Treatment

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cancer care plan

Cancer Care Plan

The Commission on Cancer requires that all patients undergoing treatment for cancer receive a care plan.

Breast cancer care plans should include two components: treatment and survivorship.

Treatment Care Plan

A plan should be developed before you begin treatment
It can help guide you as talk with your doctor about what is important to you (such as treatment options, benefits, and potential side effects)
The treatment plan can be shared with other doctors or healthcare providers

Survivorship Care Plan

A follow-up care plan should be developed when you have completed treatment
Breast cancer survivors need to be monitored for the rest of their lives and have different health care needs than before they were diagnosed
A Survivorship Care Plan helps to ensure that you and all of the members of your health care team know what follow-up is needed, when it is needed, and who you should see for that care

Surgery

Surgery is usually the first line of attack against breast cancer.

The type of surgery you have will depend on your stage at diagnosis, biological factors, and your personal choice.

Lumpectomy (breast-conserving surgery) is the removal of only the tumor and a small amount of surrounding tissue.

Mastectomy is the removal of all of the breast tissue.

Lymph node removal (axillary lymph node dissection) can take place during lumpectomy and mastectomy if the biopsy shows that breast cancer has spread outside the milk duct.

Sentinel lymph node dissection is less-invasive lymph node removal

Breast reconstruction is the rebuilding of the breast after mastectomy and sometimes lumpectomy.

Prophylactic mastectomy is preventive removal of the breast to lower the risk of breast cancer in high-risk people.

Prophylactic ovary removal is a preventive surgery that lowers the amount of estrogen in the body, making it harder for estrogen to stimulate the development of breast cancer.

Cryotherapy (cryosurgery) is an experimental treatment that uses extreme cold to freeze and kill cancer cells.

Please consult your physician or healthcare provider to learn more about surgery.

radiation theraphy

Radiation therapy (or radiotherapy) is a targeted and effective way to destroy cancer cells in the breast that may stick around after surgery. It is relatively easy to tolerate and its side effects are limited to the treated area. Radiation therapy uses a special kind of high-energy beam to damage cancer cells by slowing or stopping them from growing and multiplying.

Cancer cells are more easily destroyed by radiation than healthy, normal cells.

Radiation can be delivered by:

A linear accelerator that delivers radiation from outside the body
Pellets or seeds that give off radiation beams from inside the body

Radiation therapy is used to treat all stages of breast cancer :

Stage 0 through stage III breast cancer after lumpectomy or mastectomy
Stage IV cancer that has spread to other parts of the body

Radiation is not an option for you if you:

Have already had radiation to that area of the body
Have a connective tissue disease (scleroderma or vasculitis)
Are pregnant
Cannot commit to a daily schedule of radiation therapy

Please consult your physician or healthcare provider to learn more about radiation therapy.

traditional CHEMOTHERAPY

Chemotherapy (or chemo) affects the whole body by going through the bloodstream.

It prevents cancer cells from growing and spreading by destroying the cells or stopping them from dividing.

It weakens and destroys cancer cells at the original tumor site and throughout the body.

Chemotherapy is used to treat:

Early-stage invasive breast cancer to get rid of any cancer cells that may be left behind after surgery and to reduce the risk of the cancer coming back
Advanced-stage breast cancer to destroy or damage the cancer cells as much as possible

Adjuvant Chemotherapy is used to treat early-stage breast cancer and is given after surgery.

Neoadjuvant Chemotherapy is used to shrink the cancer and is given before surgery.

Women usually receive 2-3 chemotherapy medicines to treat breast cancer
In early stage breast cancer, these combinations lower the risk of the cancer coming back
In advanced breast cancer, these combinations make the cancer shrink or disappear in about 30-60% of people treated

Most standard chemotherapy regimens include a medicine from these groups:

Anthracyclines are chemically similar to an antibiotic; they damage the genetic material of cancer cells, causing them to die.
Adriamycin, Ellence, and Daunorubicin are anthracyclines

Taxanes interfere with the way cancer cells divide.
Taxol, Taxotere, and Abraxane are taxanes

Please consult your physician or healthcare provider to learn more about chemotherapy.

Precision therapy

Personalized Medicine

A form of medicine that uses information about a person’s genes, proteins, and environment to prevent, diagnose, and treat disease.

In breast cancer, personalized medicine uses specific information about a person’s tumor to help diagnose, plan treatment, find out how well treatment is working, or make a prognosis.

Examples of personalized medicine include using targeted therapies to treat specific types of cancer cells, such as HER2-positive breast cancer cells, or using tumor marker testing to help diagnose cancer.

Personalized medicine describes tailoring breast cancer treatment to provide the most effective treatment for each woman's disease.

The following information is needed:

Genetic
Personal characteristics, such as lifestyle factors
Tumor characteristics

Please consult your physician or healthcare provider to learn more about personalized/precision medicine.

IMMUNOTHERAPY

Immunotherapy medicines use the power of your body’s immune system to attack cancer cells
They work by helping your immune system work harder or smarter to attack cancer cells
Immunotherapy uses substances made by your body or in a lab to improve the function of the immune system by allowing the immune system to stop or slow the growth of cancer cells or stop cancer from spreading to other parts of the body

Please consult your physician or healthcare provider to learn more about immunotherapy.

HORMONAL THERAPY

Hormonal therapy medicines treat hormone-receptor-positive breast cancers by:

Lowering the amount of the hormone estrogen in the body
Blocking the action of estrogen on breast cancer cells

Most of the estrogen in women's bodies is made by the ovaries
Estrogen makes hormone-receptor-positive breast cancers grow
Reducing the amount of estrogen or blocking its action can reduce the risk of early-stage hormone-receptor-positive breast cancers from coming back (recurring) after surgery
Hormonal therapy medicines can also be used to help shrink or slow the growth of advanced-stage or metastatic hormone-receptor-positive breast cancers

Types of hormonal therapy medicines include:

Aromatase inhibitors
Selective estrogen receptor modulators
Estrogen receptor downregulators

Please consult your physician or healthcare provider to learn more about hormonal therapy.

Clinical trials

Clinical Trials

Clinical trials are important in discovering new treatments for and new ways to detect, diagnose, and reduce the risk of breast cancer.

Clinical trials show researchers what does and doesn’t work and help doctors decide if the side effects of a new treatment are acceptable when weighed against the benefits offered by the new treatment.

Clinical trials are conducted in four phases.

Each phase builds on the results of the previous phase.

Phase I: Safety

Phase I trials are small, with usually between 15 to 50 people participating, to learn the:

Best way to give a new treatment (as an injection or as a pill)
Highest dose that can be given safely, without serious side effects

Phase II: Effectiveness

Phase II trials are slightly larger than phase I trials and usually involve 25 to 100 people, to learn the benefits of the treatment:

Tumor gets smaller
Cancer stops growing
Longer time before the cancer comes back
Longer survival time
Better quality of life

Phase III: General Use

Phase III trials are usually large (up to tens of thousands of participants) and are the last step a new treatment goes through before the U.S. Food and Drug Administration considers approving it for general use.

Phase IV: Long-term Benefits & Side Effects

Phase IV trials usually are done after a treatment has been approved for use by the U.S. Food and Drug Administration and may involve hundreds of thousands of people.

Clinical Trial Facts

Less than 5 percent of adult cancer patients overall participate in clinical trials, and the rate is even lower for patients from African Americans.
Some of the concerns that keep people from joining clinical trials arise from misperceptions about how clinical trials work.
Patients don’t know to ask about clinical trials and their doctors don’t mention them.
A common misperception is that clinical trials are only for patients with advanced cancer.
Clinical trials focus on all cancer stages.

The top concerns related to clinical trial participation include:

Worry over side effects/safety (55%)
Uncertainly about insurance and out-of-pocket costs (50%)
Inconvenience of trial locations (48%)
Concerns about getting a placebo (46%)
Skeptical of a treatment that is not yet proven to work (35%)
Worries over feeling like “guinea pigs” (34%)

Please consult your physician or healthcare provider to learn more about participating in a clinical trial.