Treatment depends on type of cancer and its stage of evolution. The surgery is an integral part of the treatment of the vast majority of breast cancers.

biopsy

A biopsy involves taking a sample of the tumor for examination. The tests performed on it will influence the choice of treatment. It is first necessary to know if the tumor is cancerous then if it is the case, to know the type of cancer. Tests done on the tumor sample also tell the doctor how advanced the cancer is and whether its growth can be stimulated by sex hormones (that is, whether the tumor is “hormone-dependent”).

Here is 3 of the test practice :

• Estrogen hormone receptor assay test and progesterone receptor assay test. In order to find out if cancer growth can be stimulated by estrogen or progesterone;
• You test HER2. In cases of invasive cancer only, a genetic test is performed to determine the degree of activation of the HER2 gene. When this gene is strongly activated, it indicates that the cancer is likely to grow faster. This is the case for about 10% of invasive cancers.

Treatments

There are 5 categories of treatments:

• surgery;
• radiotherapy;
• chemotherapy;
• hormonal therapy;
• targeted therapy.

surgery

La surgery is often the first treatment undertaken. It is used to remove the cancerous tumor. In the case of breast cancer, it is called mastectomy. The mastectomy is partial or segmental (part of the breast is removed) or total (the entire breast is removed). Surgery is almost always added to the lymph nodes in the armpit. The choice of the type of mastectomy is based, among other things, on the tumor size, its type and location in the breast. The preference of the woman is also taken into account.

• Partial mastectomy or lumpectomy. The surgeon removes the cancerous tissue (tumor) as well as some healthy tissue around the tumor. It is also called breast conserving surgery;
• Total mastectomy. The breast is completely removed: mammary glands, fatty tissue, nipple and skin. It is chosen when it is not possible to do a partial mastectomy. This is done in about 20% to 25% of breast cancer cases. Depending on the case, a breast reconstruction can be performed at the same time as the mastectomy or at a later time;
• Lymph node surgery. In order to determine the stage of the disease and to choose the best treatment after surgery, it is almost always essential to know whether the cancer has reached the lymph nodes located in the pit of the skin.armpit, on the affected side. These nodes drain the lymph that circulates in the breast. This can be done either by removing only the first nodes in this chain (this is called a sentinel node (s) biopsy) or by removing the entire chain. This removal sometimes causes complications, such as lymphedema in one arm (affected side). Lymphedema is an accumulation of lymph. It is caused by the disruption of the usual drainage pathways. It is rarer if only the sentinel nodes are removed. To learn more about its prevention and treatment, see the box below.

Radiotherapy

Partial mastectomy should usually be followed by radiotherapy in order to destroy the cancer cells that may have remained in the breast. It reduces the risk of a tumor coming back.

In case of total mastectomy, radiotherapy is not always necessary. To find out more about this treatment, see our Cancer file.

Chemotherapy

La chemotherapy uses a class of pharmaceuticals, called antineoplastics, to treat cancer. For breast cancer, it is usually given after surgery. It destroys cancer cells that have escaped from the main tumor. Whether or not to start chemotherapy depends on the stage ofdisease course. To find out more about this treatment, see our Cancer file.

Hormonal therapy

La hormonal therapy is, most of the time, combined with surgery, radiation therapy or chemotherapy.

If examination of the tumor shows that the cancer has hormone receptors, its development is therefore stimulated by sex hormones (estrogen and progesterone). Certain medicines can slow or stop the progression of such cancer by blocking the action of hormones.

There are 2 types of drugs anti-hormonal :

• The antiestrogens, such as tamoxifen (Nolvadex-D®) which binds to the surface of cancer cells, to receptors normally occupied by estrogen. This drug is administered orally in tablet form;
• The aromatase inhibitors : anastrozole (Arimidex®), letrozole (Femara®) and exemestane (Aromasin®). They prevent the production ofestrogen by fatty tissues and adrenal glands. These drugs are only used in postmenopausal women. These are also tablets administered orally.

Targeted therapy

Sometimes in women with invasive breast cancer, cancer cells overexpress the HER2 gene. This causes the tumor to grow faster. When this is the case, a drug can be given, trastuzumab (Herceptin®), which specifically blocks the action of the HER2 gene. This medication is administered by intravenous injection.

The search continues to find other biological therapies. This type of treatment usually causes fewer side effects than chemotherapy and hormonal therapy because it is more targeted.