Introduction

Breast Cancer is composed of a variety of tissues, from extremely fatty tissue to extremely dense tissue. There is a network of lobes inside this tissue. Each lobe is composed of lobules, which are tiny, tube-like structures that house milk glands. Milk is transported from the lobes to the nipple via tiny ducts that link the glands, lobules, and lobes. The areola, the darker region that encircles the nipple, contains the nipple in the center.

Healthy cells in the breast begin to alter and expand out of control to create a tumor, which is a mass or sheet of cells. A tumor may be benign or malignant. Malignant refers to the ability of a cancerous tumor to develop and metastasize to other bodily regions. A benign tumor is one that is still growing and has not yet spread.

Although breast cancer often progresses to adjacent lymph nodes, in which case it is still regarded as a local or regional illness, it can also spread through the blood vessels and/or lymph nodes to other parts of the body, including the bones, lungs, liver, and brain. This is the most advanced stage of breast cancer, often known as metastatic or stage IV. Stage IV breast cancer is typically not present if just local lymph nodes are involved.

Types Of Breast Cancer

Breast cancer comes in a variety of forms and can be divided into two groups: invasive and noninvasive. Breast cancer in situ is another name for noninvasive breast cancer. Noninvasive cancer doesn’t spread from the initial tissue, whereas invasive cancer does so from the breast ducts or glands to other regions of the breast.

The most typical kinds of breast cancer are divided into these two groups, and they include:

• Ductal carcinoma in situ: DCIS, also known as ductal carcinoma in situ, is a noninvasive ailment. The cancer cells in DCIS are limited to the ducts in your breast and won’t spread to the nearby breast tissue.

• Lobular carcinoma in situ: A lesion called lobular carcinoma in situ (LCIS) develops in your breast’s milk-producing glands. The cancer cells won’t invade the surrounding tissue, just like DCIS.

• Invasive ductal carcinoma: Breast cancer of the most frequent form is invasive ductal carcinoma (IDC). This form of breast cancer starts in the milk ducts of your breast before spreading to surrounding breast tissue. Breast cancer can start to spread to neighboring organs and tissues after reaching the tissue outside your milk ducts.

• Invasive lobular carcinoma: Initially forming in the lobules of your breast, invasive lobular carcinoma (ILC) later invades neighboring tissue.

Stages Of Breast Cancer

The mass of the tumor and whether it has invaded the lymph nodes or other regions of the body are factors that a doctor considers when determining the stage of cancer.

Breast cancer can be staged in several different ways. Stages 0 through 4 are included below, and each stage has a subcategory.

• Stage 0: Also referred to as ductal carcinoma in situ. The malignant cells have not progressed to the tissues around the ducts; they are contained solely inside.

• Stage 1: The tumor can be up to 2 centimeters wide at this point. There are either no afflicted lymph nodes or a few cancerous cells in a few lymph nodes.

• Stage 2: The tumor is 2 cm in diameter and has begun to spread to the lymph nodes nearby, or it is 2–5 cm in diameter but has not yet done so.

• Stage 3: Either the tumor is more than 5 cm in size and has progressed to a few lymph nodes, or it is up to 5 cm in size and has progressed to more lymph nodes.

• Stage 4: Cancer has advanced to distant organs, typically the lungs, liver, bones, or brain.

Different Types Of Treatments

The types of therapies usually referred to as breast cancer treatment options for treating early-stage and locally progressed breast cancer are described below. The finest available therapies are referred to as “standard of care.” You are advised to consider the possibility of clinical trials with your doctor while deciding on a treatment strategy. 

A clinical trial is a research project that evaluates a novel therapeutic strategy. Clinical trials allow physicians to determine if a novel treatment is risk-free, efficient, and perhaps even superior to the accepted practice. Here are some of the common breast cancer treatment options:

Chemotherapy

Chemotherapy is the use of medications to kill cancer cells, often by preventing the growth, division, and production of new cancer cells. It may be administered before surgery to minimize the size of a big tumor, facilitate surgery, and/or lower the chance of recurrence. Neoadjuvant chemotherapy is the name for it when it is administered before surgery. Additionally, adjuvant chemotherapy, which is administered after surgery to lower the chance of recurrence, may be used.

A typical neoadjuvant or adjuvant chemotherapy regimen, or schedule, consists of a mix of medications administered over the course of a certain number of cycles. Depending on what was most effective in clinical studies for that particular sort of regimen, chemotherapy may be administered according to a variety of schedules. It can be administered once per week, twice per week, or three times per week. Chemotherapy comes in a variety of forms that are used to treat breast cancer.

Chemotherapy for breast cancer is not always necessary for patients. Your oncologist could advise the best chemotherapy treatments for breast cancer depending on the stage of cancer:

• Prior to surgery (Neoadjuvant Chemotherapy): Chemotherapy may be used to reduce a tumor. A less invasive procedure could be available if you choose this option. By observing how cancer reacts to chemotherapy, medical professionals may learn more about the biology of the disease.

• After surgery (Adjuvant Chemotherapy): The presence of malignant cells in your body might occasionally go undetected by imaging examinations. To eradicate any cancer cells that may have survived the surgery, your doctor may advise chemotherapy. The likelihood of cancer coming back can also be decreased by this therapy.

• Advanced Cancer: Chemotherapy may be the main treatment if your breast cancer has metastasized (spread to other places of your body).

• IBC: The lump of inflammatory breast cancer (IBC) is difficult for a surgeon to readily remove. The first course of action for IBC is frequently chemotherapy.

Preparation For Chemotherapy For Breast Cancer

You’ll get blood tests a few days prior to your chemotherapy treatment. Based on your laboratory results and body mass index, your oncologist and pharmacist can customize your treatment using the information from the blood tests (BMI).

A central venous catheter (CVC) is a large, resilient tube that you could use to receive chemotherapy. A CVC will be surgically installed before therapy if your doctor advises it. Up until you finish chemotherapy, it remains in place.

Procedure Of Chemotherapy For Breast Cancer

Most patients who have breast cancer receive chemotherapy through one of their veins (IV). Chemotherapy can be administered intravenously or as a single brief injection. Longer-lasting infusions often occur in a hospital or specialized infusion facility. Your nurse will deliver your chemotherapy meds and any other medications you require after you arrive at the infusion facility. You could be given an anti-nausea medicine in addition to chemotherapy treatments, for instance.

Chemotherapy is often administered in cycles. You could have chemotherapy once per week, twice, three times, or even four times. Typically, cycles last for two to three treatments. There is a break between each cycle to give your body time to heal. For three weeks, you may, as an illustration, have the same therapy every Monday. The next week is additional for recovery before the cycle is repeated. Many patients receive therapy in several rounds. Three to six months may pass between treatments.

Side Effects Of Chemotherapy For Breast Cancer

The type of medication you take and how long you take it will determine the adverse effects of chemotherapy. Typical chemo side effects include:

• Tiredness.
• Digestive problems like diarrhea or constipation.
• Alterations in the hair, skin, or nails, such as loss of hair and brittle nails
• Losing your appetite.
• Vomiting and nauseous.
• Tingling or numbness.

Many people continue to work, exercise, and take care of their families while receiving chemotherapy. Others may find the therapy to be time- and energy-consuming. It could be challenging to continue with routine tasks.

The advantages and disadvantages of chemotherapy should be discussed with your healthcare professional. With the use of supporting medications, such as nausea meds, you can control side effects. In most cases, side effects from chemotherapy fade away once your treatment is through.

Radiation Therapy

High-energy x-rays or other particles are used in radiation treatment to kill cancer cells. Radiation oncologists are medical professionals that specialize in administering radiation therapy as a cancer treatment. Radiation therapy for breast cancer comes in a variety of forms:

• External-beam radiation therapy: This sort of radiation therapy, which is administered from a machine outside the body, is the most popular. This covers both full and partial breast radiotherapy, as well as expedited breast radiotherapy, which might last a few days rather than a few weeks.

• Intra-operative radiation therapy: This is when radiation therapy is administered in the operating room using a probe.

• Brachytherapy: Brachytherapy for breast cancer is done by inserting radioactive sources into the tumor. Although intra-operative radiation treatment and brachytherapy are not often employed, the research findings are encouraging. They could be choices for a patient who has a tiny tumor that has not migrated to the lymph nodes if they are accessible.

• Partial breast irradiation: Radiation therapy called partial breast irradiation (PBI) targets the tumor region specifically rather than the entire breast. After a lumpectomy, it occurs more frequently. The amount of time that patients must undergo radiation therapy is typically reduced by directing radiation directly to the tumor location. Only a select few patients, nevertheless, could be eligible for PBI. PBI is currently being researched, despite encouraging preliminary findings. However, it is already a standard of therapy in some situations, such as for some patients with early-stage breast cancer.

• Intensity-modulated radiation therapy: An improved method of administering external-beam radiation treatment to the breast is intensity-modulated radiation therapy (IMRT). To more effectively target the tumor and distribute the radiation more uniformly across the breast, the radiation’s intensity is changed. The use of IMRT reduces the radiation dosage, which may reduce the risk of harm to neighboring organs like the heart and lungs as well as certain acute adverse effects like skin peeling during treatment.

• Proton therapy: X-rays, commonly known as photon therapy, are used in conventional radiation therapy for breast cancer to destroy cancer cells. A form of external-beam radiation therapy known as proton therapy employs protons rather than x-rays. Protons have the power to kill cancer cells at high energies. Different physical characteristics of protons might make radiation treatment more precise than photon therapy and possibly result in lower radiation dosage. The treatment could help cut down on radiation exposure close to the heart.

Fatigue, breast enlargement, redness or skin discoloration, and soreness or burning where the radiation was applied to the skin, along with blistering or peeling, are all possible adverse effects of radiation treatment. To alleviate some of these side effects, your doctor may suggest topical creams or lotions.

Rarely, radiation treatment can cause pneumonitis, a radiation-related swelling of the lung tissue, in a tiny portion of the lung. This danger varies according to the size of the radiation-treated area, and it usually goes away with time. You might be able to choose from a variety of radiation therapy options with various schedules. Discuss the pros and cons of each choice with your doctor.

Surgery Options

The removal of the tumor during surgery, along with some nearby healthy tissue, is referred to as surgery for breast cancer. Under the arm, close-by axillary lymph nodes are also examined during surgery. A doctor who focuses on operating to remove the cancer is known as a surgical oncologist. More information on the fundamentals of cancer surgery

Whether you need medication-based therapy, such as chemotherapy, hormone therapy, and/or targeted therapy, is unaffected by the surgery you ultimately choose. It doesn’t matter what kind of surgery you undergo; pharmacological treatments are prescribed depending on the tumor’s features. The more surgical choices a patient has often depended on how big the tumor is.

Lumpectomy vs. Mastectomy

Even though both lumpectomy and mastectomy are surgical procedures to treat breast cancer via surgery, they are very different from each other 

Lumpectomy

Breast cancer or other aberrant tissue can be removed surgically through a procedure called a lumpectomy. A lumpectomy is a surgical operation in which the surgeon eliminates the cancerous or other abnormal tissue along with a small portion of the surrounding healthy tissue. This guarantees the removal of all aberrant tissue.

As just a piece of the breast is removed during a lumpectomy, it is also known as breast-conserving surgery or broad local excision. In contrast, all of the breast tissue is removed after a mastectomy. A quadrantectomy or excisional biopsy are other terms used by doctors to describe lumpectomies.

An option for treating early-stage breast cancer is a lumpectomy. A lumpectomy may occasionally be performed to rule out a cancer diagnosis. Radiation therapy is frequently administered to the breast after a lumpectomy procedure to lower the risk of the cancer returning.

A lumpectomy is a surgical procedure that removes cancer or other diseased tissue while leaving your breasts looking normal. The elimination of the entire breast (mastectomy) to treat early-stage breast cancer is not as successful in preventing a recurrence of the disease as a lumpectomy followed by radiation treatment.

If a biopsy reveals you have cancer and the tumor is thought to be tiny and in its early stages, your doctor could advise a lumpectomy. Several non-cancerous or pre-cancerous breast irregularities may also be removed via a lumpectomy.

Mastectomy

In order to treat or prevent breast cancer, a mastectomy is a surgical procedure where the entire breast tissue is removed from the breast. A mastectomy could be a possible course of therapy for those with early-stage breast cancer. Another alternative is breast-conserving surgery, or lumpectomy, in which only the breast tumor is removed.

It might be challenging to choose between a lumpectomy and a mastectomy. For avoiding breast cancer recurrence, both treatments are equally beneficial. However, not everyone with breast cancer has the choice of having a lumpectomy; others would rather have a mastectomy.

Modern mastectomy methods allow for the preservation of breast skin and the restoration of a more natural-looking breast appearance. It’s also referred to as a skin-sparing mastectomy. Breast reconstruction surgery can either be performed concurrently with your mastectomy or at a subsequent procedure at a later time.

In order to avoid breast cancer, a mastectomy is suggested. If you don’t have breast cancer but are at a very high risk of getting it, you could also think about getting a mastectomy. Removing both of your breasts during a preventative (prophylactic) or risk-reducing mastectomy greatly lowers your chance of later getting breast cancer.

Only individuals with a very high risk of breast cancer—determined by a strong family history of the disease or the presence of certain genetic abnormalities that raise the risk of breast cancer—are eligible for a preventative mastectomy.

Other Surgical Types

Other than lumpectomy and mastectomy, there are a few more surgical options that are preferred but again, it depends on a lot of factors which will be determined by your doctor

Lymph Node Dissection

Cancer in your lymph nodes is a cautionary indication that it may be moving outside of your breast since your lymph system is frequently where cancer spreads initially. Your surgeon could take one or more lymph nodes under your arm that are close to the afflicted breast out and examine them to find out. The most likely location for breast cancer cells to drain is here.

Procedures for lymph nodes include:

Biopsy of sentinel lymph node: This test will determine whether cancer has spread to your lymphatic system. As the first lymph node to filter fluid flowing from the afflicted breast, the sentinel lymph node is a useful sign. Often, and occasionally before, the procedure to remove the primary tumor from your breast, your surgeon will take a sentinel node biopsy. The sentinel node will be removed, and its cancerous cells will be examined.

Axillary lymph node dissection: Your surgeon may decide to remove a greater part of lymph nodes for analysis if the sentinel node biopsy reveals cancer or if they have another cause to think you have extensive cancer in your lymph nodes. A collection of axillary lymph nodes, or the lymph nodes beneath your arm, are removed by the surgeon during an axillary lymph node dissection. The tissue will be meticulously examined for indications of malignancy.

Reconstructive Breast Surgery

You might be considering reconstructive surgery to restore your breast form if you are having one or both of your breasts removed to treat breast cancer. Immediately after your lumpectomy or mastectomy, surgeons can frequently reconstruct the breast using plastic surgical procedures. They can also conduct a different operation at a later date, perhaps after your chemotherapy or radiation therapy has ended and your tissues have had a chance to heal.

Whether you undergo immediately or delayed reconstructive surgery, you could require a second procedure to polish your results. A rebuilt nipple may be added during subsequent procedures, or the size balance between your breasts may be adjusted. Breast reconstruction can take place in phases and can use a variety of techniques. Based on your situation and preferences, you and your surgeon will decide on the best procedures and timing.

Techniques for breast reconstruction include:

Reconstructed implants: Your breast’s volume and form are restored with a breast implant by replacing the tissue that was taken from it. The implant consists of a silicone shell that is packed with silicone gel or saline. The surgeon covers it with your skin, either the skin from your natural breast or a skin transplant from another area of your body and inserts it over or under your muscle.

“Flap” or autologous reconstruction: This technique reconstructs your breast using tissue from another area of your body. Breast tissue resembles skin, fat, and occasionally muscle from places like your abdomen or buttocks more closely in appearance and texture. For more natural-looking outcomes, surgeons may combine flap and implant repair.

Hormone Therapy

Most cancers that test positive either for estrogen or progesterone receptors respond well to hormonal therapy, often known as endocrine therapy. Hormones are used by this kind of tumor to drive its expansion. When hormonal treatment is administered alone or in conjunction with chemotherapy, blocking the hormones can help reduce breast cancer mortality and recurrence.

Contrary to menopausal hormone therapy (MHT), hormone therapy for the treatment of breast cancer is different. MHT is another name for hormone replacement therapy (HRT) or also referred to as postmenopausal hormone therapy. Breast cancer hormone therapies function as “anti-hormone” or “anti-estrogen” treatments. They inhibit hormone activity or reduce the body’s hormone levels. Endocrine treatment is another name for hormonal therapy. The body’s endocrine system produces hormones.

Prior to surgery, hormonal treatment may be used to reduce a tumor, facilitate surgery, and/or reduce the chance of recurrence. Neoadjuvant hormonal treatment is what this is known as. When prescribed before a surgery, it is normally administered for at least three to six months and then continued following the procedure. In order to lower the chance of recurrence, it may also be administered just after surgery. Adjuvant hormonal treatment is what this is known as.

Hormone Therapy Types

There are majorly 3 types of hormone therapy for breast cancer that are performed.

Tamoxifen

The medicine tamoxifen prevents estrogen from attaching to breast cancer cells. It is successful in reducing the risk of distant recurrence, the risk of getting cancer in the other breast, and the risk of recurrence in the cancer-affected breast. Both menopausal women and those who have not yet experienced it can benefit from tamoxifen.

Tamoxifen is a tablet that needs to be taken orally every day for five to ten years. It may be taken with medicine to prevent the ovaries from generating estrogen for premenopausal persons. 

It is crucial to go through all other prescription drugs and nutritional supplements you use with your doctor, especially any anti-depressants as some of them may interact with tamoxifen. Tamoxifen frequently causes vaginal dryness, discharge, or bleeding, as well as hot flushes. Uterine lining cancer, cataracts, and blood clots are all extremely uncommon hazards. But in postmenopausal individuals, tamoxifen may enhance bone health and cholesterol levels.

Aromatase inhibitors (AIs)

By inhibiting the aromatase enzyme, AIs reduce the amount of estrogen produced in organs other than the ovaries in postmenopausal women. When the ovaries cease producing estrogen during menopause, this enzyme converts weak male hormones called androgens into estrogen. 

These medications include letrozole, exemestane, and anastrozole referred to by Arimidex, Aromasin, and Femara respectively. The AIs are all oral tablets that must be taken every day. Only those who have experienced menopause or who take medications that prevent the ovaries from producing estrogen are eligible to utilize AIs. 

To lower the risk of recurrence in post-menopausal patients, treatment with AIs, either as the initial hormone medication taken or following treatment with tamoxifen, may be more beneficial than taking simply tamoxifen. Muscle and joint discomfort, hot flashes, vaginal dryness, an elevated risk of osteoporosis and fractured bones, and infrequently high cholesterol and hair loss are adverse effects of AIs. 

According to research, all AIs function equally effectively and have comparable negative effects. However, for unknown reasons, individuals who have unfavorable side effects while using one AI medicine may experience fewer negative effects with a different AI.

AIs should not be used by patients who have not reached menopause or who are not receiving injections to stop the ovaries from functioning since they do not prevent the effects of estrogen produced by the ovaries. In order to confirm that the ovaries are no longer making estrogen, clinicians frequently check blood estrogen levels in patients whose monthly cycles have just stopped, those whose periods were interrupted by chemotherapy, or those who have a hysterectomy but still have their ovaries.

Ovarian suppression or Ablation

Drugs are used in ovarian suppression to prevent the ovaries from releasing estrogen. Surgery is used to remove the ovaries by ovarian ablation. In the case of those who have not yet reached menopause, these choices may be utilized in conjunction with another kind of hormone treatment.

Gonadotropin or luteinizing discharging hormone (GnRH or LHRH) agonist medications are used to inhibit ovarian function by preventing the ovaries from producing estrogen, which results in temporary menopause. These medications include leuprolide (Eligard, Lupron) and goserelin (Zoladex). They are often used in conjunction with other hormone therapies since they are not particularly successful in treating breast cancer on their own. They prevent the ovaries from producing estrogen and are administered by injection every four weeks. If therapy is discontinued, the effects of GnRH medications disappear.

In ovarian ablation, the ovaries are surgically removed in order to cease the synthesis of estrogen. While this is irreversible, it might be a useful choice to take into account for those who no longer wish to get pregnant. Over time, the cost is often cheaper.

Results

While receiving hormone therapy for breast cancer, you will visit your oncologist frequently for check-ups. If you are suffering any adverse symptoms, your oncologist will inquire. Many adverse effects are controllable.

In patients with early-stage hormone-sensitive breast cancers, hormone treatment after surgery, radiation, or chemotherapy has been demonstrated to lower the chance of breast cancer recurrence. It can also successfully lower the chance of developing and spreading hormone-sensitive breast cancers in persons with the disease.

Depending on your scenario, you may be subjected to tests to keep an eye on your health and look for cancer development or recurrence while receiving hormone treatment. Your doctor may change your treatment based on the results of these tests to see how you are reacting to hormone therapy.