Your breast surgeon and oncologist will be able to provide you the most suitable treatment plan with regards to the CHOICE and TIMING of the treatment options based on your cancer stage and subtype, your age, genetic history and your general health.  These are the possible treatment options which your doctors may choose for you.

A. Surgery

These are some of the Surgery Options to remove the cancer at your breast and the draining lymphatics in your armpit.  The choice usually depends on several factors such as cancer type and grade, cancer stage, genetics as well as your personal choice.

• Wide local excision and sentinel lymph node biopsy
• Breast conserving surgery and sentinel lymph node biopsy or axillary lymph node clearance
• Mastectomy with axillary lymph node clearance (+/- Reconstruction)

B. Chemotherapy

Breast cancer cells are generally sensitive to chemotherapy.  Its role is to eliminate any remaining cancer cells in your body and reduced recurrence and improve survival rate. Chemotherapy can be given before (neo-adjuvant) or after surgery (adjuvant therapy) or as palliative treatment of cancer recurrence or metastases. Your oncologist will discuss with you whether you (1) need chemotherapy (2) the sequence of the treatment whether it is before or after the surgery 3 ) which combination of chemo drugs and number of cycles or duration of therapy (4) when you should start the treatment.  Most breast cancer chemotherapy regimens consist of around 4-8 cycles in total.

 Side effects of chemotherapy depends on the type of medication you have been given

C. Hormone Therapy for Breast Cancer

1. Drugs which Block Estrogen Receptors

Hormone therapy can be used to treat ER+ and / or PR+ invasive breast cancer or DCIS and can be started before (known as neo-adjuvant therapy) or after surgery (known as adjuvant therapy).  It is also used to treat breast cancer recurrence or breast cancer which has spread to the rest of the body.  The drug blocks your oestrogen hormone from making the cancer cells grow or help prevent it from recurring.  These drugs can be given to premenopausal and post-menopausal women.

• Tamoxifen ( Nolvadex)
• Toremifene (Fareston)
• Fulvestrant (Faslodex, Eranfu)

There is a slight increased risk of developing uterine cancer (<2%)  and blood clots (such as deep vein thrombosis (DVT) or strokes) so inform your doctor if you get unusual vagina bleeding or calf redness or swelling).

2. Drugs which Lower Oestrogen Levels

Hormone therapy can also lower oestrogen levels and help slow the cancer’s growth or help prevent it from recurring.  Aromatase inhibitors (AIs) are drugs that stop oestrogen production in fatty tissue of post-menopausal women with early or advanced breast cancer. It can be given in combination with other agents targeting the hormonal pathway.

• Letrozole (Femara)
• Anastrozole (Arimidex)
• Exemestane (Aromasin)

There is a slight risk of developing muscle/bone pain as well as osteoporosis.  Your doctor may prescribed some medication to strengthen your bone.

D. Radiation Therapy (also known as Radiotherapy)

Radiation therapy is the treatment with high-energy rays (or particles) which destroy the cancer cells at areas affected by the breast cancer.  The radiation aims to reduce the risk of cancer recurrence by treating the tumour bed as well as the area around the lymph nodes. Radiation can also be given to areas of cancer spread such as bone or brain metastases for symptoms control Your oncologist will discuss with you whether you need Radiotherapy, which type and when you should start the treatment.

There are 2 common types of Radiotherapy

• Whole Breast or Chest Wall Irradiation. This is the most common treatment whereby the breast is treated daily between Monday to Friday over a 4-6 week period.  The amount of radiation and schedule depends on the cancer status and your general health
• Intra-Operative Radiation Therapy (IORT).  Some cancer centres offer IORT whereby a single dose of Radiation is given to the area where the cancer was removed (called the tumour bed) in the operating theatre DURING the surgery.  This is applicable only to patients with very early stage and low risk cancers.  (There is a list of suitability criteria for this mode of treatment so you need to discuss with your doctors)

Side effects of radiotherapy include skin changes (similar to sunburn), breast swelling, feeling tired, or fatigue and swelling of your arm due to lymphoedema)

E. Targeted Therapy for Breast Cancer

Around 1 in 5 women with breast cancer have excess growth promoting protein known as HER-2 on the cell surface.  These cancers (known as HER-2 positive breast cancers) tend to grow and spread more aggressively.  Your doctor may recommend monoclonal antibodies medication which can target cancer cells with these HER-2 proteins. They are generally used in combination with chemotherapy and may be used alone or in combination;

• Trastuzumab (Herceptin)
• Pertuzumab (Perjeta)
• Trastuzumab emtansine (Kadcyla)
• Lapatinib
• Neratinib

Side effects include were diarrhoea, upper respiratory tract infection, headache, fatigue, swelling of nasal passages and throat, itchiness and rash, joint and back pain, nausea, inflammation of mouth and lips with loss of taste and loss red blood cells

A proportion of patient with advanced metastatic breast cancer of the ER+ HER2 negative subtype may be treated with oral targeted therapy against the cell cycle pathway that will inhibit cancer growth. These drugs are given in combination with hormone therapy above

• Palbociclib
• Ribociclib
• Abemaciclib
• Alpelisib

Follow-Up Schedule after your Treatment

It is important to see your breast surgeon and/or oncologist regularly so that any issues such as tumour recurrence can be detected and treated early.  This is the recommended follow-up schedule but we suggest you discuss with your own treating doctor(s)

• 3 monthly for the first 2 years
• 6 monthly for the next 3 years
• yearly review thereafter or as advised by your treating doctor(s)

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Disclaimer. TELEME blog posts contains general information about health conditions and treatments. It is not intended to be a substitute for professional medical advice, diagnosis or treatment. The information is not advice and should not be treated as such. 

If you think you may be suffering from any medical condition, you should seek immediate medical attention from your doctor or other professional healthcare providers. You should never delay seeking medical advice, disregard medical advice, or discontinue medical treatment because of information on this website.