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A number of treatment options at the Saul and Joyce Brandman Breast Center - A Project of Women's Guild are available for women with breast cancer, including:
- Radiation Therapy
- Hormone Therapy
- Integrative Medicine
- Women's Health
- Physical Therapy
- Physical Therapy for Lymphedema
A woman's treatment options depend on a number of factors. These factors include her age and menopausal status, her general health, the size and location of the tumor and the stage of the cancer. In addition, the results of lab tests and the size of her breast are considered. Certain features of the tumor cells (such as whether they depend on hormones to grow) are also considered. a very important factor is the stage of the disease. The stage is based on the size of the tumor and whether the cancer has spread.
Chemotherapy is a drug used to kill cancer cells. Chemotherapy for breast cancer is usually a combination of drugs. The drugs may be given in a pill or by infusion. Either way, the drugs enter the bloodstream and travel throughout the body.
Most patients have chemotherapy in an outpatient part of the hospital, at the doctor's office or at home. Depending on the drugs and her general health, a woman may need to stay in the hospital during her treatment.
Chemotherapy is given in cycles. A typical treatment cycle generally lasts for about three to six months. Each treatment period is followed by a recovery period. Some common drug combinations used to treat breast cancer include CMF (cyclophosphamide, methotrexate and fluorouracil), CAF (cyclophosphamide, adriamycin and fluorouracil), AC (cyclophosphamide and adriamycin) and CEF (cyclophosphomide, epirubicin and fluorouracil).
Sometimes, another drug called paclitaxel is given after AC chemotherapy.
Neoadjuvant therapy is chemotherapy given prior to surgery, usually to shrink the tumor. Chemotherapy may still be required after surgery as well.
Side effects of chemotherapy include fatigue, nausea and vomiting (this is often successfully treated with anti-nausea medications). Lowered white blood cell counts and increased risk of infection, mouth sores, temporary hair loss and a tendency for premenopausal women to go through early menopause may also result.
Radiation therapy (also called radiotherapy) is the use of high-energy rays to kill cancer cells. The radiation may be directed at the breast by a machine (external radiation). The radiation can also come from radioactive material in thin plastic tubes that are implanted directly in the breast (implant radiation). Some women have both kinds of radiation therapy.
For external radiation therapy, the patient goes to the hospital or clinic, generally five days a week for several weeks. For implant radiation, a patient stays in the hospital for several days with the implants. They are removed before she goes home.
Radiation therapy generally follows breast-sparing surgery, such as lumpectomy and segmented (or partial) mastectomy. Sometimes, depending on the size of the tumor and other factors, radiation therapy is also used after mastectomy. The radiation destroys breast cancer cells that may remain in the area.
Before surgery, radiation therapy, alone or with chemotherapy or hormone therapy, is sometimes used to destroy cancer cells and shrink tumors. This approach is most often used in cases in which the breast tumor is large or not easily removed by surgery.
There are two methods of hormone therapy. One uses drugs that change the way hormones work. The other is surgery to remove the ovaries, which make female hormones. Like chemotherapy, hormonal therapy can treat cancer cells throughout the body.
Some tumors rely on female sex hormones to grow. Tumors that test positive for hormones are more likely to respond to hormonal drugs. Research suggests that two-thirds of all breast cancer tumors test positive for estrogen receptors. About two-thirds of these also test positive for progesterone receptors.
Hormone therapy, such as tamoxifen, can destroy tumors by blocking their access to estrogen. Tumors with hormone receptors tend to grow less aggressively. Women with these types of tumors can expect better outcomes. Tamoxifen is generally taken for a period of two to five years. However, the ideal length of treatment is not known.
Tamoxifen is generally well tolerated. Side effects include a small increased risk of uterine cancer or blood clots.
For premenopausal women, another type of hormonal therapy can be used. Doctors can remove the ovaries (oopherectomy) or use drugs so the ovaries will not cycle and make estrogen. Today, this is rarely used now that tamoxifen is available. However, further research is looking at whether this treatment can improve the outcome when added to chemotherapy and tamoxifen.
Hormone therapy is not given to women whose tumors are hormone-receptor negative (do not contain estrogen or progesterone receptors). Instead, these women usually receive chemotherapy alone after surgery. Studies are ongoing to determine the optimal therapy for estrogen-receptor negative tumors.
Questions you may want to ask your doctor about hormone therapy:
- Why do I need this treatment?
- If I need hormone therapy, which would be better for me - drugs or surgery?
- What drugs will I be taking? What will they do?
- Will I have side effects? What can I do about them?
- How long will I be on this treatment?
Integrative Medicine is the blending of complementary and alternative therapies with treatments being done by the rest of the Saul and Joyce Brandman Breast Center - A Project of Women's Guild team. This helps provide a more holistic approach to your overall care and treatment. Acupuncture, a type of alternative therapy, is an ancient healing art that harnesses the body's natural energy. It helps to balance the body's energy and restore the natural energy flow. Acupuncture has been found to relieve nausea and fatigue caused by chemotherapy. Our Integrative Medicine practitioner is a licensed MD who works closely with the Women's Health specialists to prescribe herbs that can reduce the side effects of chemotherapy. Lifestyle modification counseling, including changes in your diet and activity, is also available to maintain wellness.
When breast cancer strikes, it's important to take a comprehensive approach to your care. The Women's Health physicians at the Saul and Joyce Brandman Breast Center - A Project of Women's Guild specialize in dealing with the health concerns in woman being treated for breast cancer. Therapy for breast cancer can often bring about an early menopause or exacerbate menopausal symptoms in women who have gone through the transition. Once diagnosed with cancer, women are commonly advised to stop hormone therapy and are faced with the challenge of seeking safe and effective alternative treatments for their menopausal symptoms. The Women's Health physicians have expertise in treating menopausal symptoms and health issues related to the menopausal transition. Effective non-hormonal treatments for breast cancer patients are available for osteoporosis, sexuality issues, hot flashes, night sweats, and vaginal and urinary symptoms. This may include the use of non-hormonal medications, nutritional counseling, herbs and complimentary therapies.
The Women's Health physicians also provide care to women at high risk for developing breast cancer. Our physicians have specialized knowledge and expertise to assist high-risk women in making the difficult decision to start or continue hormone therapy. Additionally, high-risk women are counseled on lifestyle habits that promote breast health.
Our Women's Health team is committed to providing comprehensive healthcare to women diagnosed with breast cancer. At a time of increasing health demands, it is vitally important to take the best possible care of yourself. We welcome the opportunity to become your partner in health.
Outpatient physical therapy can be very helpful in returning a patient to their normal function following breast cancer surgery. During evaluation, pain complaints, posture, ability to reach, strength, joint mobility, incision site healing, and nerve mobility are examined. Additionally, baseline circumference measurements of the arms are taken. Patient education regarding skin care and the prevention of lymphedema and infections of the arm following lymph node removal are reviewed.
Common problems occurring soon after lumpectomy or mastectomy include decreased ability to move the arm due to pain or tightness, mild weakness due to post surgical discomfort, and post surgical swelling of the lower arm. Early physical therapy treatment of these problems can accelerate patient healing to return to a normal level of activity as soon as possible.
Physical therapy treatment techniques include gentle stretching, massage techniques to improve incision site healing and range of motion, joint mobilization, postural reeducation, strengthening, nerve gliding, and home exercise programs.
Lymphedema is a swelling condition that sometimes occurs following surgical removal of lymph nodes. Early treatment of this swelling helps to reduce the amount of therapy needed with the least amount of lifestyle changes.
The treatment of lymphedema is carried out by a physical therapist certified in its treatment. Lymphedema treatment consists of complete decongestive therapy, including manual lymphatic drainage, short stretch compression bandaging, exercise, and skin care. Long-term independent management of lymphedema is encouraged with the use of compression garments, self-bandaging, and patient education.
17 Steps for Prevention of Lymphedema
The National Lymphedema Network has the following guidelines for patients who are at risk of developing lymphedema and patients who have developed lymphedema.
Anyone who has had either a simple mastectomy, lumpectomy or modified radical mastectomy in combination with axillary node dissection and often radiation therapy may be at risk for lymphedema. Lymphedema can occur immediately after an operation, within a few months, a couple of years, or even 20 or more years after cancer therapy. With proper education and care, lymphedema can be avoided or, if it develops, kept under control.
The following instructions should be reviewed carefully before your procedure, and discussed with your physician or physical therapist.
- If you notice a development of swelling in your arm or hand, even if slight, consult with your physician for a lymphedema evaluation. Lymphedema is much easier to treat if caught early.
- Never allow an injection, IV or a blood drawing in the affected areas (s), unless it is an emergency.
- Have blood pressure checked in the unaffected arm.
- Be sure your arm has full range of motion after surgery. If you are having any difficulty moving your arm, physical therapy may be of benefit. Consult your physician about a referral for physical therapy.
- Keep the swollen arm, or "at-risk" arm, spotlessly clean. Use lotion after bathing. Make sure your arm is dry in any creases and between the fingers.
- For the fist month to six weeks after surgery, avoid any heavy lifting with the affected arm. Avoid carrying bags with over-the-shoulder straps.
- Be sure that the jewelry and clothing that you wear is loose fitting and is not too tight on your arm or hand.
- If your arm is swollen, avoid saunas and hot tubs as the extreme heat may cause an increase in your swelling.
- Use sunscreen to avoid blisters and burns on the affected arm.
- Wear gloves while doing housework, gardening or any type of work that could result in a scratch or cut. If a cut or scratch does occur, cover it with an antibacterial ointment and band=aid until it is well healed.
- When manicuring your nails, avoid cutting your cuticles. You may, however, push your cuticles back.
- Make every effort to return to your previous exercise level slowly. If your arm becomes sore after exercise, decrease the intensity immediately. If you use weights to exercise, decrease the amount of weight and/or number of repetitions initially.
- When traveling by air, patients with lymphedema should wear a compression sleeve and gauntlet. Additional bandages may be required on a long flight. Increase fluid intake while in the air. Avoid caffeine and alcohol and try to get up and walk around at least once an hour.
- Use extra care when shaving your armpit, as you may have some numbness in the area after surgery.
- If your arm begins to feel full or heavy, consult your physician about a possible physical therapy evaluation in order to have your baseline arm-girth measurements taken for future reference.
- Warning: If you notice a rash, blistering, redness, fever or an increase of arm temperature, see your physician immediately. An inflammation or infection in the affected arm could be the beginning, or a worsening of lymphedema.
- Maintain your ideal weight with a well-balanced, low sodium, high-fiber diet. Avoid smoking and alcoholic beverages. Lymphedema is a high protein edema, but eating too little protein will not reduce the protein element in the lymph fluid. Rather, this will weaken the connective tissue and worsen the condition.