As the incidence of breast cancer continues to rise, it is now the number one malignant tumor among women and has become the number one killer.
Many patients have many questions after being diagnosed with breast cancer, such as “Do I have to have my breast cut off?”, “Can I skip chemotherapy/radiotherapy?”, “Why do other patients need to take medicine after discharge? “…… In fact, not all breast cancers are the same, not every patient is treated in the same way. Nowadays, the comprehensive treatment of breast cancer gradually tends to individualized, humanized and precise treatment, just like we also go to buy clothes, depending on your height, body type, age and temperament The size, color, and style that suit you are also different. In the same way, although breast cancer is the same, the treatment plan for each patient differs from doctor to doctor. So, what are the current treatments for breast cancer, or the “weapons to overcome breast cancer”? Assist weapons.
Weapon I. Surgery
After the diagnosis of breast cancer, surgery is the first step of treatment for most of the patients, excluding those who have no indication for surgery in advanced stage. For general patients, most of the surgical procedures performed in clinical practice are modified radical mastectomy, i.e. removal of the affected breast and lymph node dissection of the corresponding drainage area. This procedure reduces the damage and facilitates the patient’s postoperative recovery compared to the previous extended radical surgery.
With the development of medicine and the patient’s demand for quality of life, breast-conserving surgery has also emerged. Many patients, especially young patients, often ask if they can have breast-conserving surgery without cutting. If they are lucky enough to meet the following indications for breast-conserving surgery, the answer is yes: the mass is small, less than 3 cm in length, and the edge of the mass is greater than 3 cm from the areola borderline; the lesion is not multicentric or multifocal, as confirmed by imaging; and patients who are eligible to complete radiotherapy and chemotherapy after surgery, if they voluntarily request or agree to breast-conserving surgery . If a patient with a mass greater than 5cm in length and a strong desire to preserve the breast, then neoadjuvant chemotherapy (preoperative chemotherapy) can be considered first, and you have a chance if the mass shrinks to less than 3cm.
In addition, with the development of breast lumpectomy, the application of McMerton and the development of ablation therapy, the modalities of breast cancer surgery are becoming more and more diversified.
Weapon 2: Chemotherapy
Breast cancer is a systemic disease and cancer cells may spread throughout the body through the blood at its early stage. Although surgery can remove the lesions and reduce the tumor load, it cannot remove the cancer cells from the blood, therefore, chemotherapy is needed to remove these potentially dangerous molecules. Chemotherapy can significantly improve the survival rate of breast cancer patients, and breast cancer is also one of the most effective tumors among solid tumors in which chemotherapy is applied, so it is important for patients to take advantage of this opportunity. For general patients, we choose postoperative adjuvant chemotherapy, while for patients with early-stage carcinoma in situ chemotherapy is usually not needed, but sometimes the decision still needs to be made in the context of the clinical situation. In addition, for some patients, the initial diagnosis is relatively late and the breast cancer lesion is too large, which makes the patient miss the opportunity of surgery or causes great deficit in aesthetics after surgery, preoperative neoadjuvant chemotherapy may change this problem, and at the same time can better understand the patient’s sensitivity to chemotherapy drugs and the rationality of chemotherapy regimen. Neoadjuvant chemotherapy refers to systemic and systematic 2-8 cycles of cytotoxic drug therapy carried out after surgical treatment, mostly used in high-risk cases with locally advanced breast cancer, metastasis in axillary lymph nodes and primary tumor diameter greater than 3 cm. Then, chemotherapy regimens have been validated by many clinical research centers internationally, and are usually a combination of 2-3 drugs, 3 weeks of treatment, 4-8 courses in total. Although most chemotherapy has certain side effects, such as bone marrow suppression, gastrointestinal reactions, hair loss, etc., they are short-lived and as long as the patient is determined and confident, the doctor will take effective measures to help you get through. You should know that overcoming temporary difficulties will bring you a better tomorrow!
Radiotherapy
Radiotherapy is also one of the most important tools in the comprehensive treatment of breast cancer, which is a localized treatment with high-energy X-rays. Nowadays, breast-conserving surgery combined with post-operative radiotherapy has become the main treatment method for stage I and II breast cancer, and its efficacy is not significantly different from that of radical breast cancer surgery. Radiotherapy can improve the local control rate and reduce the mortality rate after breast cancer surgery, improve the overall survival rate of patients, and also reduce the local and regional lymph node recurrence rate to some extent. Many patients will ask whether they need radiotherapy, and the indications for radiotherapy are as follows: after breast-conserving surgery; after radical surgery, pathology reports 1-3 metastases in axillary lymph nodes combined with high-risk factors; after radical surgery, pathology confirms that axillary metastatic lymph nodes account for more than 1/3 of the total number of lymph nodes examined or have more than 4 lymph nodes metastases; patients with pathology confirms metastases in the internal breast lymph nodes; patients with primary foci located in the center or inside of the breast After radical surgery, especially those with axillary lymph node metastasis. The area, dose and duration of radiation therapy are determined by the disease, usually Monday through Friday for 5 weeks. As long as the radiation dose is appropriate, there are few significant side effects.
Endocrine therapy
The growth of breast tissue depends on estrogen, which binds to its receptor and enters the cell, activating estrogen-sensitive genes through a series of processes. Patients with positive estrogen receptors or progesterone receptors should receive endocrine therapy regardless of their age, menstrual status, tumor size, and whether their lymph nodes have metastasized. The goal of endocrine therapy is to reduce the level of estrogen in the circulation and in the tumor, thus suppressing hormone-dependent cells and causing the tumor to regress. Currently, the main endocrine therapy drugs used are estrogen receptor antagonists, such as tamoxifen, toremifene and fulvestrant. For menopausal women, aromatase inhibitors are mainly applied, and the representative drugs are anastrozole, letrozole and exemestane, etc. Because these drugs can cause calcium loss, they are usually taken with vitamin D calcium tablets. In addition, gonadotropin-releasing hormone analogs can also be used to remove the ovaries, such as norethindrone, which is often called “pharmacological ovarian removal”, and its efficacy is similar to surgical removal of ovaries.
Molecular targeted therapy (MTT)
Molecular targeted therapy refers to the treatment that targets the important molecular mechanism (target) in the occurrence and progression of cancer, which is essentially a kind of biological therapy, not chemotherapy. Currently, the main biological targeted therapy drug for breast cancer is trastuzumab (Herceptin), which can specifically act on HER-2 receptor overexpressing breast cancer cells. Therefore, not every patient needs molecular targeted therapy. If HER-2(++++) is seen on the specimen’s pathology report indicating HER-2 protein overexpression, or HER-2(+++), then a FISH test can be done again to clarify whether it is positive or not. If there is indeed HER-2 gene amplification, then choosing molecular targeted therapy will be of great benefit.
Anti-HER-2 drugs mainly include two categories, one is antibody drugs, mainly including trastuzumab; the other is small molecule compounds, the representative drug is lapatinib (Lapatinib). There are also a variety of other anti-HER-2 targeted therapy drugs that have shown better therapeutic effects and may be available in the near future. These mainly include the antibody-based drug T-DM1, and the small molecule compounds Neratinib (HKI-272) and Afatinib (BIBW2992).
In addition to anti-HER-2 targeted drugs, there are many other drugs with other targets of action that can be used to treat breast cancer. Most of them are in clinical research stage and have not been widely used. Only bevacizumab and everolimus have been approved by some countries for the treatment of breast cancer.
Immuno-biologic therapy
Immuno-biologic therapy
Immuno-relay cell therapy is a treatment method to infuse patients with in vitro activated and expanded autologous or allogeneic immune effector cells. CIK cell activation produces IL-2, IFN-γ and other cytokines, which have direct inhibitory effect on tumor cells. cellular immunotherapy of choice. In addition, some studies found that the killing effect of CIK or TIL was significantly increased after activation with dendritic cells (DC).
2.Cytokine therapy
The principle of cytokine therapy is that certain cytokines injected into the body can regulate and enhance the function of one or more immune cells and exert stronger anti-tumor activity. Cytokine therapy has been realized with the industrial development of highly purified or recombinant cytokines. At present, the cytokines commonly used in clinical practice are tumor necrosis factor α (TNFα), interleukin 2 (IL2), interleukin 24 (IL24), gamma interferon (IFNγ) and colony-stimulating factor (CSF).
Weapon 7: Chinese Medicine treatment
In addition to the above mentioned treatments, traditional Chinese medicine also plays an irreplaceable role in the field of breast cancer treatment. The treatment of breast cancer is based on the principle of dialectical treatment, which is divided into four types: liver stagnation, dysregulation of the flushing and the flow of Qi, poisonous heat and deficiency of Qi and blood.
Vitamin D therapy
Studies have found that vitamin D can inhibit the proliferation of cancer cells and induce apoptosis and differentiation of cancer cells, and also plays an important regulatory role in the process of tumor invasion and metastasis and angiogenesis. This anti-proliferative, pro-apoptotic, anti-tumor invasive and anti-angiogenic effect of vitamin D suggests that it can be a potential therapeutic agent. However, breast cancer is not a simple disease and is divided into different molecular subtypes depending on its gene expression, and its responsiveness to different therapies and disease outcomes vary greatly. To achieve targeted vitamin D-based therapy, the expression status of the vitamin D receptor (VDR) in breast cancer tumors needs to be tested, and patients with positive expression will benefit more from treatment with vitamin D agents. It should be noted that the vitamin D preparations commonly used in clinical practice are usually used to promote calcium absorption and treat osteoporosis, etc. The control of tumor growth is very limited with regular doses of vitamin D, and overdose of vitamin D can cause serious adverse effects such as hypercalcemia. Therefore, researchers are developing vitamin D analogs (Analogs) that not only improve the therapeutic effects of vitamin D by hundreds, but also do not cause side effects such as hypercalcemia in the body and help to greatly increase calcium reabsorption in the kidneys and calcium absorption in the small intestine. This will provide a more powerful weapon for the clinical treatment of breast cancer and further improve the outcome and prognosis of patients with great promise.
Summary, there are more and more “weapons” to overcome breast cancer, and the precise combat is more and more targeted. That is to say, the treatment is tailored to the individual. I believe that after reading this, you probably have a good idea of the treatment methods for breast cancer! If you want to know more, please pay attention to the WeChat public number “Dr. Zheng Wei” to get more knowledge about breast and thyroid diseases.