Breast Cancer – Treatment – The individual plan

The individual treatment plan for each breast cancer patient depends on the size and type of the tumor and how far it has spread. Breast surgery aims to remove the tumor completely. Paying close attention to the tumor-free margins on the pathologist report helps to achieve this.

There are several treatment options:

 

  • Breast conservation therapy (BCT) following surgical removal of tumor is available for the majority of patients. So-called neoadjuvant therapy (a primary chemo therapy) may be used in some cases to reduce the size of a larger tumor, which means that BCT is still possible. Lymph nodes are removed during the operation and microscopically analyzed to detect whether the cancer cells have spread. Axillary lymph nodes do not have to be removed if the breast cancer is in its early stage (carcinoma in situ).
     
  • Surgical breast removal (mastectomy) is necessary if the tumors are large and cannot be reduced in size. Also, if the tumor has spread to other areas of the breast and/or has grown deeply into the mammary ducts, the breast will have to be removed. The operation involves removing the whole mammary gland including the top tissue layers. The breast muscles remain in place. The breast is removed after chemotherapy if the carcinoma is inflamed. Some women decide to have the breast removed as a preventative measure, especially if they have a hereditary risk.
     
  • Breast reconstructive surgery is nowadays available for almost all mastectomy cases. Either the patient’s own tissue or silicon or sodium implants can be used. In addition to the size and shape of the breast, the nipple and areola complex can be reconstructed.
  • Radiation therapy is performed following breast-conserving therapies to prevent the cancer from coming back (relapse). Radiotherapy can be started between six and eight weeks after surgery. Chemotherapy may follow. Chemo and radiation therapy are not usually administered at the same time to avoid more serious side effects.
     
  • Drug therapy (chemotherapy), as a supporting (adjuvant) measure, has the same purpose: to prevent reoccurrence and destroy any existing metastases. Drug therapies include cell growth inhibiting (cytostatic) drugs, hormones and antibody treatments.
     
  • Neoadjuvant therapy (neo = “new”, adjuvant = “supporting”) can reduce large but well-defined tumors to such a small size that in some cases surgery can be done without removing the whole breast. It is also used – depending on whether the tumor responds to drug treatment – to examine the effectiveness of the chemotherapy.
     
  • Therapy monitoring is done by testing the concentration of HER2/neu proteins in the patient’s blood to see if and how quickly the tumor cells are growing. This information helps the physician or oncologist to choose the right medication, especially when there are metastases. All new HER2/neu readings during the course of the disease provide important information about the progress of the therapy and/or the need to adjust it.