|surgical | oncology|
Oncology treatment drugs are often used in various combinations as decided by the multidisciplinary team that is treating the patient. An oncologist uses medication to fight cancer cells.
Oncology treatment plays a fundamental role in the treatment of all women presenting with breast cancer even when the breast cancer is diagnosed early and is still confined to the breast.
Hormone (endocrine) manipulation and/or chemotherapy will be used shortly after surgical treatment of early breast cancer.This will achieve a higher cure rate and is called adjuvant therapy. Adjuvant Therapy is additional cancer treatment given after the primary treatment to lower the risk that the cancer will come back. In the past couple of years, many oncologists (cancer physicians) are using such therapy even before they operate. This is called neo adjuvant therapy (primary medical treatment or induction chemotherapy). Should your doctor suggest this please see the relevant reading on the subject.
A general guide as to who gets chemotherapy is as follows:
There are also different types of chemotherapy that can be used and these need to be discussed with your treatment team.
Oncology options in breast cancer
Remember these modalities (chemotherapies) are generally not used for in situ breast cancer. Thus a core biopsy is essential, so that invasive cancer can be diagnosed. Fine needle aspiration cytology(FNAC) tells the doctor that cancer is present, not whether it is in situ or invasive.
Cytotoxic chemotherapy regimens should be discussed with patients by the cancer specialist looking at the toxicity of the treatment proposed and the patient's own beliefs and goals.
The use of a computer model such as http://www.AdjuvantOnline.com can provide accurate information for patients on the absolute reduction in the risks of relapse and death for the individual. The optimal timing of chemotherapy after surgery is not known, but currently it is recommended to start chemotherapy 4-6 weeks after surgery.
Delay of adjuvant radiation therapy due to the administration of adjuvant chemotherapy has not proven to decrease disease disease survival.
The length of time that adjuvant chemotherapy is given for is four to eight months depending on the type of chemotherapy given.
The chemotherapy is more effective when the drugs are given in combination. They are given intravenously, usually intermittently in a pulsed fashion. The most commonly used technique is as an infusion into a vein in the hand or arm through a small plastic tube called a cannula or a port is placed into a central vein (a permanent vein catheter). These drugs are generally given at intervals over a certain weeks for a period of between four and eight months.
Note that birth control measures must be used during chemotherapy. Pregnancy must be avoided as some anticancer drugs may cause birth defects, particularly during the first trimester of pregnancy (first twelve weeks).
The following chemotherapeutics are used for breast cancer in various combinations:
Technology now exists to make antibodies in the laboratory (the normal chemicals used by the immune system to detect and attack foreign particles in the body). These antibodies have been made to detect HER2 receptors. The antibody is therefore known as anti-HER2 otherwise called trastuzumab or by its commercial name Herceptin.
Research has shown that 20%-25% of ladies have tumours that over express Her2. This can be measured on a sample of cancer taken from the breast - even if it was removed many months or years ago. In these patients it is possible to give Herceptin to attack cancer cells that may still remain in the body. In the body Herceptin finds the cancer cells wherever they may be hiding and sticks to the Her2. This then is thought to trigger a self-destruct mechanism within the cell (apoptosis). It also encourages the body’s normal immune cells to attack the tumour and there is also some evidence that it conditions the cancer cell to be more sensitive to subsequent chemotherapy. Scientific studies have shown modest responses when given to patients on its own (15% of women responded) but it has been shown to work much better when given with chemotherapy (response rate about 60%). Many trials are currently underway to establish which types of chemotherapy Herceptin should be given with and to which patients.
When given with chemotherapy the side effects normally relate to the chemotherapy (see chemotherapy). Herceptin generally does not make these worse. The only exception is if it is given in combination with chemotherapy agents called anthracyclines (e.g. adriamycin). Trials have shown that Herceptin can increase the risks of adriamycin damaging the heart. No such effect appears to occur with other drugs.
Herceptin does have some mild side effects of its own particularly related to infusion related reactions such as fever, chills and rigors, throat irritation, a runny nose and flushing or pain in the sites of the tumours. These are usually mild but can be distressing in some patients. They usually occur 30 minutes to two hours after starting the infusion and are more common after faster infusions. These symptoms can be diminished by taking a paracetamol and an anti-histamine. Many oncologists (cancer physicians) today are using such therapy even before surgery. This is called neo adjuvant therapy (primary medical treatment or induction chemotherapy).