Breast Cancer Treatments Research Paper

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Breast Cancer Treatments

Breast cancer is the most common cause of cancer related deaths in females and its rising incidence makes it the second most common cause of deaths due to cancer in both genders. Its incidence increases with the following risk factors, age and first degree relatives affected with the illness. However, only five to ten percent of all breast cancers are hereditary. The BRCA1, BRCA 2 and the p 53 genes have proven to be the involved mutations. Other risk factors include prior breast cancer, a lengthy reproductive life, null parity, obesity, exogenous estrogen intake and an already existing proliferative fibrocystic change, especially atypical hyperplasia. (Abbas et.al, 739-750)

Treatment affectivity depends on several factors. The type of tumor determines its aggressiveness. A well defined tumor that is small in size, belonging to a less invasive variant, with estrogen and progesterone receptor sensitivity, generally responds well to treatment. However, the reverse is true for tumors that are aggressive in nature, poorly defined with involvement the axillary lymph nodes, an over expression of c-erbB2 (HER2/neu) and show S. phase and DNA ploidy have poorer prognosis. (Abbas et.al, 739-750)

Modern technology and research have brought forward several treatment modalities, with proved efficacy, to patients suffering from the disease. Moreover, ongoing researches and clinical trials, world wide, continue to experiment better proving results.

Surgery is generally describes as the "primary treatment for breast cancer" (Stanford Medicine: Cancer Institute), which eliminates the tumor from its roots, and prevents its re growth. Pre-invasive or better defined invasive lesions usually only require lumpectomy, which excises only the lump along with a portion of normal tissue. This is usually done with radiation therapy to ensure destruction of any microscopic deposits of cancer cells else where in the breast. The rest of the breast tissue remains intact. (Stanford Medicine: Cancer Institute)

If the growing tumor is less well defined, a simple or modified mastectomy can be performed. In simple (also known as total) mastectomy, the entire breast tissue is removed along with some axillary lymph nodes. The skin of the breast can be safely left intact (skin sparing mastectomy) if the tumor is not close to the surface. Nipple areolar sparing mastectomy is a newer approach, which spares the breast skin along with the nipple areolar complex. Long-term safety of this approach has not been clearly determined as yet. (Stanford Medicine: Cancer Institute)

Modified radical mastectomy is removal of the entire breast along with the skin over the breast and nipple areolar complex, the axillary lymph nodes and lining over the chest muscles. Radical mastectomy is the third form which removes the entire breast tissue along with the skin and nipple areolar complex, axillary lymph nodes and chest muscles. These two forms of surgery are conducted when the tumor has aggressively spread to the axillary lymph nodes and chest muscles, which may be the case for undiagnosed tumors, due to heedlessness on part of the patient. (Stanford Medicine: Cancer Institute)

However hostile a mastectomy may sound, it is a curative modality that provides the doctor with confidence of complete removal of the tumor. If a radical or modified radical mastectomy has to be performed, it can be accompanied with breast reconstruction surgery, to provide symmetry to the breasts or to "approximate to the natural appearance" (Stanford Medicine: Cancer Institute), incase of removal of broth breasts. This can be done immediately, along with the mastectomy (immediate reconstruction) or it can be delayed (delayed reconstruction) to a different surgery. The reconstruction can be carried out using implants or through an autologous tissue. Incase of an implant, silicone expanders are used which act as envelopes. These are filled with saline solution and placed between the skin and chest wall, allowing the soft tissues of the breast to grow. Once the required growth is achieved, the implants are removed. The other method of breast reconstruction utilizes the transverse rectus muscle, present in the patient's own abdomen, and is placed in the mastectomy wound. (Stanford Medicine: Cancer Institute)

Chemotherapy is the next best option. It can be given before a surgery to conserve as much of the breast as possible, or after the surgery incase of aggressive tumors. Chemotherapy is the name given to anti-cancer drug therapy used to kill rapidly dividing cells. Naturally, other rapidly dividing cells, such as those present in the gastrointestinal tract and the skin are also affected, leading to unwanted side effects. The side effects may be different for each drug and each individual. These effects can be mild, moderate or severe, depending on the choice of drug combination, its dose and duration of therapy.

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(Harvey and Champe)

There are a number of different drug combinations used for breast cancer: Adriamycin and Cytoxan, Adriamycin and Taxotere; Cytoxan, methotrexate, and fluorouracil; fluorouracil, Adriamycin, and Cytoxan used in different dose and frequency. Type of cancer, menopause and other co morbid conditions determine the type of chemotherapy used. (Harvey and Champe)

Another option is radiation therapy. The conventional form of radiation treatment is the external beam therapy, which requires three to six weeks. The radiation is targeted directly at the cancer cells, with or without the axillary lymph nodes. There have been advancements in this form of therapy and is available at Stanford. This includes intraoperative radiation therapy (IORT) and 3 D. conformal APBI. The advantage of this is that only a single dose is required which is accompanied with tumor surgery. In IORT, radiation is delivered through an incision during surgery, targeting the breast tissue alone. The 3D conformal APBI further spares radiation to only part of the breast tissue, rather than the whole breast, from where the tumor had been removed. (Stanford Medicine: Cancer Institute)

Radiofrequency ablation is a method that uses electrical current to kill cancer cells. This is very commonly used for liver cancers and is now being studied for the treatment of breast cancer. At Anderson Cancer Center, plans are underway to begin a clinical trial to see the efficacy of ablating breast cancer tumors along with radiation, without surgery. (Sabel)

Some tumors are estrogen and progesterone receptor positive, which means that they rely on these hormones to grow. Hormone therapy is given to patients with these tumors and generally have good prognosis. Like chemotherapy, there are several options available and the choice of drug depends on the type and size of the tumor, age of the patient and receptor sensitivity. (Harvey and Champe)

Tamoxifen is an "anti estrogenic drug" (Harvey and Champe, 744) that blocks the effects of estrogen on the growth of malignant neoplasm on the breast. This drug has also been used prophylactic ally to prevent the growth of breast tumors in high risk patients. Raloxifene, another estrogen blocker, is the second drug of choice for cancer prevention and is used in postmenopausal women or women suffering from osteoporosis. Aromatase is an enzyme present in adipose cells that convert fat into estrogen. Aromatase inhibitors, such as Anastrozole, Letrozole and Exemestane are used in advanced aggressive estrogen producing tumors and are used to prevent recurrence of breast cancer in post menopausal women. Fluvestrant is another drug that eliminates estrogen receptors rather than just blocking its effects. Its used in post menopausal women who have not responded well to estrogen blocking drugs. (Harvey and Champe)

Biologic therapy is also preferred to reduce the side effects of other forms of cancer therapy. These are agents that boost the immune system of the body (immunomodulaters), such as, interferon, interleukins, and colony stimulating factors, monoclonal antibodies and vaccines. Efficacy of chemotherapy is also increased with the use of these drugs. Trastuzumab is the most common biologic agent used in breast cancer. It attaches to Her 2 receptors, slowing or stopping the growth of breast tumors. Lapatinib is another drug that acts in a similar fashion. Bevacizumab is anti-angiogenic. It blocks release of angiogenic growth factor which is needed for new blood vessel formation. Without these new blood vessel sprouts, the rapidly dividing cancer cells cannot receive the nutrition they require to grow. (Harvey and Champe)

Currently, "the only available tests" (National Human Genome Institute) are DNA tests that can be performed on individuals with a positive family history of breast cancer. These tests diagnose mutations in the BRCA 1 and 2 gene. Once diagnosed with a predisposition, biologic therapy can be initiated as prophylactic treatment. (National Human Genome Institute)

Most patients suffering from cancer tend to suffer from psychological issues, such as post traumatic stress disorder. Patients and oncologists have expressed moderate to extreme satisfaction with the results obtained from psychological therapy. Researches show that psychological therapy not only helps patients combat depression and anxiety, but also improve the patient's immune status and reduces side effects, resulting in better results and survival rates. Approximately, "627 relevant trials" (Newel et.al, 558-584) have been conducted that recommend oncologists to advice psychological therapies to their patients. (Newel et.al, 558-584)

Funds are continued to be raised world wide for the support of breast cancer research and treatment. People have shown tremendous….....

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