Treatment of breast cancer at different stages: chemotherapy, surgical removal of the tumor

Medically reviewed: 24, January 2024

Mammary Glands Cancer Treatment

Breast cancer treatment shouldn’t be delayed, because as practice shows, women go to doctor when tumor is on second and further stage. It’s important to detect and prevent breast cancer as soon as possible.

Breast cancer surgery

This method is the main and most effective. Conducted partial or complete removal of the breast.
Lumpectomy is used to remove a small tumor site (no more than 4 cm) in the area of ​​the mammary gland.

At the same time, healthy areas of nearby tissues are removed along with the tumor. After removal, a course of radiation or chemotherapy is performed to destroy the remaining cancer cells and prevent the re-formation of the tumor.

If lymph nodes are affected, they are removed. With non-invasive forms of cancer, the nodes try to be preserved, since after their removal, the woman develops swelling of the arms, restriction of movement in the shoulder joint, and chest pain.

In order to determine whether the lymph nodes are affected by cancer or not, a so-called “biopsy of the sentinel node” is necessarily performed during the operation. For this, one of the axillary lymph nodes is excised, examined for the presence of cancer cells in it. If they are not detected, the remaining lymph nodes are preserved. If cancer cells are found in the lymph nodes, this is evidence of a high risk of spreading the disease to other organs and parts of the body.

It is necessary to study the removed tissue by the histological method to confirm the cancerous nature of the neoplasm.

Sectoral resection

Sectoral resection is performed when the induration is small (the tumor is usually 1-2 cm in size) and does not extend beyond the breast. An incision is made, the affected area is removed, the intracutaneous suture is applied.

Central resection

Central resection is used for multiple intraductal papillomas. The incision passes through all the milk ducts, a healthy tissue is cut out 2-3 cm around the tumor. After this operation, the woman will not be able to breastfeed.

Nipple resection

Nipple resection is performed to diagnose cancer of the nipple and areola around it. At the same time, part of the milky ducts is affected. After healing in the future, lactation complications may occur.

Oncoplastic resection

Oncoplastic resection is the operation of partial removal of the affected tissue and the healthy areas closest to it with simultaneous plastic surgery to restore the shape of the breast. Transplantation of healthy tissues is used, and often the second breast has to be operated on to restore the symmetry of the nipples and the identical form of the mammary glands. After such an operation, radiation therapy is required.

Mastectomy

The mammary gland is removed completely, but the lymph nodes are not affected. Such an operation is performed with non-invasive tumors of large size, the presence of a hereditary predisposition to breast cancer, and also for prophylactic purposes. With the help of plastic surgery, you can restore the gland.

Radical mastectomy

Surgical treatment of breast cancer is to remove not only itself, but also the complete or partial removal of adjacent muscles and adipose tissue. The method is used in advanced stages, when multiple metastases are located in the lymph nodes that penetrate these tissues and muscles.

“Radical” removal implies the complete disposal of the body from cancer cells and protection against the occurrence of metastasis. Surgical removal is necessarily complemented by subsequent radiotherapy and chemotherapeutic treatment of breast cancer.

Palliative mastectomy

In the case when metastases have already appeared or the tumor is so extensive that metastases must inevitably appear, operations are performed, the purpose of which is to alleviate the patient’s condition. The tumor is removed partially to reduce the area of ​​the lesion. This removes the most damaged or bleeding tissue. After that, a medicinal treatment is applied, which helps to relieve pain, prolong life.

Breast reconstruction after cancer removal

In some cases, after radical mastectomy, a reconstructive surgery is performed for the cosmetic reconstruction of the breast. For this transplant of muscles and adipose tissue is made from the back to the place of the removed pectoral muscles.

In most cases, cancer recurrence and the appearance of metastases after radical removal of the affected mammary glands is not observed (relapse occurs in about 18% of patients). Moreover, recovery operations do not increase the likelihood of metastasis.

The duration and quality of life after such operations are influenced by the stage of development of a malignant tumor, the age of the patient and the effectiveness of subsequent chemotherapy.

The larger the lesion, the more difficult is the healing of the wound after the operation. It is complicated in diabetic patients, in obese people, and in women who smoke.

For such patients, operations for simultaneous removal and reconstruction of the mammary gland are not carried out, since restorative tissue transplantation lengthens and complicates the healing process. This postpones the subsequent treatment with radiation and chemotherapy (they are performed only after complete healing of wounds).

Chemotherapy for breast cancer

Treatment of breast cancer with drugs that kill cancer cells. Medicines are prescribed strictly individually, since the choice of the drug depends on many factors, including the type of tumor, the degree of damage, the nature of the operation, the organ where the operation was performed.

Chemotherapy drugs are the strongest allergens, cause nausea and vomiting. They are toxic, affect the work of the heart, liver, kidneys and other organs. Therefore, when choosing drugs, age and associated diseases are taken into account. Along with the intake of such drugs are prescribed antiallergic drugs that must be taken in advance.

Treatment can be carried out on an outpatient basis or in a hospital. It is preferable to conduct it in the hospital under the constant supervision of a doctor. Here, in the event of vomiting, the patient can receive expert help, whereas at home, it is usually more difficult to administer antiemetics and perform anesthesia at night.

Addition: In order to select the most appropriate drug, the doctor may recommend that patients conduct a study to determine the genotype of the tumor (biomarker analysis). This will determine the type of drugs most sensitive to tumor cells, to clarify individual contraindications.

It usually takes 5-7 courses of chemotherapy. Taking into account the side effects and the individual reaction of the organism, the treatment of associated diseases is also carried out, otherwise it will not be possible to complete the course completely.

Hormonal therapy

Most (about 75%) of all types of malignant breast tumors are hormone-dependent. In their cells there are receptors that are sensitive to the action of female sex hormones. By acting on these receptors, estrogens and progesterones accelerate tumor growth.

Moreover, 10% of them are sensitive only to progesterone, the rest depend on the hormones of both types. Hormone dependence explains the acceleration of tumor growth during pregnancy or in different phases of the menstrual cycle.

It has been established that women who have already undergone breast cancer are at risk for the recurrence of the formation of a primary tumor. Hormone therapy is prescribed immediately after the completion of chemotherapy, if a woman has a estrogen-dependent tumor.

Most often, the following hormonal agents are used for this purpose:

• Tamoxifen. Appointed to young women who have not entered into menopause. The drug is necessary for blocking estrogen receptors.
• Analogs of GnRH. The drugs are aimed at suppressing the work of the ovaries in young women who have not entered menopause.
• Aromatase inhibitors. Used in women in the postmenusal period in order to reduce the amount of estrogen.

So, with the help of estrogen therapy, it is possible to stop the process of neoplasm growth and even reduce it somewhat in size, provided that the drugs of this group are used daily. This thesis was voiced at the 31st annual San Antonio symposium. The symposium was called Breast Cancer.

A total of 66 women participated in the study, and a third of them showed positive dynamics. They all had resistance to treatment with anti-estrogens, and breast cancer metastasized. At the same time, while taking estrogen in some women, the cancer began to progress and was transferred back to anti-estrogen therapy. What is most surprising, she began to act.

A few months later, the effect of it again disappeared, but again began to work estrogen therapy. So, a part of the observed women were alternately treated with estrogen and aromatase inhibitors. It happened for several years. Before starting treatment with estrogen and a day after its start, images were taken on positron emission tomography.

It was found that hormone-sensitive tumors were saturated with glucose and actively glowed. Why this happens, to explain up to this point in time failed. It is established that the hormone IGF-1, provoking breast cancer suppressed by estrogen.

Targeted breast cancer therapy

In some women, the tumor causes the expression of the HER2 gene; therefore, they have been shown treatment with trastuzumab monoclonal antibodies – Trastuzumab, Herpectin. Its action is aimed at suppressing the activity of HER2 in tumor cells, which helps to stop its growth. Perhaps the appointment of this drug in combination with chemotherapy.

It has been established that such a combination leads to a slower growth of the neoplasm and contributes to an increase in the life expectancy of women. There are clinical trials of the relative positive effect obtained with the treatment of trastuzumab with the adjuvant therapy technique, carried out throughout the year. The risk of re-development of the tumor has decreased, the survival rate of women has increased.

There are also other options for targeted therapy, which are currently not fully understood, among them:

• Signal transduction inhibitors. The use of these antibodies allows you to stop the transmission of nerve impulses within atypical cells, provokes their division and stops the growth of the tumor.
• Inhibitors of ingiogenesis. These antibodies are aimed at stopping the growth of new blood vessels, which prevents the tumor from getting food and oxygen.
• Antagonists of other hormones or receptors, including prolactin and androgen receptors. They are found in significant quantities in the tumor.

Since there are a lot of varieties of targeted therapy, it enables specialists for each woman to choose an effective treatment for her.

Antiangiogenic therapy

A randomized trial has passed a drug such as Bevacizumab (monoclonal antibodies aimed at blocking vascular growth receptors or VEGF receptors). It is currently available for purchase.

Data on the study of this therapeutic agent were published in the announcement in 2005 by the US National Institute of Oncology. There is evidence that compared with standard chemotherapy, Bevacizumab slows tumor growth by 5 months or more. But at the same time, the survival rate of women does not change.

A company that has been developing this drug has submitted an application to the Office of Quality Control of Drugs and Food to be able to use this drug to slow the growth of metastatic breast tumors.

Immunotherapy for breast cancer

Human immunity helps the body resist the development of a tumor.

Therapy with dendritic cells. Human own dendritic cells are processed using oncofetal antigens and administered three times a month to the woman in the form of injections.

There is an assumption that such cells, returning back into the body, will teach T-lymphocytes to recognize oncofetal antigens on the surface of atypical cells, which will provoke a global immune response. As a result, cancer cells will be destroyed by their own immunity, and the disease will reverse development.

Chemoimmunotherapy for breast cancer

Getting rid of a breast tumor with the help of our own immunity is a very attractive and promising treatment. Immunization has many advantages over other methods of therapy, and also allows immune cells to memorize the tactics of dealing with atypical cells, which makes repeated treatment unnecessary.

Chemoimmunotherapy is aimed at enhancing the T-cell response to any cancer antigen and reproducing new T-cell responses using cytotoxic drugs. Some of these drugs, for example, Paclitaxel, Cyclophosphamide, Doxorubicin in combination with immunized dendritic cells are able to destroy cancer cells much more effectively.

While in past years there was an opinion that immunotherapy during chemotherapy would be ineffective, as T-cells are depleted. Now it became clear that after their exhaustion, the phase of their active growth begins.

IMP321 allows you to increase the number and improve the functioning of immune cells, natural killer cells and cytotoxic T-lymphocytes. At the clinical trial stage, success was recorded in 90% of cases, and cancer progressed only in 3 patients in six months. It is assumed that chemoimmunotherapy will be included in the protocols for the treatment of breast cancer with chemotherapy.

Thermochemotherapy for breast cancer

Chemotherapy helps to reduce the size of the tumor in 58.8% of cases, while its combination with thermotherapy, this figure increases to 88.4%. At the same time, the tumor became smaller in size by 80% in 80% of cases. The same effect was observed in only 20% of cases in patients who received only chemotherapy.