How to treat breast cancer?

Treatment Measures

Breast cancer should adopt the principle of precision and comprehensive treatment. According to the biological behavior of the tumor and the patient's physical condition, a variety of treatment methods should be combined, taking into account local treatment and systemic treatment to improve the efficacy and the patient's quality of life.

What are the general treatment measures for breast cancer?

Health education

Doctors should actively talk with breast cancer patients, let patients understand the basic knowledge of breast cancer, and help patients build positive emotions.

Psychological support

By building a good family and social support system, patients can experience the care of family and society, which can effectively alleviate their negative emotions and benefit the patient's recovery and prognosis.

Physiological support

Breast cancer patients may experience adverse physiological reactions during diagnosis and treatment, including nausea, vomiting, pain, hot flashes, etc. Patients should maintain a stable mood and actively take medication or physical intervention measures.

Medication

Due to the large individual differences, there is no absolute best, fastest, and most effective medication. In addition to commonly used OTC drugs, the most appropriate drug should be selected under the guidance of a doctor in combination with personal conditions.

According to the different mechanisms of action of the drugs, drug therapy is divided into chemotherapy, endocrine therapy (hormone therapy), and targeted therapy.

Chemotherapy

Chemotherapy is a systemic treatment method that kills cancer cells by using cytotoxic drugs. It can be divided into adjuvant chemotherapy and neoadjuvant chemotherapy.

Adjuvant chemotherapy

It refers to systemic chemotherapy performed after surgery, the purpose of which is to kill small lesions that can’t be removed by surgery, reduce cancer metastasis and recurrence, and improve the patient’s survival rate. It is suitable for patients with invasive breast cancer and axillary lymph node metastasis. For patients with negative axillary lymph nodes and high-risk recurrence factors, postoperative adjuvant chemotherapy is also suitable.

Neoadjuvant chemotherapy

It refers to systemic chemotherapy performed before the implementation of local treatment methods (such as surgery or radiotherapy), in order to shrink the tumor through chemotherapy first, and then cure the tumor through treatment methods such as surgery or radiotherapy. It is suitable for patients with large tumors (>5cm), axillary lymph node metastasis, and those who wish to preserve their breasts but it’s difficult to achieve due to large tumor size relative to breast volume.

Chemotherapy drugs for treating breast cancer generally interfere with the reproduction of cancer cells by changing or inhibiting the biochemical metabolism of cancer cells, mainly anthracyclines and taxanes.

- Anthracyclines: Common drugs include doxorubicin, epirubicin, pirarubicin, etc. Common adverse reactions include cardiac toxicity (doxorubicin can cause the most serious situation), bone marrow suppression, gastrointestinal reactions, etc.

- Taxanes: Common drugs include paclitaxel, docetaxel, etc. Common adverse reactions include bone marrow suppression, allergic reactions, skin reactions (erythema), gastrointestinal reactions, etc.

- Others: Commonly used drugs in clinical practice include cyclophosphamide, 5-fluorouracil, oral capecitabine, etc.

Endocrine therapy

It prevents the growth of cancer cells by removing or blocking the action of hormones. Compared with chemotherapy, endocrine therapy has the advantages of definite efficacy, low toxicity, ease of use, no need for hospitalization, and easy acceptance by patients. Although it takes a long time to take effect, it has a long remission period and is particularly suitable for breast cancer patients with positive hormone receptors (ER/PR) at all stages.

Anti-estrogen drugs

Common drugs include tamoxifen, toremifene, etc., which can reduce postoperative recurrence and metastasis of breast cancer and reduce the incidence of contralateral breast cancer. It is clinically suitable for premenopausal and postmenopausal women. Common side effects include hot flashes, nausea, vomiting, venous thrombosis, eye side effects, vaginal dryness or increased secretions.

Aromatase inhibitors

Common drugs include letrozole, anastrozole, exemestane, etc., which can reduce estradiol and achieve the purpose of treating breast cancer. It is clinically suitable for postmenopausal women. Its efficacy is better than tamoxifen. Common side effects are mainly bone lesions, such as osteoporosis and joint pain.

Others

Commonly used endocrine drugs in clinical practice also include luteinizing hormone-releasing hormone analogs goserelin and leuprorelin, estrogen inactivator fulvestrant, etc.

Targeted therapy

It is a treatment method that blocks tumor growth through specific interference. Compared with chemotherapy, it has less impact on normal cells, and patients have better tolerance during treatment. It is suitable for breast cancer patients with positive HER-2.

The main drugs are trastuzumab, pertuzumab, T-DM1, lapatinib, pyrotinib, etc. Depending on the condition, it can be combined or sequentially with chemotherapy for the treatment of neoadjuvant, adjuvant, and advanced breast cancer. Sometimes it can also be used in combination with endocrine drugs.

Surgery

Surgery is still the first choice for breast cancer patients. Surgery is contraindicated for patients with poor general condition, serious diseases of major organs, and inability to tolerate it due to old age and physical weakness. The choice of surgical method should comprehensively evaluate the stage of breast cancer and the patient's physical condition.

Breast-conserving surgery

The scope of surgical resection is the tumor and 1-2 cm of tissue around the tumor. It is suitable for patients with early breast cancer who need to preserve their breasts. It is generally suitable for patients with stage II, with a maximum tumor diameter of ≤3 cm, and who can retain a suitable breast volume and good breast shape after surgery.

Patients with stage III (except inflammatory breast cancer) who have reached the breast conservation standard after neoadjuvant chemotherapy can also be carefully considered.

Total mastectomy

The scope of surgical resection is the entire breast, including the axillary tail and the pectoralis major muscle fascia. It is suitable for patients with carcinoma in situ, microcancer, and the elderly and weak who are not suitable for radical surgery.

Radical surgery and extended radical surgery

The scope of radical surgery includes the entire breast, pectoralis major, pectoralis minor, and all lymph nodes in the axilla. In addition to the above scope, extended radical mastectomy also requires the resection of the internal thoracic arteries and veins and surrounding lymph nodes. Because the resection range is too large, it is now rarely used.

Modified radical mastectomy

Compared to radical mastectomy, the difference lies in whether the pectoralis major and (or) pectoralis minor muscles are resected. Because the surgery retains the pectoralis muscles, the postoperative appearance effect is better, and it is currently a commonly used surgical method.

Radiotherapy

Radiotherapy is a local treatment method that uses radiation to kill cancer cells. It is often used in combination with surgery or chemotherapy to reduce tumor metastasis and recurrence and improve patient survival. Palliative radiotherapy can sometimes be considered for patients with advanced breast cancer.