Breast Cancer (ABC)
A diagnosis of ABC can be devastating but it does not mean that life ends tomorrow. Treatment for ABC depends on many factors, including whether it is the first treatment or additional treatment for the progression of disease. If the cancer has been previously treated, it usually means a new cycle and different treatment is necessary.
The goals for treatment in ABC can differ depending on the stage of the disease. In earlier stages (Stage 3, locally ABC), treatment goals may be curative. These goals change in the later stages (Stage 4/MBC) when treatment cannot eliminate the cancer. Treatment then becomes life-long with multiple goals.
ABC that requires life-long treatment, have the following goals:
- To provide relief from symptoms
- To maintain a good quality of life
- To halt the progression of the disease, by stabilising tumour growth.
Although many people are familiar that cancer advances in four stages, many are unaware that two other factors are equally important in determining treatment: the grade of one’s cancer and whether the cancer cells have receptors for particular treatments.
There are three grades in breast cancer – grade 1 (low grade), grade 2 (intermediate grade) and grade 3 (high grade). The grade refers to how abnormal the cancer cells look under the microscope; the more normal they look, the lower the grade; the more abnormal they look, the higher the grade. As high grade cancers may be faster-growing and more likely to spread, knowing the grade of cancer helps doctors to determine the most appropriate treatment.
Certain cancer cell receptors or biomarkers – which are indicators of tumour behaviour – are also relevant as their presence allows for more individualised treatment, or targeted therapy. For example, cancer cells that are receptive to the hormones oestrogen and progesterone rely on these hormones to grow; as such they can be treated with drugs that block the hormones from binding with the oestrogen receptors, thereby inhibiting further growth of the tumour.
There are different forms of treatment available, but while radiation therapy, chemotherapy and surgery form the established arsenal of cancer therapy, newer treatment options are offering patients improved treatment results and longer periods of progression-free survival.
A localised form of treatment, radiation therapy employs focussed X-rays to destroy or neutralise cancer cells and stop them from multiplying. It can also shrink the tumour, which in certain cases can help relieve pain.
A drug treatment that uses powerful chemicals to slow down or stop the growth of cancer cells. It is usually given in the form of an intravenous injection or drip, but some chemotherapy drugs can also be given in the form of a tablet.
New types of chemotherapy drugs are giving doctors more options to treat women with ABC. In addition, doctors have found that using different drugs in combination, in different sequences and/or dosing schedules benefits some patients with ABC, sometimes even after standard chemotherapy has failed.
As ABC means that the cancer has spread beyond the breast and lymph nodes, surgery may only be useful in some situations such as when the breast tumour is causing an open wound, to prevent bone fractures, or to relieve pressure or pain in a specific area.
For ABC, surgery as a treatment option is generally used in combination with other forms of treatment.
Cancer treatment has advanced sufficiently that researchers have been able to identify different factors that contribute to tumour growth and progression. By targeting the tumour’s source of fuel, for example, such treatment helps prevent its further growth.
Targeted therapies are designed to block the growth and spread of cancer cells. They differ from chemotherapy that attack cells that are growing quickly (including cancer cells). Such targeted therapies include hormone therapy and immunotherapy.
Cancer cells that are oestrogen receptor positive (ER+) rely on the hormone for growth, hence this form of treatment involves starving the hormone-dependent cancer cells of the fuel it needs to grow. Different drugs accomplish this in different ways – by reducing the amount of oestrogen the body produces, by selectively blocking the receptors or by destroying the receptors.
While resistance to certain drugs can occur, new forms of anti-oestrogen therapy, available in pill-form, have been shown to be effective even in advanced stages, and in patients whose cancer has become resistant to first-line therapy.
Immunotherapy targets certain parts of a person’s immune system to fight diseases. This can be done in a couple of ways:
- Stimulating your own immune system to work harder or smarter to attack cancer cells.
- Giving you immune system components, such as man-made immune system proteins.
Types of immunotherapy includes cytokines, vaccines, Bacillus Calmette-Guerin (BCG) and some monoclonal antibodies. Some types of immunotherapy are also sometimes called biologic therapy or biotherapy.
This form of treatment is modelled after the body’s own immune system. For example, one new drug targets the Human Epidermal Growth Factor Receptor 2 (HER2) proteins on the surface of the tumour; as the proteins help fuel the growth of cancer cells, this treatment either binds to the protein or kills the cancerous cells, leading to improved survival rates for women with Stage IV HER2-positive breast cancer. Using this approach, researchers are trying to find ways to affect another protein involved in some types of breast cancer, such as HER1 and Epidermal Growth Factor Receptor (EGFR).
In some instances, doctors may prescribe a combination that can achieve better results than a single treatment or type of treatment, especially if the cancer has become resistant to other drugs.
Scientists are trying to develop a therapeutic vaccine that treats ABC. Unlike vaccines which prevent infections, therapeutic breast cancer vaccines would be customised for individual women by using her white blood cells to create a vaccine that will boost her immune response against the abnormal protein and cause the tumour to shrink significantly.
Cancer can cause pain and discomfort, and pain management should be part of the treatment plan. In some cases, shrinking the tumour can relieve pain, but there are also various drugs that doctors can prescribe. Some patients may also find non-pharmacological techniques such as yoga, meditation or tai chi helpful.
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