cancer treatment - non surgical treatment
After surgery to remove the cancer, you will nearly always be recommended further treatments. These treatments are known as adjuvant treatments. They reduce the chances of your cancer coming back either in the breast (local recurrence) or in other parts of the body (metastasis).There are four types of adjuvant treatment:
- Chemotherapy
- Radiotherapy
- Hormonal therapy
- Biologic or immunological therapy
Once all the results from your surgery, and any staging investigations, are available, an individual plan of treatment will be formulated. This is done at our Panel meeting. Your doctor will then discuss this plan with you. You will be able to discuss the role of each type of treatment in your individual situation.
Chemotherapy
Chemotherapy is treatment with anti-cancer drugs. These drugs act on cells which divide rapidly or abnormally.
Chemotherapy is given as a number of 'cycles'. For each cycle, you will be given a combination of drugs on one day, and then your body will be given time (usually three weeks) to recover before the next cycle is given. Different combinations of drugs are given tailored to each individual and their cancer.
Chemotherapy drugs have a number of side-effects. Most of these are because they affect other normal cells which are rapidly dividing.
Common cells affected are:
- Blood cells. This can lead to anaemia, neutropenia (low levels of the white blood cells, which are essential to fight infections) and thrombocytopaenia (low levels of the platelets which are important in clotting). Because of this, you will need to have a blood test before every cycle.
- Gut lining cells. This can lead to nausea. In more serious cases, there can be irritation or ulceration leading to diarrhea or bleeding.
Radiotherapy
Radiotherapy is an X-ray treatment. You will almost always need radiotherapy if you have had a partial mastectomy to 'sterilise' the rest of the breast.
It may also be given if you have a large tumour, a lot of lumph nodes involved or sometimes if you have close margins which can’t be improved by further surgery.
Radiotherapy is a local treatment, given to the breast or it's drainage areas.
It is given as a short treatment every day (Monday to Friday) for 4 to 6 weeks. A common side effect is tiredness. You may also get skin reddening (like sunburn) in the area where it is given. Occasionally this skin reaction can be more severe.
Hormonal treatment
Hormonal treatments are given if your cancer is 'ER positive'. The hormonal treatments stop natural oestrogens from being used by the tumour cells to grow and divide.
If you are still having periods (premenopausal), one way of doing this is to remove the ovaries. A drug called Zoladex may also be used to turn off the ovaries.
Other hormonal treatments are tablet treatments. If you are premenopausal, Tamoxifen can be given. If you are post-menopausal, either tamoxifen or arimidex can be used.
Common side effects are menopause type symptoms (weight gain and hot flushes). Usually these improve with time, but sometimes you may need other medication to help control them.
Biologic treatments
These are a new type of treatment, which are targeted against specific cancer cells. The only biologic treatment for breast cancer currently available is Herceptin. This is targeted against cancer cells which have a receptor called HER2. This is only present in 1 in 5 breast cancers.
At the moment, Herceptin is approved for treatment in New Zealand, but is not yet funded by Pharmac.