Treatment guidelines
Treatment
Treatment
surgical | oncology

Treatment guidelines

It must be remembered that if breast cancer is detected early, it is a curable disease. In patients with tumours less than 1 cm there is a greater than 90% 10 year disease free survival rate.

Even in patients with large breast cancers chemotherapy and hormone therapy (as well as new target therapies) can result in a relatively long period of palliation (in some instances longer than 10 years).

An important concept to grasp in the treatment of breast cancer is the one of dissemination (spread) of the malignant cells throughout the body, setting up islands of cancer cells in various organs (metastases). These metastases, which in breast cancer usually occur in the bones, lungs, liver and brain, are generally responsible of the death of the patient. By this time the cancer has grown from a single cell to 1012 or 1,000,000,000,000 cells.

When  one examines survival graphs (prognosis), it can be seen that Stage I has a five year survival of about greater than 90%. Why do 10 - 15% of Stage I die within five years? The reason is that metastatic spread may take place even in Stage I breast cancer. These metastases may remain silent, so that the doctor cannot find them with the usual tests her uses to detect metastases (x-ray chest, ultrasound of the liver, enzyme tests of liver function such as the alkaline phosphatase, x-ray long bones and spine, bone scan, etc). These silent metastases remain hidden for many months and we call them micrometastases. It is these micrometastases that eventually cause the demise of 10 – 15% of Stage I breast cancer. The other 85 – 90% who do not have these silent metastases, will survive for five years and longer, after appropriate treatment.

It is because of these established statistics in terms of breast cancer survival, that there is a growing trend to be more aggressive with the use of chemotherapy.

Breast Cancer Treatment Guidelines
Instead of looking at treatment of breast cancer stage for stage, it is important to remember that each patient presents as an individual and the specialist must tailor make the treatment to each individual patient. There are certain fundamental treatment principles that should be adhered to, such as who should receive chemotherapy, who should receive radiation therapy and what different surgical options available for each patient.

In other words, the size of the tumour, the type of cancer the size of the breast and position of the tumour and the state of general health and the psychological make-up of the patient help determine which treatment options are utilised and in what order they are employed.

Once a cancer has been diagnosed, there is no harm in taking a few days to discuss the different treatment options. Waiting a day or two, participating in the discussions and understanding what the different treatment options are, will help ensure the best overall outcome for the patient.  

It is for this reason that principles of treatments have been devised. Two big collaborative groups responsible for these treatment consensus statements are the American NIH and the St Gallen consensus.

The treatment of breast cancer is a multimodal approach involving three lines of attack.

Bullet

Surgery

Bullet

Radiotherapy (DXT)

Bullet

Oncology (Chemotherapy and hormone manipulation)

Once  the diagnosis is made, there is no need to jump into a decision. Breast cancer is not flu – patients need to explore their options and find out what treatment is available to them. The average doubling time of breast cancer cells in 40 days, the cancer did not arrive yesterday and will not be gone tomorrow - so go for a second opinion, speak to other patients who have been treated by the doctor you chose.