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AmMed Cancer Center > Treatment Information by Cancer Type > Breast Cancer

Breast Cancer

Cancer Information :

Treatment for Breast Cancer

The optimal treatment for invasive breast cancer usually entails a combination of the various accepted modalities of surgery, radiation therapy, and various systemic therapies including hormonal agents, chemotherapy and new biological agents.

Surgical treatment of Breast Cancer:

The goal of surgical treatment is to control cancer so that it does not recur either in the breast or over the chest wall or in the axilla. The secondary goal is to preserve cosmesis of the female breast as much as possible. The range of surgical procedures includes more limited surgery such as removal of the cancer lump (lumpectomy) or the whole breast (total mastectomy). In some instances, all the subcutaneous breast tissue can be removed with the preservation of the nipple and overlying skin (subcutaneous skin sparing mastectomy). In cases of total mastectomy, the natural female breast figure can sometimes be reconstructed immediately either with implants of foreign prosthesis or using one's own tissue by rotating muscle flaps from the stomach wall or back muscle (immediate reconstructive plastic surgery). In cases of invasive breast cancer, the axillary lymph nodes on the same side as the involved breast need to be sampled or removed. A newer procedure that will limit the amount of surgery on the axilla will identify only the frontline lymph node(s) and frequently spare further removal of all the remaining lymph nodes, thereby limiting future risk of arm swelling and weakness (sentinel lymph node dissection).

Radiation Therapy in Breast Cancer

Radiation therapy is frequently a critical component in the curative treatment of breast cancer, especially if only lumpectomy is performed. The remaining breast needs radiation treatment to reduce or prevent local recurrence. Even in cases where the whole breast is removed, when the size of the tumor is large or multiple lymph nodes are involved by cancer spread, then chest wall radiation will reduce the chance of local recurrence and improve chances of survival. With modern radiation equipment and accurate planning, skin damage and other side effects from treatment is usually minimal. Radiation is also used in cases where breast cancer has spread to critical areas of the body such the brain and bones. Local palliative radiation can relieve pain and prevent bone fractures.

Hormone Treatment in Breast Cancer

Around 30% to 50% of breast cancers carry a special target called the estrogen receptor. Such tumors will sometimes respond to pharmacologic manipulation of the body endocrine environment, usually through decreasing estrogen in the body or blocking or downgrading the estrogen receptors. Essentially, all breast cancer patients with positive assay for estrogen receptor can benefit from hormonal therapy. The advantages of such treatment rests with minimal toxicity and prolonged duration of efficacy, in contrast to chemotherapy. Different types of hormonal agents include tamoxifen and raloxifen that can be used in both pre- and post-menopausal women. The newer aromatase inhibitors (arimidex, femara, aromasin) are usually only used in post menopausal women. Women who are still menstruating sometimes can be benefited by the removal of their ovaries (oophorectomy) or chemical suppression of the ovaries by injection of Lupron or Zoladex. The newer agent, fulvesant, is a pure anti-estrogen that can be tried when other drugs have failed.

Chemotherapy Treatment in Breast Cancer

Chemotherapy is used in various stages in breast cancer, either as adjuvant therapy in conjunction with surgery and radiation with curative intent or in cases of metastatic disease for palliation of symptoms and prolonging survival. Standard chemotherapy drugs include the Anthracyclines (Adriamycin, Epirubicin), the Taxanes (Paclitaxel, Docetaxel), Alkylating Agents (Cyclophosphamide), Antimetabolites (Methotrexate, 5FU, Capecitabine, Gemcitabine) and Navelbine. Some newer agents have shown promise in breast cancer treatment and are currently entering the market. These include Abraxane and Ixabepilone. Chemotherapy are usually used in combination to increase their effectiveness. Side effects for chemotherapy drugs can usually be safely prevented or controlled by screening for suitable patients with adequate blood counts and organ function and generous use of anti-nausea medication. Low white cell counts can be prevented with prophylactic use of white cell raising drugs such as neupogen and neulasta.

Biologic (Target) Therapy in Breast Cancer

Besides estrogen receptors as a target, breast cancer cells sometimes carry other potential targets for newer drugs to control growth, proliferation and spread of breast cancer. One very successful drug is called herceptin that targets a growth receptor on breast cancer cell surface called HER 2. Use of this agent in conjunction with chemotherapy or hormonal agent can increase cancer control, decrease risk for disease recurrence and lengthen survival for breast cancer patients. A newer version of this class of inhibitor that can be taken orally is called Lapatinib. Another class of biologic agent targets against new blood vessel formation that feeds new cancer growth (anti-angiogenesis). The first of this class of drug, Bevacizumab (Avastin) has recently been approved by the US FDA for use in breast cancer treatment in combination with chemotherapy. Biologic therapy is one of fastest growing areas in breast cancer treatment and many more new agents are in development or clinical trials. We can expect many more new and effective agents for use in breast cancer in the years to come. The promise of prolonged control of breast cancer with minimal side effects is very bright indeed.

Breast Cancer Treatment at AmMed Cancer Center in Hong Kong

Breast cancer is the most common cancer in Hong Kong women. AmMed Cancer Center in Hong Kong is dedicated to the treatment of this common malady by offering patients the most up-to-date multimodal breast cancer therapy. The center is equipped with the latest equipment including a PET/CT fusion scanner to detect cancer, IMRT state-of-the-art radiation equipment, a chemotherapy infusion center with a full team of certified registered nurses and an affiliation with the best cancer center in the United States, the New York Memorial Sloan-Kettering Cancer Center. AmMed Cancer Center follows international cancer treatment protocols and rigidly follows quality assurance standards. New and promising drugs are imported early on through named patient program for the benefit of patients. Through its network of affiliated physician specialists, AmMed Cancer Center can offer the latest surgical, radiation and systemic treatment for breast cancer in Hong Kong. Through its affiliation with Memorial Sloan-Kettering Cancer Center in New York, patients desirous of a second opinion at this world-renowned center can obtain such, either on site in New York or through an electronic medium arranged by AmMed.