After surgery, most women with breast cancer will need additional treatment to destroy any remaining cancer cells and lessen the chance of recurrence. If a woman has advanced breast cancer, treatment instead of or beyond surgery can alleviate the symptoms of cancer, although a cure may not be possible. Choosing the right treatment to address a woman’s individual needs can be complicated.
No “one-size-fits-all” combination of surgery and postoperative treatment exists. What’s more, each combination presents numerous choices in itself, such as the many chemotherapy drugs available. You and your doctor must work together at each stage of diagnosis and treatment to decide which therapies are best for you.
Two standard postoperative therapies are used, sometimes singly, but often combined with each other: chemotherapy and radiation also biological therapy can be included alone or with other two.
Chemotherapy uses potent drugs, one at a time or in combination, to destroy cancer cells that may remain in the body after surgery of the breast cancer. Treatment with cancer-fighting medications can also shrink a tumor before surgery and make it easier to remove.
Chemotherapy can prolong survival time by delaying or preventing the return of cancer. Some chemotherapy drugs can also be used to substantially relieve cancer symptoms in women with advanced disease.
Chemotherapy medication may be given by mouth or intravenously using a needle. The treatments are given in cycles or rounds — an active period of one or more treatments is followed by a recovery period of days or weeks.
Most women with breast cancer receive their chemotherapy in the outpatient section of a hospital, in their doctor’s office, or even at home. Certain drugs, or a poorly functioning immune system, may make a hospital stay necessary for some parts of chemotherapy treatment.
The most commonly used chemotherapy drugs include:
- 5-FU (5-fluorouracil)
- Adriamycin (doxorubicin)
- Cytoxan (cyclophosphamide)
- Mexate (methotrexate)
- Novantrone (mitoxantrone)
- Taxol (paclitaxel)
- Taxotere (docetaxel)
To combat nausea and vomiting that can be a side effect of some chemotherapy drugs, your doctor may also prescribe anti-nausea drugs such as:
- Anzemet (dolasetron)
- Compazine (prochlorperazine)
- Kytril (granisetron)
- Marinol (dronabinol)
- Zofran (ondansetron)
After surgery, the tumor site and surrounding tissue may be treated with radiation. Most often, this happens from outside the body with high-energy X-rays generated and targeted by a machine. Women with advanced breast cancer may receive radiation to help relieve pain in areas unrelated to the site of the original cancer. Radiation treatments are given in a hospital or cancer clinic.
A newly approved procedure called brachytherapy can deliver radiation internally, through radioactive implants referred to as “pellets” or “seeds.” You may be able to have brachytherapy on an outpatient basis; ask your doctor.
Both kinds of radiation destroy any remaining cancer cells. In some cases, radiation can also be used before surgery, to shrink the tumor and make it easier to remove.
Biological therapy (also called immunotherapy) uses substances that stimulate your body’s immune system after it has been suppressed by chemotherapeutic drugs. Biological therapy drugs can help your body stay healthy to fight cancer. They can also be used to prevent or ease complications, such as anemia or infection, that may be due to other cancer treatments. Some biological therapy medications include:
- Leukine (sargramostim)
- Neumega (oprelvekin)
- Neupogen (filgrastim)
- Procrit or Epogen (epoetin alfa)
Estrogen and progesterone, two female hormones, can actually nourish a certain class of breast cancers. Some hormone-dependent cancers are treated by surgically removing the ovaries, the source of estrogen. These drugs can also be used to block hormones:
- Arimidex (anastrozole)
- Cytadren (aminoglutethimide)
- DES (diethylstilbestrol)
- Fareston (toremifene)
- Megace (megestrol)
- Nolvadex (tamoxifen)
- Zoladex (goserelin)
You have also natural hormone preparation so-called indole 3 carbinol. It has a weary good impact on breast cancer tumors.
New and upcoming therapies
- Herceptin, a unique cancer drug, is the first FDA-approved cancer treatment to target a defective gene. It can be very effective in advanced breast cancers that are associated with too many copies (an “overexpression”) of the Her-2/neu gene.
- Autologous bone marrow transplantation and peripheral stem cell transplantation are currently being studied in clinical trials. Doctors first collect specialized cells from a woman’s own bone marrow or blood, then give her high-dose chemotherapy, and finally replace the marrow or blood cells using a needle. By reaping and replacing the specialized cells, doctors are able to deliver high-dose chemotherapy, which blocks rapidly dividing cancer cells, but at the same time destroys the cells that generate bone marrow and blood.
- Certain genes and genetic mutations have already been identified as increasing breast cancer risk. Other genes may actually be protective against cancer. Gene therapy research is investigating ways to locate such genes, repair them if defective, and then find ways to administer them to women through injection.
Breast cancer is a serious illness that requires the most sophisticated treatment the medical industry has to offer. However, many alternative therapies make excellent partners when combined with standard treatment. Choosing to include some or all of these additional modes of healing can positively affect your well-being and get you through breast cancer treatment as gently as possible. Of course, be sure to consult your doctor if you want to try any alternative remedy — not all alternative therapies combine well with chemotherapy or hormone therapy.
The side effects of some chemotherapy such as nausea, loss of appetite, and mouth sores can make it difficult for a woman with breast cancer to eat enough of the right foods. While pills can’t replace nutritionally balanced meals, certain supplements can provide the vitamins and minerals your body needs to function, especially during cancer treatment. But be sure to tell your doctor about any supplements you may decide to take during cancer treatment; some vitamins can actually counteract certain anti-cancer drugs.
A daily multivitamin is a good place to start. Depending on your health, other single supplements may benefit you, such as:
Herbs are more respected these days as legitimate healing agents. While they cannot substitute for modern medical cancer treatment, certain herbs may boost your immune system before or during treatment, or help your body handle chemotherapy with fewer side effects.
Some herbs you may want to consider during breast cancer treatment:
- Green tea is a simple drink with potent healing potential. Research at the Medical College of Ohio has shown that one component of green tea inhibits an enzyme that allows cancerous tumors to grow and spread. Other research confirms green tea’s various anticancer effects. For maximum protection, drink a cup or more daily. If caffeine is a concern, you might want to know that green tea contains only about one-third the caffeine in regular black tea.
- Milk thistle has a long-standing reputation as a liver-strengthener. The liver filters everyday toxins from the bloodstream; during chemotherapy treatment, your liver must handle an additional workload. Taken daily, the extract of milk thistle called silymarin can protect the liver from damage and maintain optimal function of this important organ.
The regular practice of stress-reduction techniques can do much to relieve the anxiety related to breast cancer. Besides easing your mind, reducing stress also helps strengthen the immune system a great fringe benefit for anyone undergoing cancer treatment.
Mind/body practices such as meditation, progressive relaxation, and self-hypnosis can relieve stress, ease the pain, and lift depression. Yoga and tai chi are gentle modes of physical exercise that offer mind-soothing benefits similar to meditation. A local chiropractor, physical therapist, or licensed massage therapist should be able to refer you to classes or groups in your area.
Side Effects & Complications
It’s unfortunate but almost impossible to avoid: Treatment to eradicate breast cancer may also damage otherwise healthy surrounding tissue. Luckily, side effects related to breast cancer treatment are generally temporary; symptoms usually subside when treatment ends, or soon after.
Side effects differ from woman to woman and from treatment to treatment. Here are the most common problems associated with the various facets of breast cancer treatment.
Discomfort is common after any surgery. The short-term pain that follows surgery may require pain-controlling medication. If you are in pain, don’t hesitate to talk to your doctor about finding a method of relief that works for you.
Surgery for breast cancer can lead to some specific postoperative concerns. Removal of a breast affects the muscles and nerve endings in the shoulder and arm. The movement may be painful and limited, and there may be a loss of strength on the side of the surgery. Ask your doctor for a referral to a physical therapist who can guide you through targeted exercises to improve flexibility and strength.
When lymph nodes under the arm are removed, the flow of lymph (fluid that carries infection-fighting cells through the body via the lymphatic system) slows down and can build up. Lymphedema, swelling of the arm or hand on the side of the surgery, can make it easy for even small cuts or scrapes to become infected. Women with lymphedema need to prevent injury to the affected arm and hand and have any infections that may develop there promptly treated.
There are special programs available for women with lymphedema that use massage, arm wraps, and pump-like devices to relieve symptoms. If you develop swelling in your arm or hand, be sure to speak up about it and actively pursue treatment. Many doctors just don’t pay enough attention to this potentially severe complication.
Chemotherapy side effects vary with the specific drugs taken. In general, though, cancer-killing drugs work by targeting rapidly dividing cells. But some non-cancer cells also divide rapidly and may be damaged by chemotherapy.
When blood cells are affected by chemotherapy, women may feel fatigued, and bruise or develop infection easily. Chemotherapy affects hair follicle cells, causing temporary hair loss (for the duration of drug treatment hair always grows back after chemotherapy). Cancer drugs also damage cells lining the digestive tract, which can result in mouth sores, nausea, vomiting, or diarrhea.
Other side effects, especially low white-blood-cell count, nausea, and vomiting, can be significantly reduced or controlled with other medications.
Radiation therapy affects the skin in much the way sunburn does, causing redness, itchiness, soreness, blistering, or peeling. Exposing the skin to the air will help any weepy sores to heal more quickly.
The breast skin may also become shiny or darker than normal. And sensation in the breast can change, becoming more or less sensitive than normal. Many women find that during radiation treatment, loose, lightweight tops are more comfortable to wear than traditional bras.
Fatigue is another effect of radiation, especially after treatment has gone on for a few weeks. Poor wound healing at the surgery site may also be a problem if radiation is performed too close to the time of breast cancer surgery.
After biological therapy
The immune-stimulating drugs used in biological therapy can ease side effects and boost your body’s ability to fight cancer during or after chemotherapy treatment. However, these same drugs carry potential side effects of their own including pain in the legs, chest, or back; skin rashes or swelling at the place where the injections were given; flu-like symptoms, such as fever, chills, and fatigue; digestive tract problems; and possible allergic reactions.
After hormone therapy
Hormone therapy drugs have unique side effects related to the hormone-blocking effect that makes them effective against breast cancer. Possible problems resemble menopause and may include hot flashes, nausea, vaginal spotting, itching, discharge, or dryness. Tamoxifen, in particular, is linked to an increased risk for cancer of the uterus (endometrial cancer), as well as stroke and blood clots in the legs (deep-vein thrombosis). The benefits of any form of hormone therapy may outweigh the risks for you; ask your doctor to help you decide.
More information about breast cancer you can find on our main breast cancer information page