Treatment choices are broadly classified into:

• Local therapy
• Systemic therapy

Local therapy is used to control the cancer in a specific region
eg.Surgery and radiation treatment

Systemic therapy is used to

• Control the spread of cancer
• To decrease the tumour size for effective local therapy
• To prevent recurrence.

Methods of systemic therapy include:

a. Chemotherapy
b.Hormone therapy
c.Biological therapy

Adjuvant therapy refers to additional treatment given after primary treatment of cancer to prevent its recurrence.

Local therapy:

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Surgical treatment of breast cancer:

Surgery is the most common form of treating breast cancer. Operations for breast cancer include Breast conserving surgery (lumpectomy), Mastectomy and Axillary lymph node dissection.

Breast conserving surgery (lumpectomy):

In this surgery, a large portion of the breast where the lump is present is removed along with the surrounding margins sparing the other regions of the breast. Hence it is called as breast conserving surgery. This is often followed by radiation therapy to prevent its recurrence. This procedure is also known as segmental mastectomy.

Mastectomy :

It is a procedure where the entire breast is removed along with some lymph nodes. In modified radical mastectomy, the entire breast is removed along with axillary lymph nodes with the lining of the chest muscles. In radical mastectomy (also called as Halsted Radical Mastectomy), the breast, axillary lymph nodes, chest muscles and additional fat and skin over the chest are also removed.

Radiation therapy:

It is a method of treatment where high energy X-rays are used to treat the cancer cells. The radiation therapy can be obtained in two ways either through a machine (external radiation) or by implanting thin plastic tubes containing radio active material (implant radiation) which requires hospital stay.

Systemic Therapy:

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Chemotherapy

It is a mode of treatment where drugs are used to destroy the cancer cells. They are used either alone or in combination with one or more drugs. Some common chemotherapeutic agents are

• Anti-metabolites (Eg.methotrexate, and 5-fluoro uracil)
• Tumour antibiotics (Eg.doxorubicin and epirubicin)
• Anti-microtubule agents (Eg.paclitaxel, docetaxel, and vinorelbine)
• Alkylating agents (Eg.cyclophosphamide)

Anti-metabolites and tumour antibiotics destroy the genetic material that are required for the survival of cancer cells. Anti-microtubule agents interfere with cell division and alkylating agents replaces certain hydrogen atoms in DNA with another molecule (an alkyl radical). This damages the DNA, and leads to cell death. They are either used to shrink the tumour before any local therapy is given (neoadjuvant therapy) or used as an additional therapy after surgery to prevent recurrence. For more information, please view this web page

Hormone therapy

Breast tissues express some receptors for sex hormones, and cancer growth partly depends on hormonal stimulation. The aim of hormone therapy is to withdraw the stimulus either by reducing hormone production or by blocking hormone receptor binding. A well known example for hormone therapy is tamoxifen (Nolvadex) which is a serum estrogen response modulator taken in the form of oral pills for a period of five years. It competes with the receptors for the estrogen and hence prevents it from binding. It is particularly useful for patients of estrogen receptor positive status. Other hormonal agents which are used in breast cancer are aminoglutethimide(cytadren), anastrozole(arimidex), exemestane(aromasin), fadrozole(afema), letrozole(femara), megestrol acetate(megace, pallace), methyltestosterone(android-10, testred, virilon) and testosterone(andro, androgel, testderm).

Biological therapy

This mode of treatment employs herceptin (Trastuzumab), a monoclonal antibody which targets cell surface receptor protein, Her-2/neu which is essential for cell growth and division. This protein is over-expressed in 25% of the tumors and due to this, tumours tend to grow faster and the chances of recurrence are high. The amount of Her-2/neu protein in tumour tissue for which herceptin has to be started is determined by a scale (0-3), where 0 means negative and 3 means strongly positive. The scaling system helps the treating physician, to decide upon the treatment options. Herceptin is given intravenously to treat the cancer.

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THERAPY - IN TRIAL

• Scientists at University of Southern California have found a protein called contortrostatin (CN) from the venom of snake, southern copperhead viper which has major impact on the metastasis of breast cancer. CN prevents multiplication of cancerous cells rather than killing them. Therefore, it helps in shrinking of the tumour and it also inhibits the formation of new blood vessel. (Source- BBC News)

• Researchers have found a compound of vitamin A, fenretinide, which prevents the chances of getting a second tumour in premenopausal young women. It is also thought to be useful in high risk patients in preventing the development of breast cancer.( Source - BBC news)

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