Understanding the Different Types of Breast Cancer Treatment

The battle against breast cancer has produced significant triumphs in recent years, with new and tailored treatments now offering patients more options for fighting their disease.

The statistics confirm that more and better treatments are translating into better outcomes: Cases of localized breast cancer now boast an impressive five-year survival rate of 99%, and even for cases that have spread to nearby structures or lymph nodes the survival rate remains high at 86%.

Here, experts will explore the range of breast cancer treatments that are now available, including surgery, chemotherapy, radiation therapy, immunotherapy, hormone therapy and targeted therapy, each playing a pivotal role in the effort to beat breast cancer.

Understanding breast cancer treatments

According to the U.S. Centers for Disease Control and Prevention, breast cancer treatments are tailored to the specific type and stage of the disease. Typically, patients receive a combination of treatments, to optimize effectiveness.

Surgery involves the removal of cancerous tissue, aiming to eliminate the tumor and prevent its spread. Chemotherapy employs specialized medications, taken either orally or intravenously, to shrink or eradicate cancer cells. Hormonal therapy blocks cancer cells' access to growth-promoting hormones.

Biological therapy collaborates with the body's immune system to combat cancer cells and manage treatment side effects. Lastly, radiation therapy employs high-energy rays, akin to X-rays, to target and eliminate cancer cells.

Breast cancer surgery

Surgery plays a crucial role in breast cancer treatment for most women diagnosed with the disease, according to the American Cancer Society. The primary objectives of surgery are to remove as much cancerous tissue as possible, determine if cancer has spread to nearby lymph nodes, restore breast shape after tumor removal and ease symptoms in advanced cases.

One common surgery is a mastectomy, which involves completely removing all breast tissue from one or both breasts.

On the other hand, for individuals with early-stage breast cancer, a lumpectomy may be a viable option. During a lumpectomy, only the tumor and surrounding tissue are removed, while preserving the rest of the breast.

Breast cancer surgery, while a crucial treatment for breast cancer, may have specific side effects, according to Breast Cancer Now. Patients undergoing surgery might experience pain and discomfort, as well as feelings of nausea. Additionally, bruising, swelling, seroma (fluid buildup) and wound infection are possible postoperative complications. Changes in sensation, scars and discoloration are also common; some individuals may develop stiff shoulders or cording issues. Another potential side effect is lymphedema, a condition characterized by painful arm swelling due to a lymphatic system blockage.

Chemotherapy for breast cancer

Chemotherapy, also known as chemo, employs potent medications to halt or slow the growth of breast cancer cells. It traverses the bloodstream, targeting cancer cells throughout the entire body.

The most common chemo drugs for breast cancer, according to Breast Cancer Now, are:

• AC (doxorubicin and cyclophosphamide)
• Capecitabine (Xeloda)
• Carboplatin
• CMF (cyclophosphamide, methotrexate, and fluorouracil)
• Docetaxel (Taxotere)
• EC (epirubicin and cyclophosphamide)
• EC-T (epirubicin and cyclophosphamide followed by paclitaxel)
• E-CMF (epirubicin, cyclophosphamide, methotrexate, and fluorouracil)
• Eribulin (Halaven)
• FEC (fluorouracil, epirubicin, and cyclophosphamide)
• FEC-T (FEC followed by paclitaxel)
• Gemcitabine (Gemzar)
• Paclitaxel (Taxol)
• Vinorelbine (Navelbine)

It’s important to know that chemotherapy for breast cancer can lead to various side effects, including hair loss, nail changes and mouth sores. Patients may also experience loss of appetite or weight changes and bouts of nausea and vomiting. Diarrhea, fatigue and hot flashes are also common, and some individuals might face vaginal dryness due to menopause triggered by chemotherapy. Additionally, nerve damage can be a potential concern.

Radiation therapy

“Radiation therapy for breast cancer uses high energy X-ray, protons or other particles to kill breast cancer cells. There are several forms and modalities of radiation depending on the stage and type of breast cancer,” said Dr. Ming Li, a breast cancer specialist at the Leonard Cancer Institute at Providence Mission Hospital in Orange County, Calif.

“The common forms include intraoperative radiation therapy, done during surgery for certain low-risk breast cancers. Another form is called brachytherapy, internal radiation, where a device is placed to deliver radiation closer to where the cancer was removed [tumor bed]. Typically, this is also for low-risk breast cancers and can be completed within a week," he said.

"Lastly, external beam radiation therapy, still the most common form of radiation, is used by a machine outside the body that focuses the radiation on the area affected by the cancer, typically given over six to seven weeks,” Li added.

As with any medical treatment, various side effects can arise. The American Cancer Society states that external beam radiation therapy to the breast may result in short-term side effects such as breast swelling, skin changes resembling a sunburn (including redness, peeling and skin darkening) and fatigue.

On the other hand, brachytherapy can lead to side effects such as redness and bruising at the treatment site, breast pain and infection. Additionally, there is a possibility of damage to fatty tissue in the breast, and in rare cases, weakness and rib fractures may occur. Another potential side effect is the accumulation of fluid in the breast.

Immunotherapy

Immunotherapy has emerged as a groundbreaking approach in breast cancer treatment, leveraging medicines to bolster a person's immune system to better recognize and combat cancer cells. The American Cancer Society says this strategy focuses on specific proteins involved in immune responses, amplifying the body's ability to target and destroy cancer cells effectively.

BreastCancer.org says that the U.S. Food and Drug Administration has approved several immunotherapy medications for breast cancer. Among them, immune checkpoint inhibitors have shown promising results in treating breast cancer:

• Dostarlimab-gxly (Jemperli)
• Pembrolizumab (Keytruda)

Possible side effects of these medications encompass fatigue, cough, nausea, skin rash, reduced appetite, constipation, and diarrhea. Although less frequent, some patients may experience more severe side effects. Among these are infusion reactions, where certain individuals might encounter such reactions while undergoing drug administration.

Hormone therapy for breast cancer

Hormone receptors play a significant role in certain types of breast cancer, as they interact with hormones like estrogen and progesterone, fueling the growth of cancer cells, says the American Cancer Society. Therapies designed to hinder these hormones from binding to the receptors are referred to as hormone or endocrine therapy.

By disrupting this crucial interaction, these treatments impede cancer cell growth. Here is a list of hormone therapy drugs for breast cancer:

• Tamoxifen (Nolvadex, Soltamox)
• Toremifene (Fareston)
• Fulvestrant (Faslodex)
• Anastrozole (Arimidex)
• Letrozole (Femara)
• Exemestane (Aromasin)
• Goserelin (Zoladex)
• Leuprolide (Lupron, Eligard)
• Triptorelin (Trelstar)
• Megestrol (Megace)

Side effects of breast cancer hormone therapy may include hot flashes, night sweats, vaginal dryness, changes in menstrual periods, mood swings, fatigue, joint pain, and increased risk of blood clots and osteoporosis.

Targeted therapy for breast cancer

Beyond traditional chemotherapy and hormone therapy, modern advancements have introduced more potent treatments capable of precisely targeting breast cancer cells while sparing healthy ones. These cutting-edge biologics are frequently used alongside chemotherapy.

One of the key advantages of targeted drugs, per the National Breast Cancer Foundation, is their ability to minimize severe side effects often associated with standard chemotherapy.

Targeted therapy drugs approved for breast cancer include:

• Abemaciclib (Verzenio)
• Ado-trastuzumab emtansine (Kadcyla)
• Alpelisib (Piqray)
• Anastrozole (Arimidex)
• Elacestrant dihydrochloride (Orserdu)
• Everolimus (Afinitor)
• Exemestane (Aromasin)
• Fam-trastuzumab deruxtecan-nxki (Enhertu)
• Fulvestrant (Faslodex)