The Cancer Group Institute



LATER BREAST CANCER TREATMENT



Hormone Receptor Classification

Breast cancer cells may contain receptors, or binding sites, for hormones like estrogen or progesterone. Cells containing these binding sites are known as hormone receptor-positive cells, and they may be less aggressive than cells which lack these binding sites (called hormone-receptor negative). Women have a better prognosis if their tumors are hormone receptor-positive.

Stages of Breast Cancer

Staging is the process of assessing how far the cancer has spread and is important in making treatment decisions and determining prognosis.

The TNM system provides information about three different aspects of the disease:

  • T Followed by a number 0 through 4 Describes the tumor's size and spread to the skin or chest wall under the breast.

  • A higher number means a larger tumor and/or more spread to tissues near the breast.

  • N Followed by a number 0 through 3 Shows whether the cancer has spread tot he lymph nodes near the breast, and if so, whether the affected nodes are attached (fixed) to other structures under the arm.

  • M Followed by a 0 or 1

    Shows whether the cancer has spread (metastasized) to other organs of the body or to lymph nodes that are not next to the breast.

    A simpler process for staging may also be used:

  • Stage 0 Noninvasive, Carcinoma in situ

  • Stage I Cancer cells have not spread beyond the breast and the tumor is no more than about an inch across.

  • Stage II The tumor in the breast is less than 1 inch across and the cancer has spread to the lymph nodes under the arm, or The tumor is between 1 and 2 inches with or without spread to the lymph nodes under the arm, or The tumor is larger than 2 inches but has not spread to the lymph nodes under the arm.

  • Stage III "Locally advanced cancer" - The tumor in the breast is large (more than 2 inches across) and the cancer is extensive in the underarm lymph nodes or It has spread to other lymph nodes or tissues near the breast. This stage includes inflammatory breast cancer.
  • Stage IV The cancer is metastatic, meaning it has spread from the breast to other parts of body.

    Recurrent cancer means the disease has recurred despite initial treatment. Most recurrences appear within the first 2 or 3 years but can occur many years later.

    Risk Factors

  • Age - the risk increases with age (especially > age 50)

  • Genetic Factors - Genetic mutations on the BRCA2 and BRCA2 genes are being investigated

  • Family history of breast cancer (mother, sister, daughter, aunt, grandmother)

  • Personal history of breast cancer

  • Race - white women are more likely to develop breast cancer

  • History of radiation treatment

  • Menstruation before age 12

  • Menopause after age 50

  • Nulliparity or late parity - women who have never had children or had their first child after age 30 are at greater risk

  • Birth control pills - there is a higher risk for up to 10 years after stopping oral contraceptives

  • Estrogen replacement therapy (ERT) - there may be a higher risk for women who use ERT longer than 10 years

  • Alcohol - Women who have 2-5 drinks per day have 1/5 times increased risk

  • Diet - Studies are ongoing regarding the association between breast cancer, obesity, and fat intake

  • Abnormal findings (atypical hyperplasia) on previous breast biopsy

  • Exercise - Research has suggested that life-long exercise may offer some protection against breast cancer

  • Breast feeding - May protect against the development of breast cancer if done for 1 ½ - 2 years

    Breast cancer also affects more than 1,000 men in the United States every year. Although routine screening is not recommended for men, most of the treatment options are the same as for women.

    Diagnosis

    Physical Examination

    In addition to monthly breast self-examinations, women between the age of 20 and 49 should have a physical examination by a health professional every one to two years, and those over 50 should be examined annually.

    Signs and Symptoms

    There are usually no symptoms in the early stages of the disease.

  • Lump or mass felt in the breast or under the arm

  • Recent changes in the appearance of the nipple (i.e., inversion or retraction)

  • Dimpling or "orange peel" appearance of the breast

  • New asymmetry of the breasts

  • Pulling of the breast tissue

  • Nipple discharge that is bloody or foul smelling

    Nipple discharge is not always a symptom of breast cancer. Spontaneous nipple discharge is associated with carcinoma about 20-25% of the time. Expressed nipple discharge is usually due to medication or endocrinologic causes.

    Diagnostic Testing

    Laboratory Evaluation

    · Complete blood count (CBC) Biopsy

  • Fine needle aspiration
  • Needle biopsy
  • Surgical biopsy
  • Axillary dissection - removal of the axillary lymph nodes
  • Sentinel lymph node biopsy - a radioactive substance is injected and the substance is carried to the first node to receive lymph from the tumor, which is the one most likely to contain cancer if it has spread from the breast.

    Radiological Studies

  • Mammogram

  • Ultrasound (sonogram)

  • Computed tomography (CT) scan to assess lymph nodes and deep tissues

    Treatment Options

    Treatment strategy depends on the stage of disease and the goals of care for the individual. Treatment usually consists of a combination of surgery, medication, radiation, and/or chemotherapy. Transplantation procedures are available for individuals with advanced or recurrent disease.

    Preliminary results of a landmark clinical trial, at the University of Chicago, have found that paclitaxel (Taxol), when given in addition to standard chemotherapy, improved patients survival by 26%, and reduced the risk of recurrence by 22%.

    This finding is one of the most significant advances in the treatment of Stage II breast cancer in the past 20 years.

    Italian researchers have reported the successful use of chemotherapy to shrink large breast tumors to a size where they can be removed surgically in a procedure that avoids the trauma of mastectomy.

    Dr. Gianni Bonadonna and colleagues at the National Tumor Institute in Milan, found that in 85% of 536 women with tumors 2.5 centimeters or larger in diameter, preoperative chemotherapy could shrink the tumor to permit breast-sparing surgery.

    After successful treatment with cancer-killing drugs, the women underwent surgery that removed about a quarter of their breast tissue and underarm lymph nodes.

    The surgery was followed by postoperative radiation to kill cancer cells. The women also received further chemotherapy if evidence of cancer was found in the nodes.

    Within eight years after treatment, 45% of the women had experienced a relapse of their cancer, a result better than that usually achieved when women with large tumors undergo standard mastectomy and postoperative chemotherpay, the researchers report in the Journal of Clinical Oncology.

    Bonadonna said he and colleagues now are examing the effectiveness of preoperative chemotherapy in a scientifically designed research study.

    While advanced breast cancer used to be a death sentence, today this is not necessarily so if proper treatment is obtained. We have made tremendous strides in learning how to help the patient with later breast cancer. Choosing the correct treatment can literally make the difference between life and death.

    It is critical to get the proper treatment, which the gives peace-of-mind of knowing that everything possible has been done to help ensure a happy outcome.

    The Cancer Group Institute's material explains, in Plain English, the historic and latest effective treatment for later breast cancer, including results. We describe surgery, radiation treatments and chemotherapy, as well as hormone therapy and bone marrow transplant options. We tell you everything you need to know to help you make the right choices today.

    This is an excerpt taken from our review on later breast cancer. Much more, including latest treatments, can be sent to you by ordering the complete later breast cancer review. Thank you for using the Cancer Group Institute as your cancer information resource center.

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