The breast cancer treatment plan is made according to the type, size, stage and grade of the cancer, and whether the cancer cells are sensitive to hormones. In addition, the general health status and preferences of the patient should be taken into account. Successfully treating breast cancer means getting rid of the cancer or getting it under control for a long time.
Recent years have witnessed the development of many promising and exciting treatments for breast cancer. In this way, today, instead of a few treatment options, there are many treatment options that are personalized according to the characteristics of the patient and the cancer. Among these options, the fact that there are many situations that require the decision and choice of the patient can sometimes be challenging and confusing. It is very critical to identify a breast surgeon who can help you in this regard, who will always be with you during the treatment process, whom you can consult, trust, and who can be your “breast cancer coach”.
In fact, in order to plan and apply the most appropriate treatment, a team of experts such as breast surgeon, medical oncologist, radiation oncologist, plastic surgeon, genetic counselor working in coordination is needed rather than a single physician. The responsibility of coordinating this team, guiding the patient, and being a “breast cancer coach” usually falls on the breast surgeon who first sees the patient. For this reason, it is very important to find a physician with the right education, experience and expertise during the first application. For example, it would be more rational to choose a breast surgeon and medical oncologist specializing in breast cancer rather than a general surgeon who does all surgeries or a surgical oncologist who treats a wide variety of cancer types.
Today, surgical treatment, chemotherapy, radiation therapy, hormone therapy and targeted therapies are performed in the treatment of breast cancer. Most likely, the treatment plan will include a combination of these treatments. All of these treatments act with their own different mechanisms, and they can also be extra effective when given together.
The initial treatment for breast cancer is often surgical treatment. The patient and the breast surgeon will decide together on the most suitable one among the different surgical treatment options. There are two main options for surgical treatment: complete removal of the breast (mastectomy) and breast-conserving surgery (lumpectomy) followed by radiation therapy.
LUMPECTOMY (REMOVAL OF BREAST CANCER)
It can also be expressed as breast conserving surgery or wide local excision. During lumpectomy, the cancer mass and a small amount of surrounding healthy breast tissue are removed.
MASTECTOMY (REPLACEMENT OF THE ENTIRE BREAST)
Mastectomy is surgery in which all of the breast tissue (lobules, ducts, adipose tissue, and part of the breast skin including the nipple and areola is removed. If the ipsilateral axillary lymph nodes are removed along with the breast tissue), Modified radical mastectomy; axillary lymph nodes are not removed, only If breast tissue is removed, it is called a simple mastectomy.
Apart from these, newer mastectomy techniques such as skin-sparing mastectomy and nipple-sparing mastectomy can be applied in selected cases to improve the appearance of the breast and allow for reconstructive treatments.
In patients with invasive breast cancer, sentinel (guard) lymph node biopsy or axillary lymph node dissection is performed during lumpectomy and mastectomy to determine whether the cancer has spread to the axillary lymph nodes. Sentinel lymph node biopsy is a much more limited procedure and causes much less postoperative problems.
The sentinel lymph node is one or more lymph nodes from which the lymphatic flow of the tumor is first drained. If cancer is not found in the sentinel lymph nodes, there is little chance of finding cancer in the remaining lymph nodes, so there is no need to remove the other lymph nodes. If cancer is detected in the sentinel lymph nodes, it will likely be necessary to remove the other lymph nodes in the armpit (underarm lymph node dissection).
It is a treatment that causes cancer cells to die by using drugs that prevent rapidly growing cancer cells from dividing and multiplying. Chemotherapy is used after surgery (adjuvant) in cancers with a high risk of spreading to the body (metastasis) or recurrence.
In addition, chemotherapy can sometimes be used before surgery (neoadjuvant) in cancers that cause a large mass in the breast and/or in advanced (locally advanced stage).
One of the main uses of chemotherapy is the treatment of cancers that have spread throughout the body, that is, metastasized. In these patients, hormonal therapy, targeted agents and, in some cases, surgical treatment, radiation therapy can also be used.
Chemotherapy side effects may vary depending on the drugs used. Common side effects include hair loss, nausea, vomiting, fatigue, and an increased risk of developing infections.
Treatment using high-powered energy beams such as x-rays and protons to kill cancer cells. Generally, it can be applied outside the body with the help of a device (external radiotherapy) or it can be done by placing a radioactive substance in the body (brachytherapy).
Radiation therapy is commonly used after lumpectomy. In cases where the risk of cancer recurrence is low, breast brachytherapy after lumpectomy may also be an option.
Radiation therapy to the chest wall is also usually applied after mastectomy for large breast cancers and/or cancers that have spread to the lymph nodes.
Side effects of radiation therapy include fatigue and redness of the skin in the area where the radiation was applied, and sunburn-like rashes. Breast tissue may also be swollen or hardened. Rarely, damage to the heart or lungs may occur, as well as longer-term and very rarely more serious problems such as secondary cancers in the treated area.
To treat hormone-sensitive, i.e., estrogen receptor (sensor) positive (ER positive) and/or progesterone receptor positive (PR positive) breast cancers, they are treatments aimed at stopping the growth of cancer cells by inhibiting the release or effects of hormones. It can usually be given before or after in combination with other treatments. There are several treatment options that can be used in hormone therapy:
Drugs that prevent hormones from binding to cancer cells (selective estrogen receptor modulators)
Medicines that stop the production of hormones in the ovaries or surgical removal of the ovaries.
Medicines that stop extra-ovarian estrogen production in menopausal patients (aromatase inhibitors)
In addition to the side effects of hormone therapy such as hot flashes, night sweats and vaginal dryness, more serious side effects such as osteoporosis and blood clots can be seen.
Targeted therapy drugs attack certain abnormalities within cancer cells.
A few of these treatments commonly used target a protein that some breast cancer cells produce in excess, called human epidermal growth factor receptor 2 (HER2). Drugs that target this protein, which helps breast cancer cells grow and survive, can damage cancer cells while protecting healthy cells.
There are also targeted therapy drugs that focus on some other abnormalities within cancer cells. Research studies of many drugs are also ongoing.
Reconstruction of the breast after mastectomy and some large lumpectomies. This surgery can be performed simultaneously with the surgery for cancer or later.