After recovering as best as one can from the staggering news that one has breast cancer, it’s time to make some decisions about treatment options. Treatment options are often determined by the staging of the cancer (in situ, invasive, lymph node involvement, metastases etc.). But before we get too far into this, let’s emphasize an important point. Consider getting a second opinion on both the diagnosis and the treatment. Misdiagnosis occurs more frequently that the establishment would like to admit, and it cuts (no pun intended) both ways. I have spoken to quite a few women who were told they had a benign growth who later developed raging cancers.
In general, you will have four major areas of options: surgery, radiation, chemotherapy and hormonal therapy. Most often, combinations are used, and the choices are driven by the stage of the disease.
Surgery: The oldest of approaches (actually thousands of years old) surgery is often the most effective option. There are currently three major types of surgery for breast cancer.
 | Lumpectomy: Just the tumor and some surrounding tissue is removed |
| Total Mastectomy: The entire breast is removed but chest muscles and axillary lymph nodes are left intact. |
| Modified Radical Mastectomy: First, the breast is removed, then a portion of the axillary lymph nodes (the ones under the arm) are removed. |
The type of surgery performed is usually determined by the stage of the disease.
Radiation: Often the physician will recommend radiation as an adjunct after surgery. Simply put, radiation damages cells that are rapidly dividing (like cancer). The hope is that any local area into which cancer cells have invaded will be irradiated sufficiently to kill any malignancies.
Radiation is normally administered every weekday for about six weeks. The procedure is almost always performed on an outpatient basis. The actual “zapping” only lasts a few minutes.
Often, the radiation oncologist will prescribe a “booster dose” at the end of they cycle. Sometimes this is administered by implanting radioactive beads that stay in place for about 36 hours.
Chemotherapy: The most dreaded of all. Thoughts of uncontrolled nausea, vomiting, and diarrhea come to mind for most when they think of chemotherapy. Actually it isn’t as bad as it used to be. Unlike radiation, chemotherapy traverses the whole body, killing rapidly dividing cells. Besides cancer cells, other rapidly dividing cells include the lining of the gastrointestinal tract, blood cells, and hair. Damage to these cells results in the troublesome side effects associated with chemotherapy.
The most common chemotherapeutic agents used in breast cancer are cyclophosphamide or Cytoxan ( C ), methotrexate (M) 5 fluorouracil or 5FU (F), Adriamycin or doxorubicin (A), Oncovin or vincristine (O) and Taxol (T). Various combinations are utilized and given intials like CMF, CAF, etc. in keeping with the abbreviations mentioned previously.
Chemotherapy is usually given in cycles. Two common cycles are the 3 week and the four week cycle. In the 3 week cycle, there is a 3 week break between chemotherapy treatments. The four week cycle has two weeks on and two weeks off. These cycles can run from 12 weeks to over a year depending on many factors.
Hormone Therapy: Think Tamoxifen (Nolvadex). Right now, this is the hormone therapy most often employed. Physicians run tests on the cancer cells to see if they are stimulated by estrogen. If they are, the cancer is referred to as estrogen receptor positive. Tamoxifen works by blocking estrogen. Tamoxifen is also often employed when the cancer is estrogen receptor negative, especially in women over 50. It is not fully understood why Tamoxifen helps in some cases of estrogen receptor negative cancers.
This article is a very brief overview of traditional treatment options. The actual decision on which therapies are right for you involve many complex factors that should be discussed with a competent health care professional.
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