Hormonal Therapy for breast cancer

Hormonal therapy is a very effective treatment against breast cancer that is hormone-receptor-positive. Find out if you should be tested to see if you need other therapies, as well. Sometimes called "anti-estrogen therapy," hormonal therapy blocks the ability of the hormone estrogen to turn on and stimulate the growth of breast cancer cells.

For years, tamoxifen was the hormonal medicine of choice for all women with hormone-receptor-positive breast cancer. But in 2005, the results of several major worldwide clinical trials showed that aromatase inhibitors (Arimidex [chemical name: anastrozole], Aromasin [chemical name: exemestane], and Femara [chemical name: letrozole]) worked better than tamoxifen in post-menopausal women with hormone-receptive-positive breast cancer.

Aromatase inhibitors are now considered the standard of care for post-menopausal women with hormone-receptor-positive breast cancer. Tamoxifen remains the hormonal treatment of choice for pre-menopausal women.

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Targeted Breast cancer Therapies

Targeted cancer therapies are cancer treatments that target specific characteristics of cancer cells, such as a protein, an enzyme, or the formation of new blood vessels. Targeted therapies don't harm normal, healthy cells. Most targeted therapies are antibodies that work like the antibodies made by the immune system. So targeted therapies are also called immune targeted therapies. In this way, targeted therapies are very different from more traditional types of anti-cancer therapies.

* Herceptin
Herceptin (chemical name: trastuzumab) is the best known targeted therapy for breast cancer. Herceptin only works against breast cancers that have extra HER2 genes and make too many HER2 protein receptors. Herceptin does have a number of potentially serious side effects.
* Tykerb
Tykerb (chemical name: lapatinib) is another targeted therapy that works against breast cancers that have extra HER2 genes. Tykerb has been approved by the FDA to be given in combination with Xeloda (chemical name: capecitabine) to treat advanced, HER2-positive breast cancer that has stopped responding to anthracyclines, taxanes, and Herceptin.
* Avastin
Avastin (chemical name: bevacizumab) is also a targeted therapy. Avastin targets the new blood vessels that feed cancer cells. Avastin has been approved by the FDA to treat certain types of advanced cancers of the lung, colon and rectum. Researchers are studying Avastin in combination with Taxol (chemical name: paclitaxel) to see if the combo can slow the progression of advanced breast cancer better than Taxol alone.

New targeted therapies are emerging on a regular basis. Stay tuned to breastcancer.org for the latest research results in this area of treatment.

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The role of surgery in breast cancer treatment

For well over a century, surgery has been the first line of attack against breast cancer. But things have changed a lot in recent years. Today, the goal is precise, targeted surgery that aims to preserve as much of the healthy breast and surrounding areas as possible. Even mastectomy (breast removal) is a more refined, less drastic option than it was a generation ago.

The most important of these deciding factors are: the stage of the cancer, the overall "personality" of the cancer, and what is acceptable to you in terms of your long-term peace of mind.

kinds of surgery

* breast-conserving surgery, (commonly known as lumpectomy) in which only the tumor is removed from the breast. This is usually followed by radiation therapy to the remaining breast tissue.
* mastectomy, an operation in which the whole breast is removed. Sometimes radiation is given after mastectomy.

For invasive breast cancer, both of these procedures may also be accompanied by an axillary lymph node dissection. Recommendations for whole body or "systemic" treatments such as hormonal therapy, chemotherapy, or both, may follow either approach.

The need for systemic treatment is independent of which surgical procedure you choose. Do not elect to have a mastectomy thinking that this will eliminate the need for chemotherapy.

If you have early-stage breast cancer, ask your doctor about the sentinel lymph node dissection as an alternative to traditional lymph node dissection. Find out if you are a good candidate. If you are, ask if your surgeon has a high level of experience with this new technique, before proceeding.

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Treatment of breast cancer

In recent years, there's been an explosion of life-saving treatment advances against breast cancer, bringing new hope and excitement. Instead of only one or two options, today there's an overwhelming menu of treatment choices that fight the complex mix of cells in each individual cancer. The decisions—surgery, then perhaps radiation, hormonal (anti-estrogen) therapy, and/or chemotherapy—can feel overwhelming.

breastcancer.org can help you understand your cancer stage and appropriate options, so you and your doctors can arrive at the best treatment plan for YOU.

In the following pages of the Treatment section, you can learn about:


* Surgery
Breast-conserving surgery (lumpectomy), mastectomy, and lymph node dissection, and what to expect from each.

* Radiation Therapy
Radiation therapy—also called radiotherapy—is a highly targeted, highly effective way to destroy cancer cells that may linger after surgery. Radiation can reduce the risk of recurrence by 50% to 66% (about a half to two-thirds reduction in risk). Despite what many women fear, radiation therapy is relatively easy to tolerate, and its side effects are limited to the treated area.

Your radiation treatment will be overseen by a radiation oncologist, a cancer doctor who specializes in radiation treatment.

* Targeted Therapies
Including Herceptin: How they work, who should get them, how they're given, side effects, and major studies.

* Hormonal Therapy
The link between hormones and breast cancer and how different groups of drugs—including ERDs, SERMs, and aromatase inhibitors—can affect that link.

* Chemotherapy
Who should get it, how it works, different types, side effects, and how to manage them.

* Complementary Medicine
How complementary medicine techniques such as acupuncture, meditation, and yoga could be a helpful addition to your regular medical treatment. Includes research on complementary techniques and ways to find qualified practitioners.

* Building Long-Term Health
Why it's so important to stick to your treatment plan, take the full course of medications, and continue with regular tests and doctors' visits to keep yourself healthy into the future.

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Stages of Breast Cancer

The purpose of the staging system is to help organize the different factors and some of the personality features of the cancer into categories, in order to:

* best understand your prognosis (the most likely outcome of the disease)
* guide treatment decisions, since clinical studies of breast cancer treatments that you and your doctor will consider are partly organized by the staging system, and
* provide a common way to describe the extent of breast cancer for doctors and nurses all over the world, so that results of your treatment can be compared and understood.

Tumor sizes:
3 spheres measuring 1 cm, 3cm, 5cm



Stage 0

This stage is used to describe non-invasive breast cancer. There is no evidence of cancer cells breaking out of the part of the breast in which it started, or of getting through to or invading neighboring normal tissue. LCIS and DCIS are examples of stage 0.
Stage I

This stage describes invasive breast cancer (cancer cells are breaking through to or invading neighboring normal tissue) in which

* The tumor measures up to two centimeters, AND
* No lymph nodes are involved.

Stage II

This stage describes invasive breast cancer in which:

* The tumor measures at least two centimeters, but not more than five centimeters, OR
* Cancer has spread to the lymph nodes under the arm on the same side as the breast cancer. Affected lymph nodes have not yet stuck to one another or to the surrounding tissues, a sign that the cancer has not yet advanced to stage III. (The tumor in the breast can be any size.)

Stage III

Stage III is divided into subcategories known as IIIA and IIIB.
Stage IIIA

Stage IIIA describes invasive breast cancer in which:

* the tumor measures larger than five centimeters, OR
* there is significant involvement of lymph nodes. The nodes clump together or stick to one another or surrounding tissue.

Stage IIIB

This stage describes invasive breast cancer in which a tumor of any size has spread to the breast skin, chest wall, or internal mammary lymph nodes (located beneath the breast right under the ribs, inside the middle of the chest).

Stage IIIB includes inflammatory breast cancer, a very uncommon but very serious, aggressive type of breast cancer. The most distinguishing feature of inflammatory breast cancer is redness involving part or all of the breast. The redness feels warm. You may see puffiness of the breast's skin that looks like the peel of a navel orange ("peau d'orange"), or even ridges, welts, or hives. And part or all of the breast may be enlarged and hard. A lump is present only half of the time. Inflammatory breast cancer is sometimes misdiagnosed as a simple infection.

Stage IV

This stage includes invasive breast cancer in which

* a tumor has spread beyond the breast, underarm, and internal mammary lymph nodes, and
* a tumor may have spread to the supraclavicular lymph nodes (nodes located at the base of the neck, above the collarbone), lungs, liver, bone, or brain.

"Metastatic at presentation" means that the breast cancer has spread beyond the breast and nearby lymph nodes, even though this is the first diagnosis of breast cancer. The reason for this is that the primary breast cancer was not found when it was only inside the breast. Metastatic cancer is considered stage IV.

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How Breast Cancer Happens

Breast profile:
A Ducts
B Lobules
C Dilated section of duct to hold milk
D Nipple
E Fat
F Pectoralis major muscle
G Chest wall/rib cage

Enlargement
A Normal duct cells
B Basement membrane
C Lumen (center of duct)






The breast is a gland designed to make milk. The lobules in the breast make the milk, which then drains through the ducts to the nipple.

Like all parts of your body, the cells in your breasts usually grow and then rest in cycles. The periods of growth and rest in each cell are controlled by genes in the cell's nucleus. The nucleus is like the control room of each cell. When your genes are in good working order, they keep cell growth under control. But when your genes develop an abnormality, they sometimes lose their ability to control the cycle of cell growth and rest.
Breast cancer is an uncontrolled growth of breast cells.

Cancer has the potential to break through normal breast tissue barriers and spread to other parts of the body. While cancer is always caused by a genetic "abnormality" (a "mistake" in the genetic material), only 5–10% of cancers are inherited from your mother or father. Instead, 90% of breast cancers are due to genetic abnormalities that happen as a result of the aging process and life in general.

While there are things every woman can do to help her body stay as healthy as possible (such as eating a balanced diet, not smoking, minimizing stress, and exercising regularly), breast cancer is never anyone's fault. Feeling guilty, or telling yourself that breast cancer happened because of something you or anyone else did, is counterproductive.

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Signs, Symptoms & Diagnosis of Breast cancer

Symptoms

Early breast cancer usually does not cause pain. In fact, when breast cancer first develops, there may be no symptoms at all. But as the cancer grows, it can cause changes that women should watch for:

* A lump or thickening in or near the breast or in the underarm area.
* A change in the size or shape of the breast.
* A discharge from the nipple.
* A change in the color or feel of the skin of the breast, areola, or nipple (dimpled, puckered, or scaly).



A woman should see her doctor if she notices any of these changes. Most often, they are not cancer, but only a doctor can tell for sure.

Diagnosis

An abnormal area on a mammogram, a lump, or other changes in the breast can be caused by cancer or by other, less serious problems. To find out the cause of any of these signs or symptoms, a woman's doctor does a careful physical exam and asks about her personal and family medical history. In addition to checking general signs of health, the doctor may do one or more of the breast exams described below.

* Palpation. The doctor can tell a lot about a lump—its size, its texture, and whether it moves easily—by palpation, carefully feeling the lump and the tissue around it. Benign lumps often feel different from cancerous ones.

* Mammography. X-rays of the breast can give the doctor important information about a breast lump. If an area on the mammogram looks suspicious or is not clear, additional x-rays may be needed.

* Ultrasonography. Using high-frequency sound waves, ultrasonography can often show whether a lump is solid or filled with fluid. This exam may be used along with mammography.

Based on these exams, the doctor may decide that no further tests are needed and no treatment is necessary. In such cases, the doctor may need to check the woman regularly to watch for any changes. Often, however, the doctor must remove fluid or tissue from the breast to make a diagnosis.

Aspiration or needle biopsy. The doctor uses a needle to remove fluid or a small amount of tissue from a breast lump. This procedure may show whether a lump is a fluid-filled cyst (not cancer) or a solid mass (which may or may not be cancer). Using special techniques, tissue can be removed with a needle from an area that is suspicious on a mammogram but cannot be felt.

If tissue is removed in a needle biopsy, it goes to a lab to be checked for cancer cells. Clear fluid removed from a cyst may not need to be checked by a lab.

Surgical biopsy. The surgeon cuts out part or all of a lump or suspicious area. A pathologist examines the tissue under a microscope to check for cancer cells.

When a woman needs a biopsy, these are some questions she may want to ask her doctor:

* What type of biopsy will I have? Why?
* How long will the biopsy or aspiration take? Will I be awake? Will it hurt?
* How soon will I know the results?
* If I do have cancer, who will talk with me about treatment? When?

When Cancer Is Found

When cancer is present, the pathologist can tell what kind of cancer it is (whether it began in a duct or a lobule) and whether it is invasive (has invaded nearby tissues in the breast).

Special laboratory tests of the tissue help the doctor learn more about the cancer. For example, hormone receptor tests (estrogen and progesterone receptor tests) can help predict whether the cancer is sensitive to hormones. Positive test results mean hormones help the cancer grow and the cancer is likely to respond to hormonal therapy. Other lab tests are sometimes done to help the doctor predict whether the cancer is likely to grow slowly or quickly.

If the diagnosis is cancer, the patient may want to ask these questions:

* What kind of breast cancer do I have? It is invasive?
* What did the hormone receptor test show? What other lab tests were done on the tumor tissue, and what did they show?
* How will this information help the doctor decide what type of treatment or further tests to recommend?

The patient's doctor may refer her to doctors who specialize in treating cancer, or she may ask for a referral. Treatment generally begins within a few weeks after the diagnosis. There will be time for the woman to talk with the doctor about her treatment choices, to get a second opinion, and to prepare herself and her loved ones.

How Breast Cancer Happens

read more "Signs, Symptoms & Diagnosis of Breast cancer"