awareness and education of it. And there are many methods of breast cancer treatment available in this modern and scientific and it is progressing day by day.

According to a study conducted at Johns Hopkins Medical Center, at least 40% of breast cancers are discovered initially by women who feel a lump during a self-exam. Awareness of the symptoms and the need for screening is key in reducing the risk of mortality.

Want to learn how cancer develops or if you are at risk? Read this article for complete information.

According to American Cancer Journal, the overall rate of breast cancer decreased by almost 40% between 1989 and 2017.

BREAST CANCER TREATMENT PLAN

Following a breast cancer diagnosis, you and your doctors will develop a breast cancer treatment plan tailored to your unique circumstances, based on the results of your pathology report. Your treatment plan will include one or more targeted therapies to differentiate cancer cells and lower your risk of future breast cancer recurrence. You and your doctor will make treatment options based on YOUR specific circumstances, including your overall medical condition and decision-making style. You may need to re-evaluate your choices frequently. Your medical staff will act as a guide for you.

Successfully treating breast cancer entails eradicating or reducing it for a long time. However, because breast cancer is composed of various cancer cells, eliminating all of those cells may need various treatments.

IMPORTANCE OF SECOND OPINION IN BREAST CANCER TREATMENT

Many women with breast cancer feel a sense of urgency to begin treatment right away. In most circumstances, you have time to explore your diagnosis and treatment plan, which may include getting a second opinion for their breast cancer treatment. Obtaining a second opinion means asking another breast cancer specialist, or a team of specialists, to evaluate all of your medical records and test results, express an opinion on your diagnosis, and make treatment recommendations. A second opinion may confirm your primary care physician’s diagnosis and breast cancer treatments, provide further information about the kind and stage of breast cancer, identify alternative treatment choices you hadn’t explored, or prescribe a different course of action that might help you.

BREAST CANCER TREATMENT OPTIONS

There has been an explosion of life-saving therapy advances against breast cancer in recent years, providing renewed hope and excitement. So there are various ways for breast cancer treatments. Breast cancer patients frequently receive multiple types of treatment. Various aspects, including the following, determine the best effective strategy:

  • Type and stage of the cancer
  • Sensitivity to hormones
  • Person’s age, overall health, and preferences

The primary treatment approaches include the following:

  • Surgery
  • Radiation therapy
  • Chemotherapy
  • Hormonal Therapy
  • Drug targeted therapy

SURGERY

An operation where doctors cut out cancer tissue. If surgery is required, the type will vary according to the diagnosis and the patient’s preferences. Following types of surgery are currently being conducted.

Lumpectomy- Breast-Conserving Surgery

During a lumpectomy, the surgeon removes cancer or other abnormal tissue along with a small quantity of surrounding good tissue. This procedure guarantees that all problematic tissue is eliminated. It is also known as breast-conserving surgery (BCS) as it will not harm the remainder of the breast and its sensations. A lumpectomy may be recommended if a biopsy reveals that you have a tiny, early-stage malignancy. Lumpectomy can also remove noncancerous or precancerous breast lesions.

Side effects of lumpectomy are temporary as any other surgical procedure, including swelling, pain, scarring,  tenderness, and bleeding, and scaring around the surgical site.

Breast-conserving surgery patients reported a 4.2% local recurrence rate by research done in 2018.

Mastectomy

It is a very common breast cancer treatment. It has five types further into it,

Breast cancer treatment mastectomy

Total Mastectomy
  • It is a surgical operation in which your entire breast is removed, including the nipple, areola, and skin. Sentinel lymph nodes are frequently removed concurrently to screen for malignancy.
  • Total mastectomy may be an option if your breast cancer is in its early stages and has not spread to your axillary lymph nodes.
Modified Radical 
  • The modified radical mastectomy procedure aids in determining whether cancer has spread to the lymph nodes beneath your arm.
  • It removes the entire breast, including the nipple, areola, skin, and axillary lymph nodes. 
Radical 
Partial
  • It can also be referred to as lumpectomy.
  • In a partial mastectomy, the surgeon removes the cancerous area, plus some healthy surrounding tissue. It may be used when there’s only one small area of cancerous tissue.
Skin Sparring
  • A skin-sparing mastectomy removes the breast tissue, nipple, and areola but leaves most of the skin intact.
  • This procedure is utilized in conjunction with breast reconstruction. This procedure is not done if the initial tumor is large or if the cancer is discovered near the skin’s surface.
  • Skin-sparing mastectomy can be performed as a “simple” or “complete” mastectomy or modified radical mastectomy to preserve skin for rapid reconstruction.
Nipple Sparing
  • A nipple-sparing mastectomy removes all breast tissue but leaves the areola and nipple intact.
  • It’s a good choice when breast reconstruction will begin right away.
  • It is only used in breast cancer’s early stages that have not spread to the skin or nipple.

After effects for all types of mastectomy are tenderness and pain at the surgical site. Some people also have:

  • Numbness and tingling in their chest and upper arm
  • Difficulty moving their arm or shoulder
  • Itching, burning or shooting nerve pain in their chest, armpit, upper arm, or shoulder
  • Phantom breast pain
  • Loss of a positive self-image. Many survivors describe feeling less feminine and appealing in their partner’s eyes. Similarly, they suffer from poor sex lives due to concerns over their partner’s impression of their bodies. In these situations, allow yourself enough time to heal psychologically and physically. Discussing your feelings with your partner will also help you adjust to life after a mastectomy.
  • Apart from the difficulties associated with surgery recovery, adjusting to changes like your physical appearance, how clothing fits, and various other unexpected changes. And for many survivors, this is the most challenging part of the diagnosing process.
  • Breast cancer and related treatment modalities, such as mastectomy, have a negative impact on patient’s mental health, most notably mood disorders (depression, anxiety, and anger), hopelessness, changes in body image, relapse of the illness, and mortality, according to a research done in 2018.

For the majority of patients, these adverse effects subside after a few weeks. According to the American Cancer Society, approximately 20% to 30% of women have post-mastectomy pain syndrome, characterized by persistent pain and unusual sensations.

Surgery to remove nearby Lymph nodes

One or more lymph nodes will be removed and examined in the laboratory to determine if the breast cancer has progressed to the lymph nodes under the arm (axillary). This is an important step in determining the stage (abundance) of the malignancy. Lymph nodes can be removed as part of breast cancer surgery or as a separate operation.

The two main types of surgery to remove lymph nodes are:

Sentinel lymph node biopsy (SLNB) An arm lymph node (or lymph nodes) from which cancer may spread is removed surgically. Removing only one or a few lymph nodes reduces the risk of lymphedema (arm swelling).
Axillary lymph node dissection (ALND) It involves the removal of many (typically less than 20) underarm lymph nodes. ALND is less common now, although it may still be the best to look at lymph nodes in specific cases.

Breast Reconstruction Surgery

A woman undergoing mastectomy may wish to reconstruct the breast mound to restore the breast’s look following surgery. Although there are various forms of reconstructive surgery, selections may vary depending on the medical condition and personal preferences. It might be a chance to have breast reconstruction performed concurrently with breast cancer surgery (immediate reconstruction) or later (delayed reconstruction). There are two main types of breast reconstruction;

Fat grafting may be used in some breast-conserving operations to fix dimples left by the surgery. The alternatives are unique to each woman. People might require more than one surgery for a complete reconstruction.

Recovery after this type of surgery requires a prolonged hospital stay as it’s a major operation and needs complete monitoring. Both types of surgery result in an individual unable to do most everyday tasks for up to two months. Post-surgical symptoms like pain, fatigue, swelling, bruising, soreness at the flap removal site (in case of flap surgery), and restriction in arm and trunk movements.

Most women return to their normal activities in 6-8 weeks, and if the surgery is an implant surgery, the recovery time reduces even further. Showering, bathing, and wound care will be discussed with a plastic surgeon. One may have to wait several weeks before engaging in vigorous exercise.

RADIATION THERAPY

Radiation therapy, often known as radiotherapy, is a breast cancer treatment that uses high-energy radiation to kill cancer cells and shrink tumors. It is also known as ionizing radiation therapy. Radiation therapy is frequently used after one month following surgery to treat early-stage breast cancer. Surgery is used to remove the tumor, and radiation is used to eradicate any remaining cancer cells. This contributes to a decreased chance of cancer recurrence.

Radiotherapy can also be used for breast cancer treatment that cannot be surgically removed is referred to as unresectable metastatic breast cancer. Also, metastatic breast cancer has progressed to other parts of the body, such as the bones, lungs, brain, or liver. According to the American Cancer Society, it has been told that more than half the number of patients receive radiotherapy.  

CHEMOTHERAPYchemo as a breast cancer treatment.

If there is a high chance of recurrence or spread of cancer, a doctor may prescribe cytotoxic chemotherapy medications to kill cancer cells. When a patient receives chemotherapy following surgery, it is referred to as adjuvant chemotherapy. Sometimes, a doctor may recommend chemotherapy before surgery to shrink the tumor and make it easier to remove. This is called neoadjuvant chemotherapy. Chemo drugs can be administered in oral, injectable, and topical form. Chemo has various side effects: hair loss, fatigue, anemia, mental health issues, bleeding disorders, and nausea. Factors affecting the effectiveness of therapy include cancer and its location and spread along with age, medical reports, and a person’s health.

HORMONE BLOCKING THERAPY

Hormone-blocking therapy is used to prevent the recurrence of hormone-sensitive cancers following a breast cancer treatment. The therapy may aid in the treatment of malignancies that express estrogen or progesterone receptors. Healthcare professionals often administer it following surgery but may do so before surgery to decrease the tumor. Hormone-blocking therapy may be the only option for patients who are not surgical, chemotherapeutic, or radiation candidates. It is usually taken for at least 5 to 10 years.

Hormone-blocking drugs include the following:

  • Tamoxifen ( for estrogen receptors blocking).
  • Aromatase inhibitors (stop estrogen production in the body usually better in postmenopausal women).
  • Raloxofine ( for estrogen receptors blocking and only used for post menopausal women )

TARGETED DRUG THERAPY

In addition to chemotherapy and hormone therapy, newer, more effective breast cancer treatments can attack specific breast cancer cells without harming normal cells. Currently, these targeted methods are commonly used in combination with traditional chemotherapy. However, targeted drugs often have less severe side effects than standard chemotherapy drugs. Breast cancer targeted therapy employs medications to inhibit cancer cells growing in specific ways. Targeted therapy may, for example, inhibit an aberrant protein (such as HER2) that promotes breast cancer cell development.

BREAST CANCER TREATMENT BY STAGE

an image with breast cancer treatment text

Breast cancer has 5 phases. Each stage has a course of breast cancer treatment options. Doctors use blood tests, CT and PET scans, MRIs, X-rays, mammograms, and ultrasounds to diagnose the condition.

Stage 0: Ductal Carcinoma in situ (DCIS) Stage 0: This condition is also referred to as ductal carcinoma in situ. The malignant cells have remained confined within the ducts and have not migrated to other tissues.

  • DCIS is a type of non-invasive breast cancer. In which the cancer cells stayed within the ducts and didn’t spread to other tissues.
  • Although DCIS cannot spread outside the breast, it must be treated since it can progress to invasive breast cancer.
  • Treatment options for this stage will be breast conservative surgery (BCS) or lumpectomy
  • Mastectomy. ( A simple mastectomy may be required if the DCIS is large, if there are several DCIS locations, or if BCS cannot entirely eradicate the cancerous part of the breast)
  • Radiation Therapy. The patient undergoes radiation therapy 4-6 weeks after the breast surgery site has healed.
  • Hormone Therapy. Taking tamoxifen (for any woman) or an aromatase inhibitor (post-menopause) for 5 years after surgery can minimize the risk of having new DCIS or invasive cancer in either breast.)
Stage 1 Breast Cancer Treatment  Stage 1: At this stage, the tumor is around 2 centimeters (cm) in diameter. It has not affected any lymph nodes, or small groupings of cancer cells have been detected in the lymph nodes.

  • In this stage, the breast tumors are still small (less than 2 cm) and have not progressed to the lymph nodes.
  • Surgery is the main treatment offered at this stage, either by lumpectomy (BCS), partial or complete mastectomy. 
  • Radiation Therapy. For stage I breast cancer treatment, radiation therapy is the standard of care. It is essential after breast conservative surgery and not required after mastectomy.
  • Hormone Therapy. Hormone therapy is advised for people over the age of 70 who are not candidates for radiation therapy.
  • Chemotherapy. Chemotherapy may be recommended for tumors ( more than 1 cm), particularly if they have any adverse characteristics (rapid growth; hormone receptor-negative, HER2-positive).
Stage 2 Breast Cancer Treatment  Stage 2: The tumor is 2 cm across and has started to spread to nearby nodes, or it is 2–5 cm across and has not spread to the lymph nodes.

  • In stage 2, these breast cancers are larger than stage I cancers (20-50mm)  and/or have spread to a few nearby lymph nodes.
  • Surgeries like lumpectomy or breast conservative surgery (BCS) and mastectomy are recommended.
  • Radiation Therapy. Radiation therapy is used to treat women who have BCS following surgery. Typically, women who undergo mastectomy are treated with radiation if cancer is discovered in the lymph nodes.
  • Combined Therapy.  Some women with stage II breast cancer require systemic therapy. Some systemic therapies are provided before surgery, while others are given after.
  • Chemotherapy. Chemo can be given before or after surgery.
Stage 3 Breast Cancer Treatment  Stage 3: The tumor is up to 5 cm across and has spread to several lymph nodes, or the cancer is larger than 5 cm and has spread to a few lymph nodes.

  • Stage III breast cancer has grown into neighboring tissues (skin over the breast or muscle underneath) or has spread to several nearby lymph nodes, including the surrounding skin.
  • There are two main approaches for this stage of breast cancer treatment;
  • Option 1: Treatment with neoadjuvant chemotherapy (before surgery). This treatment might reduce the size of tumors; if not, then mastectomy is recommended. Radiation Therapy follows it
  • Option 2: A mastectomy is frequently required because these tumors are big and/or have invaded adjacent tissues. Sentinel Lymph node biopsy (SLNB) or Axillary lymph node biopsy (ALNB) may also be required. It is usually followed by chemotherapy, Hormonal therapy, or drug therapy. 
Stage 4 Breast Cancer Treatment  Stage 4: Cancer has progressed to distant organs, the most common of which are the bones, liver, brain, and lungs.

  • Known as metastatic breast cancer. In this stage, cancer spreads out to other parts of the body including the lymph nodes and nearby organs thus having this name
  • Chemotherapy, radiation therapy, and hormone therapy (if required) are the treatment modality recommended for stage IV cancer patients.
  • Immunotherapy, which boosts the body’s ability to fight cancer, is also carried out.
  • A doctor may offer surgery to address pain or other concerns caused by stage 4 breast cancer. These include spinal cord compression, removing single masses caused by metastasis, and fixing any broken bones.
  • Pain medication may also be prescribed.

BREAST CANCER TREATMENT CONSIDERATIONS

The stages of breast cancer assist physicians and patients in determining the extent to which cancer has spread throughout the body and which treatment choices may be beneficial. Other considerations, however, can also influence treatment selections, such as;

  • Age
  • Family history
  • Genetical screening and testing
  • Overall health condition
  • Patient preference

SURVIVAL RATE OF BREAST CANCER TREATMENT

The Surveillance, Epidemiology, and End Results Program (SEER) of the National Institutes of Health (USA) forecasts that in 2021, there will be 281,550 new cases of female breast cancer and 43,600 deaths. Breast cancer’s 5-year survival rate was 90.3% from 2011–2017, according to SEER.

The average survival rates according to the stage at diagnosis, says SEER, were:

Stage 5-year survival rate
Localized: Cancer has not yet spread beyond the breast 90.3%
Regional: Cancer has reached nearby lymph nodes 29%
Distant: Cancer has spread to other parts of the body 6%
Unknown stage 2%

Approximately 90% of females diagnosed with breast cancer survive for at least five years after diagnosis, according to the National Cancer Institute. 

AT WHEN CAN ONE BE CONSIDERED CANCER-FREE?

If patients remain in total remission for five years or longer after breast cancer treatment, some physicians may declare them cured. Even after therapy, certain cancer cells may linger in your body for several years. These cells may one day cause cancer to recur. So screening and regular consultation with your health care professional or oncologist is always the best choice.

To reduce your risks of getting breast cancer, check out this guide and share with your loved ones. It’s not rocket science, having a lifestyle that includes being physically active and consuming healthy diet, Mediterranean diet, can limit the risks of having any cancer.

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Aimen

Being a Doctor by profession, Aimen is passionate about helping people get better health in their lives. Aimen enjoys her research on Prime With Time subjects and strives to create better awareness of the problems and changes related to women's health.
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