Breast cancer is the most common malignant tumor in Chinese women, accounting for the second most common malignant tumor in all women. According to statistics, on average, one out of every 2,000 women suffers from breast cancer. As a breast cancer patient, it is necessary for you to know the following, not only to have an overall understanding of the whole treatment, but also you have the obligation to remind your female relatives and friends around you to have regular medical check-ups for early detection, early diagnosis and early treatment of breast diseases.
Treatment of breast cancer
People generally believe that breast cancer is only a localized lesion and can be cured if it is removed by surgery. However, with the deepening understanding of the biological characteristics of breast cancer in modern medicine, it has been proved that breast cancer is a systemic disease from the beginning, that is to say, when the tumor is very small, the tumor cells can metastasize through blood and lymph and exist in the body in the form of single cells or small cell clusters. Therefore, the concept of breast cancer treatment in modern medicine has changed fundamentally from the past treatment of surgery alone to the concept of comprehensive treatment, which includes surgery, chemotherapy, radiation therapy, endocrine therapy, molecular targeted therapy, immunotherapy and other means.
I. Surgical treatment
Currently, the most common surgical methods include modified radical mastectomy and breast-conserving surgery. The former includes the affected nipple, the whole breast, and the middle and low lymph nodes in the affected axilla. In the latter, only the tumor is enlarged and the middle and lower lymph nodes in the axilla are removed. The biggest advantage of breast-conserving surgery is that the patient’s breast is preserved and only part of the breast tissue is partially removed. Although additional radiation therapy must be given to the affected side after surgery, the elasticity of the breast tissue can still be preserved, and the postoperative physical and psychological trauma to the patient is less. Over the past 20 years, a large body of evidence has demonstrated that breast-conserving surgery in eligible patients can achieve the same long-term survival time as mastectomy, but the local recurrence rate of breast-conserving patients is still 3-5% higher than that of patients without breast-conserving surgery. However, although the patient’s wishes are an important factor in the surgeon’s decision, the decision to perform breast-conserving surgery must be made by a breast surgeon after a detailed evaluation of your condition to determine whether you are a candidate for this procedure.
Chemotherapy
Numerous studies have proven that breast cancer is a systemic disease from the beginning, and tumor cells can (not necessarily) metastasize distantly through bloodstream and lymphatic channels when the tumor is very young, and exist in the body as single cells or small cell clusters. Such latent cancer cells cannot be detected by current imaging examinations (e.g. ultrasound, CT, MRI, etc.), and they usually do not grow and increase in value until the primary tumor is removed, and then once the primary tumor is removed, these latent cancer cells will grow and increase in value rapidly, and can form obvious lesions in a short period of time. Therefore, some patients may have metastasis to other organs after surgery, which is the reason why people generally say that cancer masses should not be moved casually.
Chemotherapy is administered orally or by intravenous infusion to kill tumor cells and inhibit their growth. Chemotherapy can significantly reduce the recurrence and metastasis of breast cancer patients. The 5-year survival rate of early stage breast cancer patients without chemotherapy will not exceed 30%, while the 5-year survival rate can be increased to about 73% after chemotherapy. In addition, chemotherapy can shrink otherwise large and non-immediately operable tumors and regain the possibility of surgery.
Chemotherapy is now no less important than surgery. Therefore, the idea of only surgery and no chemotherapy is totally wrong in the modern medical view. Every breast cancer patient should follow their doctor’s advice and complete their regular chemotherapy on time and according to their treatment schedule.
However, chemotherapy drugs can kill cells in the body, but they are not clear about right and wrong, and they can kill normal cells in the body while killing tumor cells. Therefore, the following side effects may occur during chemotherapy.
(1) Nausea, vomiting and loss of appetite
Nausea, vomiting and loss of appetite are the most common side effects, which occur in most patients and can generally be relieved after stopping the drug. Patients should try to alleviate their concerns, because excessive mental stress and fear will increase the chance of gastrointestinal reactions. It is important to recognize the importance of diet and nutrition for postoperative recovery, as it is an important tool to ensure smooth treatment and to keep the body’s resistance from decreasing. Strong patients are invigorated to ensure adequate nutritional intake. Patients should eat little and often, chew and swallow slowly during chemotherapy, and should strive to eat more, but not reluctantly. After nausea and vomiting, food can be eaten repeatedly if the body allows.
Family members should try to prepare food in such a way that the food is as fancy as possible each time, or choose food that the patient likes to eat, which can play a role in promoting appetite. Dry foods should be prepared as much as possible and separated from soups and drinks. It is best to start with a little light and liquid diet, such as apple juice, orange juice, tea, etc. Avoid foods that are too sweet, too oily, spicy, or have an unpleasant smell. In addition, food should not be too hot or too cold to avoid diarrhea due to gastrointestinal dysfunction.
Nausea, vomiting and loss of appetite usually do not require medical attention. When the situation is particularly serious you can consult your supervising physician by phone.
(2) Abdominal pain, diarrhea
II. Endocrine treatment
In recent years, a large number of medical trials have proved that endocrine therapy for breast cancer has an important role in the survival of patients. At present, the main drugs include estrogen receptor antagonists (triamcinolone, toremifene), aromatase inhibitors (Reninde, fluron, exemestane) and so on. Endocrine therapy has certain indications.
Firstly, breast cancer patients with hormone receptors including estrogen receptor (ER), hormone receptor (PR) must be positive for at least one of them to receive endocrine therapy.
Secondly, triamcinolone and toremifene are suitable for both pre- and post-menopausal patients, while aromatase inhibitors (Renindezvous, Fluron, Exemestane) are only suitable for post-menopausal patients and not for pre-menopausal patients, although they have stronger inhibitory effect on breast cancer recurrence than triamcinolone and toremifene.
Endocrine therapy is usually started after chemotherapy is finished and should be taken continuously and daily for five years.
III. Radiation therapy
It is one of the important means of local treatment for breast cancer. It is also an important part of breast-conserving surgery. Radiotherapy can reduce the risk of local recurrence for cases after stage II.
Molecular targeted therapy
In recent years, trastuzumab injection (Herceptin) has been used clinically to treat breast cancer, and it has better effect on C-erbB-2 positive patients. It has been shown in Herceptin can significantly reduce the risk of recurrence and metastasis in early stage breast cancer, and for patients with advanced breast cancer, Herceptin can improve the quality of survival and prolong the survival time. However, although the drug is good, it is very expensive, costing about 300,000 RMB based on the recommended one-year course of treatment in the United States.