Treatment of breast cancer and its methods depend on the nature of the disease, its stage, and the extent of its spread in the body. Often, individuals with breast cancer undergo several treatment methods for its management. In recent years, significant progress has been made in the treatment of breast cancer, which is a source of hope for cancer patients. Today, instead of just one or two treatment methods, there is a list of treatment options available for combating cancer cells in breast cancer.
I will try to provide you with explanations about the diagnostic methods, types of surgical and non-surgical treatment methods for breast cancer. (The content of this article is the result of 15 years of science and experience of Dr. Farhad Mousazadeh, a breast surgeon and specialist in breast diseases, and researching up-to-date and credible articles.) We would be happy if you could help increase public awareness by sharing the link to this article in virtual spaces and among your friends.
Breast cancer is also referred to as breast cancer.
Understanding the concept of breast cancer and its treatment
Before addressing the treatment of breast cancer, familiarity with the language of any science has its own importance. If you are diagnosed with breast cancer or are studying this disease for various reasons such as the illness of loved ones or even scientific research, you should first become familiar with some modifications such as:
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- The structure of the female breast
- How the breast functions
- Breast cancer: a cellular disease
- Mutations: the main cause of cancer formation
- Metastasis
- The stage of breast cancer
Preventing breast cancer before worrying about treating breast cancer
Breast cancer is one of the most common cancers among women and a portion of men, claiming a significant number of lives annually worldwide. Given the high risk of this disease and its mortality rate, understanding methods of breast cancer prevention can be highly effective. Various prevention strategies, such as weight control, the impact of nutrition, the timing of breastfeeding, and daily habits, are effective in prevention. The complete article on breast cancer prevention
Know the cause of breast cancer before ways to treat breast cancer
Breast cancer is the uncontrolled growth of mutated cells in breast tissue. In fact, when breast cells are affected by an external factor or cellular errors, they begin to grow and divide uncontrollably. The uncontrolled growth of cells ultimately leads to the formation of malignant masses called tumors.
The main cause of breast cancer is the mutation of breast cells or the acquisition of a defective gene from parents. When the gene related to breast cancer mutates, it leads to uncontrolled cell growth. This, in turn, leads to tumor formation. However, in many cases, benign masses may be mistaken for tumors. The best way to prevent such errors is through breast cancer detection using ultrasound and mammography.
Breast cancer treatment is possible when the created tumor is removed. It is also necessary to prevent the continued uncontrolled growth of cells.
If tumor cells separate from it, they can be transferred to other parts of the body. However, these detached cells still grow uncontrollably. In this way, they create new masses in host tissues, a process known as metastasis. Breast cancer accompanied by metastasis is known as metastatic breast cancer.
In the course of breast cancer treatment, factors predisposing to cancer should be identified
Numerous factors can be directly and indirectly identified as causes of breast cancer. Sometimes identifying risk factors can help prevent breast cancer. However, this may also be effective in breast cancer treatment. According to Dr. Farhad Mousazadeh, the most important factors predisposing to breast cancer are:
- Age of the person
- Gender of individuals
- Family history of breast cancer
- Genetics
- Smoking
- Alcohol consumption
- Obesity to an extent considered a disease
- Placement of the breast in high-energy rays such as chest radiation therapy
- Undergoing hormone-related treatments or hormone therapy
Studies show that the incidence of breast cancer in women is a hundred times higher than in men. This issue is attributed to the secretion of estrogen hormone in women’s bodies. This issue is so influential that even individuals who experience early menarche (first menstruation) or late menopause are more exposed to breast cancer than others. Because the number of menstrual cycles for these individuals is higher than normal.
Women who experience multiple pregnancies throughout their lives are also less likely to be exposed than others. Because the number of menstrual cycles for these women has been lower. This means that estrogen in their bodies has been secreted less frequently over long periods (9 months per pregnancy).
The Importance of Early Detection of Breast Cancer in Breast Cancer Treatment
Of every 9 women, one will develop some form of breast cancer during her lifetime. Secondary factors, such as a family history of breast cancer or a history of abnormal findings in a biopsy, increase the risk of developing this disease. The average age of women with breast cancer in Iran is 10 years earlier than the global average.
Annually, almost 250,000 people worldwide are diagnosed with breast cancer; 40,000 people die each year due to breast cancer. These numbers are relative. According to statistics, breast cancer was the second most common cancer in the world, but this year, according to the World Health Organization, breast cancer has overtaken lung cancer and has become the most common cancer in the world. After two decades, lung cancer dropped from first place to second place, and colorectal cancer became the third most common cancer in the world. Therefore, early detection of breast cancer is very important.
Regarding the early diagnosis of breast cancer, the sooner this disease is diagnosed, the lower its stage and severity will be; with early diagnosis, the likelihood of preserving the breasts and the person’s natural lifespan increases. And if diagnosed at stage zero or one, the patient will have a completely normal life and lifespan.
Another advantage of early diagnosis is the reduction of costs and the selection of less invasive methods. For example, the earlier the disease is diagnosed, the fewer chemotherapy sessions are needed, and in some cases, the treatment process is complete without chemotherapy. Read the relevant article for practical information on breast cancer diagnosis.
Always remember, for the treatment of breast cancer, it is necessary to first accurately diagnose the type of tumor and the type of cancer in the individual. The earlier the person’s disease and cancer type are diagnosed, the simpler the treatment of breast cancer will be.
In fact, diagnosing the disease in the early stages prevents metastasis of cancer. Treating a single tumor is certainly simpler than treating metastatic breast cancer. For early diagnosis of breast cancer, the individual should undergo periodic examinations by a specialist physician. This process is called breast cancer screening.
In breast cancer screening, the individual visits a specialist physician at specified intervals (such as every six months or annually) for breast examination. The specialist physician should perform a physical examination of the breasts. Breast ultrasound and mammography also help to fully examine and evaluate breast tissue. If a new mass is observed in breast tissue, a breast biopsy may also be necessary. The diagnosis of breast mass types is only possible through accurate pathological tests. Early diagnosis of tumor type will help accelerate the breast cancer treatment process.
Symptoms of Breast Cancer
The symptoms of breast cancer, like most other diseases, vary greatly from person to person. It is possible that some affected individuals may have no symptoms.
Early Symptoms of Breast Cancer
Some early and warning signs of breast cancer include:
The presence of a lump in the breast or under the arm
Thickening of the skin or partial swelling of the breast
Irritation or dimpling of the breast skin
Redness or flaking of the nipple
Pain or indentation of the nipple
Discharge of blood or any other fluid except milk from the nipple
Any change in the size or shape of the breasts, especially unilaterally
Breast pain
Itching or irritation of the breast
Change in breast color
Redness or indentation of the breast skin (similar to citrus peel)
Types of Breast Cancer Treatment
Breast cancer treatment depends on the type of disease. However, treatment for various types of breast cancer involves surgical and non-surgical methods. The main surgical treatments for breast cancer include mastectomy and lumpectomy. Non-surgical methods for breast cancer treatment include radiation therapy, chemotherapy, hormone therapy, immunotherapy, and targeted therapy. In this article, we will discuss each of these surgical and non-surgical treatment methods for breast cancer in detail.
For the treatment of breast cancer patients, primarily a combination of treatments is necessary. For example, most individuals require a combination treatment including surgery, radiation therapy, and chemotherapy.
It is important to note that the type of breast cancer will determine the most effective treatments. This means that a treatment plan may be suitable for one person but may not be beneficial for another.
According to Dr. Farhad Mousazadeh, the sequence of breast cancer treatment stages also varies for different individuals. Sometimes the tumor may be large, making surgery more difficult. In such cases, the doctor may consider several sessions of chemotherapy for the patient. Chemotherapy helps shrink the tumor, making it easier to remove breast tissue and causing less damage to surrounding tissues.
Diagnosing such issues, which is actually very important, is the responsibility of a specialist physician. Therefore, it is necessary to pay the utmost attention when choosing a breast therapist.
Breast cancer treatment methods are very diverse and are constantly changing and advancing, and new methods may be added to this list in the future. In that case, I will definitely talk to you about the new methods in the future. The methods mentioned here are selected based on the patient’s condition, and for some patients, one or several methods may be used in combination. The type of cancer also affects the choice of treatment methods. For example, in triple-negative breast cancer, which is one of several types of breast cancer, a combination of treatment methods is used.
Breast Cancer Surgery: How is it Done?
Many women with breast cancer need to undergo surgery for their breast cancer treatment. However, some individuals may not need surgery at all. Your doctor’s experience and knowledge will help you make better decisions in this regard. There are various types of breast cancer surgeries. Based on the patient’s condition, a specialist physician can choose one of these methods. The point to note is that in every surgery and for every individual, the doctor should pay attention to the following:
Remove the tumor and cancerous cells as much as possible.
Examine the extent of cancer invasion into the lymph nodes under the arm (for this, the doctor needs to take a sample of the sentinel lymph nodes. Also, dissecting the lymph nodes under the arm is a suitable solution.)
Restore the shape of the breast after removing the tumor, known as breast reconstruction surgery.
All signs and symptoms of advanced breast cancer should be eliminated.
The type of breast cancer, the location of the tumor, the extent of its spread, and the patient’s health conditions determine the type of surgery for breast cancer treatment. Below, we introduce various types of Breast Cancer surgeries.
It is necessary to remember that the goal of breast cancer surgery is to remove the tumor and some of the surrounding tissue while preserving the breast tissue as much as possible. Breast surgery methods vary depending on the location of the tumor and the amount of tissue removed with the tumor. If necessary, the surgeon may also remove the lymph nodes under the arm for further testing.
In many cases, non-surgical methods are much more effective. Therefore, it is better to carefully consider the doctor’s opinion and other available options before choosing a treatment method. Breast cancer surgery methods include:
Mastectomy Surgery for Breast Cancer Treatment
It can be said that the most distressing treatment for breast cancer is mastectomy surgery. Because in this surgical method, the doctor removes all breast tissue. Even the nipple may be removed along with the areola (the dark-colored circle around the nipple). However, if these areas are not infected, the surgeon will perform a mastectomy with nipple preservation.
It should be noted that sometimes a mastectomy surgery is performed simultaneously for both breasts. This occurs when breast cancer has spread to the second breast.
Usually, in mastectomy surgery, some lymph nodes are also removed. Because breast cancer may have also invaded these glands. Detecting this is possible by sampling the sentinel lymph nodes or dissecting the lymph nodes under the arm.
Mastectomy is suitable for individuals:
- Whose breast cancer has also affected their lymph nodes.
- People at risk of breast cancer who want to prevent it.
Breast Reconstruction Surgery with Mastectomy
In many cases, to reduce the psychological burden of mastectomy surgery, breast reconstruction surgery is recommended. Breast reconstruction surgery can be done either simultaneously with mastectomy, known as oncoplastic surgery, or at a later time. If the patient needs radiation therapy after mastectomy, it is better to postpone breast reconstruction until after completing the treatment.
Treatment of breast cancer with radical mastectomy (MRM)
There are various surgical methods for treating breast cancer, with the oldest being the complete removal of the breast and the lymph nodes under the arm, known as radical mastectomy. This method is called modified radical mastectomy (MRM) and is actually one of the traditional methods of breast cancer treatment, involving the complete removal of the breast and the lymph nodes under the arm.
Modified radical mastectomy is one of the treatment methods for breast cancer. In modified radical mastectomy, the skin, breast tissue, nipple, areola, and lymph nodes under the arm are completely removed. However, none of the chest wall muscles are manipulated or removed. In this surgical method, breast reconstruction with implants can also be performed.
In this method, the skin, nipple, breast tissue, areola, and lymph nodes under the arm are completely removed, while the chest wall muscles remain untouched.
Unfortunately, in some cases, we are forced to use this method (which is not pleasant for us or the patient). In cases where the tumor is large and has not responded to preoperative chemotherapy or neoadjuvant therapy, or in cases where the tumor is multifocal and located in several points of the breast, there is no other way than modified radical mastectomy.
Regarding the removal of lymph nodes, it should be noted that in the past, a very large number of lymph nodes were removed, sometimes up to 60 lymph nodes were removed from under the arm. However, nowadays, especially in cases where we suspect lymph node involvement, we remove the sentinel lymph nodes and decide on removing the other lymph nodes under the arm based on the pathology results. This method greatly reduces the risk of arm swelling or lymphedema after breast surgery.
The overall goal of the MRM procedure is to remove all or most of the cancer, while preserving as much healthy skin tissue as possible. This allows the patient, if desired in the future, to undergo breast reconstruction surgery after complete recovery.
Patients undergoing modified radical mastectomy are placed under general anesthesia. The surgeon then marks the chest wall and prepares it for incision, pulling the skin back to empty the breast. Many of the lymph nodes under the arm will also be completely removed. Usually, the entire surgical procedure takes between two to four hours.
Radical mastectomy for breast cancer treatment
Radical mastectomy is one of the rare types of breast cancer surgery. This surgical method is used when the cancer has spread to the muscles of the chest wall. Otherwise, modified radical mastectomy can complete the treatment of breast cancer.
To treat breast cancer with radical mastectomy, all or most of the breast tissue, lymph nodes under the arm, nipple, and chest wall muscles are removed. Breast reconstruction surgery is also a suitable option for correcting the appearance of the chest wall.
Partial mastectomy (partial mastectomy) in breast cancer treatment
Partial mastectomy, used to treat breast cancer, is also known as partial mastectomy. In this surgical method, the tumor and a small margin of surrounding tissue are removed. Therefore, a significant portion of the breast tissue is preserved. During surgery, some of the lymph nodes in the breast or under the arm need to be evaluated. One of the complementary treatments for partial mastectomy is radiation therapy. Radiation therapy after lumpectomy helps to eliminate any remaining cancer cells in the breast tissue. The number of radiation therapy sessions will depend on the extent of the disease and the size of the tumor.
In partial mastectomy, the surgeon removes the tumor and a portion of the surrounding tissue. In this method, the patient will most likely need radiation therapy after surgery. Therefore, partial mastectomy is not suitable for pregnant women or those who cannot tolerate radiation. It should be noted that in cases where the tumor is large or the cancer has spread to tissue outside the breast, partial mastectomy is not recommended. All the methods introduced so far belong to relatively old methods, and today there are newer methods available that not only remove the tumor but also preserve the appearance of the breast. These methods include:
Breast Cancer Surgery with Breast Conservation and Oncoplastic Surgery
One of the best surgical methods that is very common today is breast cancer surgery with breast conservation, which in some cases is performed in the form of oncoplastic surgery.
In this surgical method, tumor removal, breast conservation, and breast cosmetic surgery (which may include breast reduction, breast lift, and breast augmentation) are performed simultaneously. This method is very common worldwide and is also performed in Iran by me and some of my esteemed colleagues.
Breast Reconstruction After Breast Cancer Surgery
Breast reconstruction is a procedure used for patients with breast cancer who have undergone mastectomy or removal of the affected breast during their treatment process.
Breast reconstruction involves replacing one or both breasts with a natural-looking, symmetrical, and appropriately sized form in individuals who have undergone unilateral or bilateral mastectomy. Additionally, in individuals who have undergone lumpectomy, the breast may not have a satisfactory appearance, or there may be congenital abnormalities in breast development, such as underdeveloped or asymmetrical breasts, requiring significant correction. In these cases, breast reconstruction may also be necessary. With breast reconstruction, patients can achieve a significantly natural appearance of their breasts. It is important to note that the reconstructed breast only looks similar to a natural breast and can never have natural functions such as lactation.
Chemotherapy
Chemotherapy is considered part of the treatment plan for breast cancer. In some cases, chemotherapy is done before surgery, and sometimes it is done after surgery. This method uses drugs to eliminate cancer cells.
When chemotherapy is done before surgery, it is called neoadjuvant chemotherapy. This method is used when the tumor is larger than 3 centimeters, which usually results in shrinking the tumor before surgery. Other cases where neoadjuvant chemotherapy is used include clear involvement of lymph nodes under the arm and in cases where the patient has metastatic breast cancer. In this case, chemotherapy is first performed, and then if the oncologist determines that surgery would be beneficial for the patient, we proceed with surgery. Chemotherapy is administered in the form of pills or intravenous injections daily, weekly, monthly, or every two weeks. The chemotherapy regimen is designed based on the patient’s condition, and they may receive one or more combination drugs.
In response to the common question from patients asking if chemotherapy leads to death, it should be noted that this treatment method has made significant progress in recent years, and the risks related to weakening the body’s immune system have significantly decreased. However, these issues will be explained to you by your doctor before starting treatment, and the advantages and disadvantages of each method will be carefully examined.
Hormone Therapy in Breast Cancer
Female hormones (estrogen and progesterone) are considered fuel for the activity of some cancer cells. In fact, these hormones help the growth and spread of cancer cells. Hormone therapy adds, blocks, or removes the desired hormones.
Hormone therapy for breast cancer can be used alone or in combination with other treatment methods chosen by the treating physician.
There are two types of hormone therapy for breast cancer:
Drugs that prevent estrogen and progesterone from supporting the growth of cancer cells.
Drugs or surgeries that stop the production of estrogen and progesterone hormones.
Hormone therapy is not applicable to all patients; it is performed in individuals who have estrogen and progesterone hormone receptors positive. In individuals who are receptor-negative, hormone therapy is usually not applicable.
One of the most common questions asked by patients receiving hormone therapy is about the duration of hormone therapy, or in other words, how long should hormone therapy be continued? Previously, this period was considered a 5-year interval, but in recent studies, this period has been extended to 7 to 10 years. The decision on the appropriate duration of hormone therapy for each individual is made by the esteemed medical oncology colleagues.
Radiation Therapy in Breast Cancer Treatment
In this method, cancer cells are destroyed by powerful radiation. Radiation therapy helps prevent the growth, division, or spread of cancer cells to other parts of the body. Since radiation therapy only targets cancer cells, it causes minimal damage to surrounding healthy cells.
Radiation therapy is used in the treatment of cancer in the following cases:
The patient has undergone surgery, the tumor has been removed, and the breast has been preserved.
Lymph nodes under the arm are involved.
The tumor size is large.
In the first case, i.e., preserving the breast, radiation therapy is definitive, but in the other two cases, the decision is made in consultation between the surgeon and the oncologist.
Finally, thank you for your time and attention, dear ones, for dedicating your time to your health and increasing your awareness. My heartfelt wish is for the health of each and every one of you. You can make an appointment and access contact information in the Contact Us section. You can also receive online consultation by following our Instagram page at @DrMoussazadeh.
Using Immunotherapy for Breast Cancer Treatment
Strengthening or preparing the body’s immune system for breast cancer treatment is considered one of the modern treatment methods. Immunotherapy aims to boost the body’s natural defense. In this way, the immune system can fight against cancer and attack cancer cells.
Immunotherapy can be used as a treatment method for triple-negative breast cancer. Additionally, this treatment method will be beneficial for improving patients with early-stage high-risk breast cancer.
Pembrolizumab is one of the most important drugs used in immunotherapy. This drug has been approved by the Food and Drug Administration (FDA) for the treatment of high-risk breast cancer and triple-negative breast cancer. Usually, the combination of pembrolizumab with chemotherapy drugs is used before breast cancer surgery. However, this immunotherapy drug will also be used in the completion process of breast cancer treatment after surgery. The duration of immunotherapy drug use will depend entirely on the patient’s condition and the specialist physician’s opinion.
Side Effects of Immunotherapy
Breast cancer treatment with immunotherapy drugs, like any other treatment method, can have side effects. Some of the side effects of pembrolizumab include:
- Skin rashes
- Flu-like symptoms
- Thyroid problems
- Diarrhea
- Severe weight changes
These side effects are the most common side effects of pembrolizumab. However, more severe side effects may occur in some individuals. It should be noted that the benefits of immunotherapy in improving the patient’s condition will be much greater than its side effects. To learn more about the use of immunotherapy in breast cancer treatment, you can talk to Dr. Farhad Mousazadeh.
Using PADTAN Therapy for Breast Cancer Treatment
One of the newest treatment methods for breast cancer is PADTAN therapy for breast cancer treatment. This method is also a type of immunotherapy. In fact, when the body’s immune system detects a harmful or intrusive agent in the body, it will produce the necessary antibodies to combat it. Antibodies are molecules or proteins that can attach to antigens and fight infections or harmful agents. Antigens are molecules that initiate an immune response in the body.
In PADTAN therapy for breast cancer treatment, monoclonal antibodies are produced in the laboratory. These antibodies also exist naturally in the body. However, the antibodies made in the laboratory are also injected into the body. Injecting these mentioned antibodies will prevent tumor growth or progression through various methods. Thus, PADTAN therapy can significantly help treat breast cancer. The function of monoclonal antibodies in the body will be as follows:
Preventing the spread of growth signals by cancer cells and limiting tumor cell division
Deactivating proteins located on the surface of cancer cells and disrupting their identification by the immune system
Preventing the immune system from attacking healthy cells
PADTAN therapy is performed using inhibitory agents produced in the laboratory. Some of these inhibitors include:
- Trastuzumab
- Pertuzumab
- The combination of pertuzumab, trastuzumab, and hyaluronidase
Side Effects of PADTAN Therapy for Breast Cancer
Although PADTAN therapy or the use of monoclonal antibodies has a significant impact on cancer treatment, its side effects should also be considered. The severity of the side effects of PADTAN therapy for breast cancer treatment depends on the type of drug. In fact, each injected drug has a specific target. Depending on the cellular mechanism affected by the drug, there will be multiple side effects.
However, most drugs related to the PADTAN therapy process for breast cancer may cause allergic reactions. For more information, you can ask your doctor about the possible side effects of the antibody used for you.
Postoperative Care for Breast Cancer
Postoperative care for breast cancer includes a set of factors such as timing of bathing, initiation of stretching exercises, care for the drain, and more. The drain is a device that removes excess fluids, and it must be emptied every 24 hours, with the amount recorded for presentation to the physician.
For postoperative care for breast cancer, it is recommended to rest at home for 4 to 6 weeks. However, individual activities can be resumed from the day after the surgery. Also, normal and light exercises like walking are not prohibited, but heavy exercises are not recommended for up to two months.
In the following article, we will discuss postoperative care for breast cancer to see how to return to normal life after this surgery.
Appropriate Exercises After Breast Surgery
Start exercising within 24 hours after surgery and after the drains are removed, with limited movements.
Ball Squeezes Exercise: Use a plastic ball placed under your palm, squeeze and release your hand.
Open and Close Hand Exercise (Ball Squeezes Exercise): Open and close your hand 15 to 25 times, repeat this movement 3-4 times a day. This helps accelerate the return of lymphatic fluid to the general circulation of the body.
Shoulder Shrugs Exercise: Sit up straight, place your elbows on the table, and shrug your shoulders forward and backward with one shoulder, then try to shrug your entire shoulder. You can do exercises for the elbow, hand, and operated arm. However, open and close arm exercises alongside the shoulder should start after removing the drains. Your arm should not stick continuously to your body. You can repeat the exercises at least twice a day and if you experience pain, you can rest for a while.
Breast Cancer in Men
Contrary to popular belief that breast cancer only occurs in women, men can also be affected by this type of cancer.
Breast cancer in men is very rare and mostly affects men over 60 years old. Men who are in the early stages of the disease usually have a very high chance of treatment. In this case, after removing the cancerous tissue, the doctor proceeds with complete treatment using radiation therapy or chemotherapy.
Life Expectancy of Breast Cancer Patients
The life expectancy of breast cancer patients depends on many factors, some of which are mentioned here:
- Race
- Patient’s age
- Extent of the disease
- Effectiveness of treatment
Best Breast Cancer Surgeon
One of the most important aspects of breast cancer treatment is to use appropriate treatment methods in a way that tumors and adjacent tissues are completely removed, and with the use of adjuvant therapies, the possibility of tumor recurrence is greatly reduced. Furthermore, surgery for the treatment of this cancer should be performed by the best breast cancer surgery specialist to not only effectively eliminate excess tumors but also preserve the aesthetic appearance of the breasts.
The best breast cancer surgery specialist is someone who has spent many years studying and, after completing general medical education, has specialized in general surgery and further in laparoscopic surgery, cosmetic surgeries, and breast cancer. In addition to knowledge and expertise, experience is also one of the most important factors in choosing the best breast surgeon. Moreover, the breast surgery specialist should be familiar with the latest surgical and breast cancer treatment methods and be able to provide the best consultation regarding the treatment process and the best treatment method for the patient, creating a sense of confidence in the patient about the effectiveness of the treatment process.Breast cancer treatment