If you have been diagnosed with early or locally advanced breast cancer, you are likely to be offered surgery to remove the cancer.
You may be offered;
You will usually have one or more of the lymph nodes at the time of surgery.
For more information, you can view the following resources:
Breast Cancer Surgery (Breast Cancer Foundation)
Treatment of Breast Cancer (Cancer Society)
Radiation therapy (radiotherapy) uses high energy x-ray beams to disrupt the DNA in cancer cells, to kill or control their growth.
It’s a localised treatment affecting only the area which is specifically targeted. Although some healthy tissue may be in the treatment area, it generally has the ability to repair itself, unlike cancer cells.
To learn more, you can view the following resources:
Breast Cancer Radiation Therapy (Breast Cancer Foundation)
Radiation Therapy Patient Information Video
Hormone therapies block the production of oestrogen, or prevent it from stimulating breast cancer cell growth. To learn more, you can view the following resources:
Hormone Therapy (Breast Cancer Foundation)
Managing side effects:
AMS Home - Australasian Menopause Society
Know Your Bones | Bone Health New Zealand
Balance - Menopause and cancer Booklet
Chemotherapy treatment uses drugs to disrupt the cycles of cell production and destroy or inhibit the growth of cancer cells. These are known as cytotoxic drugs (toxic to cells).
Chemotherapy can be used as adjuvant therapy (following surgery to improve the chances of cure) or as palliative therapy (given to relieve symptoms and prolong survival in the setting of advanced cancer).
Unlike surgery and radiotherapy which are local treatments, this is systemic treatment, meaning cells throughout the whole body are treated as the drugs circulate via the bloodstream.
Chemotherapy targets all rapidly dividing cells, and this includes cancer cells that are actively dividing and growing. Other body cells including hair follicles, fingernails and toenails, cells in the digestive system and blood cells also divide frequently so they also acquire some damage from the treatment. However, they are generally able to repair themselves. Cancer cells are more likely to be destroyed by the treatment as they don’t have this repair mechanism.
Chemotherapy dosages and the timing of cycles are calculated to find a balance between inflicting maximum damage on cancer cells while minimising effects on healthy cells. Regular treatment cycles consist of drug administration followed by a period of rest and recovery. This enables the healthy cells to repair before the next cycle is given.
When chemotherapy is given after surgery it is called adjuvant treatment. The aim is to reduce the risk of cancer recurrence by destroying any microscopic cancer cells which may remain in the body after the tumour has been removed.
In certain cases, such as inflammatory cancer, locally-advanced cancer and some highly proliferative types of cancer, chemotherapy can be administered before surgery to shrink the tumour in the breast and lymph nodes. It might also be given to downsize a large tumour to make breast conserving surgery an option rather than mastectomy.
Neo-adjuvant chemotherapy also provides an opportunity to proceed with chemotherapy while awaiting more information, such as genetic test results, which might impact on surgery decisions.
Each patient's treatment plan is individualised and many factors are considered when deciding whether to treat breast cancer with chemotherapy:
Your medical oncology team will advise you of the benefits versus risks of chemotherapy in your situation.
Different chemotherapy drugs are used depending on the characteristics of your particular breast cancer, and the state of your general health. Usually you will have a combination of drugs to increase the effectiveness of the treatment. Drugs may also be given sequentially.
Chemotherapy is generally given by intravenous infusion. This may be given into a vein in the arm or hand or administered via an implantable port inserted under the skin of the upper chest, gaining easy access to a major blood vessel. This reduces discomfort caused by frequent access and avoids damage to small veins. Once in place the port can be easily accessed with a needle, enabling drugs to be administered and blood samples taken without too much discomfort. The port can be seen as a bump under the skin and can be removed once treatment ends.
Chemotherapy drugs are commonly given in three-weekly cycles, although some drugs are given weekly or two-weekly. There are also some drugs that are given orally.
Adjuvant chemotherapy treatment may last from four to six months or sometimes longer, depending on the combination of drugs used.
Your chemotherapy will be administered in the oncology day stay clinic so you will go home after each treatment. You will then have a period of rest and recovery at home before returning for your next cycle of treatment. A blood test will be taken to make sure your blood cells have recovered sufficiently before giving the next treatment.
To learn more, you can view the following resource:
St George's Cancer Care Centre
The therapies outlined in this resource target specific receptors that control the growth of cancer cells. Whereas chemotherapy targets all rapidly dividing cells, targeted therapies are less likely to harm healthy cells, because of their specificity.
Learn more here: Targeted Therapy and Immunotherapy