In our previous blog article: 【Breast Health】Found suspicious lumps in breasts? 3-ways to conduct a self-breast check-up, we talked about how it is difficult to find symptoms of breast cancer in the early stages. This leads to many patients being diagnosed at relatively advanced stages.
Surgical treatment for breast cancer includes breast-conserving surgery, mastectomy and lymph node removal.
When the cancerous cells are only in a small part of the breast, only part of the breast needs to be removed. The cancerous area of the breast will be removed, the surrounding area and other breast tissue area may also be removed. As relatively fewer tissues are removed, the surgery will leave a small scar, reducing the impact on the appearance of the breast.
Mastectomy is when the entire breast is surgically removed including the skin and nipple area. Doctors will usually remove the breast, some nearby tissues, or even part of the chest muscles. If the cancer tumours are large or the cancerous cells have spread to the entire breast, then Mastectomy must be conducted.
After the surgery, a horizontal scar across the chest will remain. In post-surgery, side effects may include infection of the scar, reduced mobility due to damage of nerves and water retention in lymphs. However, with the improvement of surgical technology and post-surgery rehabilitation, side effects have reduced nowadays.
If the patient is worried that the removal will affect aesthetics, then they can consider breast reconstruction surgery.
There are 30-40 lymph nodes in the underarm area, and they are relatively vulnerable to cancerous cells. Cancerous cells can spread to the entire body through lymph nodes. If there are cancerous cells in the lymph, the risk of relapse is relatively high. To stay on the safe side, the doctor will remove some of the lymph nodes from the same side of the breast for testing during the surgery. If cancerous cells are found, the remaining lymph nodes may also need to be removed, or radiation therapy or chemotherapy may be required after surgery.
Removing the lymph nodes may lead to water retention in lymph such as bloating in the arm. It may also affect the nearby nerves, making the upper arm numb, stiff, and painful. These side-effects can be alleviated by physical therapy so patients do not need to worry too much.
Nowadays, pre-operative (neoadjuvant) therapy has become a trend for breast cancer treatment. Patients first receive drug treatment before surgery , aiming to shrink the area infected by cancerous cells and make the surgery easier to conduct. This also decreases the chance of having to surgically remove the whole breast. Pre-operative therapy also allows doctors to observe the tumour’s response to medication, helping them formulate the best post-surgery treatment and reduce the chance of relapse.
Chemotherapy is a common treatment for cancer. It uses medication to disrupt the growth and division of cells and destroy cancerous cells. Medication can be oral or infused into the body via veins. Intravenous infusions can be done through a peripheral cannula, indwelling port or central line. The average chemotherapy treatment takes around 4-8 cycles, each cycle being 2-3 weeks. In between cycles, the patient can rest and let the side-effects die down before continuing with the next cycle.
Different types of chemotherapy may be used before and after surgery, and after the spread of cancerous cells.
Before surgery: chemotherapy can help reduce the size of tumours before going into surgery and reduce the need for removing the whole breast.
Post-surgery: chemotherapy helps to destroy the residual cancerous cells and reduce the chances of spreading or relapse.
After the spread of cancerous cells: chemotherapy can reduce the size of the tumour, alleviate symptoms, maintain quality of life and prolong life.
Unfortunately, chemotherapy is unable to differentiate between cancerous cells and normal healthy cells, so some cells like those in the mouth, stomach and bowel, and the hair follicles will be damaged. This results in side effects including nausea, tiredness, diarrhea, hair loss, mouth sores etc.
Radiotherapy uses high-energy x-rays to kill cancerous cells. External radiation is commonly used to treat breast cancer. Usually, radiation therapy is used post-surgery, removing any residual cancerous cells, but sometimes it is also used pre-surgery or even to replace surgery.
Both external or internal radiation may cause the skin to become irritated, such as itchiness, redness, other side effects also include nausea and tiredness. After radiation therapy is completed, side-effects will slowly disappear except for fatigue which may last for several months.
Hormonal therapy works through lowering hormone levels or stopping hormones, and depriving cancer tumours of these hormones to remove the growth stimulus. However, this therapy is only effective in breast cancer cells with hormonal receptors on the surface (i.e. hormonal receptor positive). Want to know more about hormonal receptor-positive breast cancer? Take a look at:【Breast Health】Get to know the 4 types of Breast Cancer and their treatments.
Side effects will depend on the specific medication used. Common side-effects include hot flushes, an upset stomach, irregular menstruation, joint and muscle pain etc.
Last of all is the targeted therapy for breast cancer. Targeted therapy is a cancer treatment that uses drugs to target specific genes and proteins that are involved in the growth and survival of cancer cells. Targeted therapy can affect the tissue environment that helps a cancer grow and survive or it can target cells related to cancer growth.
Current approved targeted therapies for breast cancer include:
Targeted therapy drugs usually come in the form of oral medication and intravenous therapy (IV). In recent years, some targeted therapy drugs have also become available in the form of subcutaneous injections. This reduces the treatment time from 80 minutes through IV to 10 minutes through subcutaneous injection. Patients are under less pressure because of the shortened time frame of treatment.
Targeted therapy has fewer side effects in comparison to traditional chemotherapy drugs but is more expensive. If you would like to know more about the side-effects of targeted therapy and how to combat its side-effects, you may also consult a doctor.
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