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  • Anisha S. Matheen

Treating Breast Cancer

'Life's better now. I wouldn't do it all over again, though it's funny how life works. Maybe it was meant to happen for many reasons because my life in many ways is richer.' - Guiliana Rancic, American-Italian Reporter, Breast Cancer Survivor.

Breast cancer like any cancer is an unimaginably challenging and remarkably unfair journey, one not only experienced by the patient but all of those that surround them. This is why we firmly believe that attaining the imperative knowledge and understanding of breast cancer treatment is crucial to the patient and their loved ones. In saying so, we will be running through the various forms of treatment and symptom management arrangements currently available to patients.


Surgery


Breast cancer surgery is one of the most crucial forms of breast cancer treatment, a procedure which entails the extraction of cancer cells from the breast tissue. Surgery is either performed alone or alongside other treatment options including hormone therapy, chemotherapy, radiation and targetted therapy - however, this all depends on the stage and classification of the breast cancer (as mentioned in our 'Types of Breast Cancer' article.)


Surgery is not only performed on patients who have breast cancer but also on individuals with an exceptionally high risk of acquiring breast cancer in their lifetime - a probability determined through processing results of detailed family history and genetic screening panel.


Mastectomy: refers to the surgical removal of either one or both breasts, performed under general anaesthesia.


Although performed on patients with breast cancer, many high-risk individuals have opted to undergo a mastectomy as a preventative measure, in hopes of avoiding developing breast cancer. Patients often chose to follow a mastectomy with surgical reconstruction - a procedure focusing on building tissue to resemble the breast with the assistance of saline implants. Others may also choose to reconstruct with the use of a surgical flap using tissue from other sections of the body.




Fig 4.1


Lumpectomy: relates to the surgical extraction of a particular portion (lump) within the breast tissue - often used in the treatment of a malignant tumour in a patient with early-stage breast cancer.


A lumpectomy is often chosen as opposed to a mastectomy in the attempt to conserve as much viable breast tissue as possible. At times, a lumpectomy may be performed to confirm the presence or absence of cancer cells within the breast.




Fig 4.2


Lymph Node Removal: a procedure required depending on the rate of spread of cancer cells originating from the breast tissue. The typical spread of cancer cells begins from moving into the lymph nodes under the arms; this can be detected through performing a sentinel lymph node biopsy. An axillary lymph node dissection is executed in more critical cases.


Sentinel Lymph Node Biopsy: references a surgical procedure utilised to determine the spread of cancer cells to the lymph nodes. Surgeons inject a safe dye, and a slightly radioactive solution to find the sentinel nodes (the first lymph node). Samples are then extracted and sent to the laboratory for further testing.


Axillary Lymph Node Dissection: refers to a procedure which removes the lymph nodes located under the arms of a patient.




Chemotherapy


As mentioned before, the selection of appropriate treatments and therapies are dependent on the classification and staging of breast cancer present in each patient. Medicating, in the form of chemotherapy, is performed in an attempt to destroy cancer cells with a rapidly and continuously growing and replicating. Chemotherapy is essentially practised on patients with breast cancer in stages 2–4 and is advantageous in those who are tested negative for estrogen receptors. The typical span of treatment ranges between three to six month, depending on the specific case in question.



Fig 4.3


Hormone Therapy


This therapy is additionally termed as endocrine therapy, a process in which the addition, blocking or removal of oestrogen or progesterone in an attempt to treat cancer. This therapy aims to prevent the binding of hormones to the receptors present on the cancer cells - in doing, so cell growth is reduced and potentially causes the deterioration of cancer cells. This procedure is performed to treat Luminal-type Breast Cancer predominantly.


Luminal-type Breast Cancer: indicated the presence of hormone receptors (for oestrogen or progesterone).



Radiation Therapy


Radiation therapy is predominantly performed following one of the surgeries previously mentioned in this article. Although radiation can be performed without yet completing tumour removal surgery - the main aim of radiotherapy is to destroy any remaining cancer cell (the majority of which are microscopic) which may not have been removed during surgery. The principal objective of which is to reduce the chances of the reoccurrence of cancer cells - thus preventing a relapse. This is an essential procedure, particularly when following a lumpectomy.



Targetted Therapy


Targetted Therapy is performed to treat HER2-type Breast Cancer mainly. Physicians often opt to prevent future growth of cancer cells with a program of selective drugs to perform targeted therapy. The drugs assist in the blocking of the HER2 receptor and limiting the potential development and further growth of cancer cells.


HER2-type Breast Cancer: a form of breast cancer which tests for the presence of the Human Epidermal growth factor Receptor 2 (HER2) protein.



 

Works Cited


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“Breast Cancer Surgery - Mayo Clinic.” Mayoclinic.Org, 2019, www.mayoclinic.org/tests-procedures/breast-cancer-surgery/about/pac-20385255.

DeSantis, Carol, et al. “Breast Cancer Statistics, 2011.” CA: A Cancer Journal for Clinicians, vol. 61, no. 6, 3 Oct. 2011, pp. 408–418, 10.3322/caac.20134. Accessed 11 Feb. 2019.

Giuliano, Armando E., et al. “Locoregional Recurrence After Sentinel Lymph Node Dissection With or Without Axillary Dissection in Patients With Sentinel Lymph Node Metastases.” Annals of Surgery, vol. 264, no. 3, Sept. 2016, pp. 413–420, 10.1097/sla.0000000000001863. Accessed 14 Oct. 2020.

James Stuart Olson. Bathsheba’s Breast : Women, Cancer & History. Baltimore, The Johns Hopkins University Press, 2002.

Kurian, Allison W., et al. “Use of and Mortality After Bilateral Mastectomy Compared With Other Surgical Treatments for Breast Cancer in California, 1998–2011.” JAMA, vol. 312, no. 9, 3 Sept. 2014, pp. 902–914, www.ncbi.nlm.nih.gov/pmc/articles/PMC5747359/, 10.1001/jama.2014.10707. Accessed 27 May 2020.

Matsen, Cindy B, and Leigh A Neumayer. “Breast Cancer: A Review for the General Surgeon.” JAMA Surgery, vol. 148, no. 10, 2013, pp. 971–9, www.ncbi.nlm.nih.gov/pubmed/23986370, 10.1001/jamasurg.2013.3393. Accessed 10 May 2019.

Newman, Lisa A. “Contralateral Prophylactic Mastectomy.” JAMA, vol. 312, no. 9, 3 Sept. 2014, p. 895, 10.1001/jama.2014.11308. Accessed 10 Nov. 2019.

Safran, Tyler, et al. “Direct-to-Implant, Prepectoral Breast Reconstruction.” Plastic and Reconstructive Surgery, vol. 145, no. 4, Apr. 2020, pp. 686e–696e, 10.1097/prs.0000000000006654. Accessed 14 Oct. 2020.

---. “Prepectoral Breast Reconstruction.” Plastic and Reconstructive Surgery, vol. 144, no. 3, Sept. 2019, pp. 525e–527e, 10.1097/prs.0000000000005924. Accessed 14 Oct. 2020.

Townsend, Courtney M, et al. Sabiston Textbook of Surgery : The Biological Basis of Modern Surgical Practice. Philadelphia, Pa, Elsevier, 2017.



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