Medical Management of Breast Cancer
Hey there, Bestie. Welcome back to another chat on breast cancer. Last time, we chatted about the prevalence of breast cancer and the diagnostic process. Today, we’re focusing on the medical management of breast cancer (A.K.A. how it is treated). The main treatment options for breast cancer are surgery, radiation, chemotherapy, and endocrine therapy. Let’s talk about each of these in a bit more detail.
Surgery for Breast Cancer:
Surgery is often the primary or initial treatment for breast cancer. When the cancer is contained to one localized area, it is used to remove the cancerous tissue from the breast. Types of surgery include modified radical mastectomy (MRM), lumpectomy or partial mastectomy, and axillary lymph node dissection (ALND) (1).
In MRM, the entire breast is removed, which may include the nipple, areola, axillary (arm pit area) lymph nodes, and some skin. Surgeons will try to spare as much noncancerous tissue as possible (nipple, skin, etc.). Importantly, the pectoralis major muscle that lies underneath the breast is spared, which helps to minimize upper extremity weakness and dysfunction after surgery (1). Some folks will choose to undergo a prophylactic mastectomy on the opposite breast, as well, in order to reduce the potential that cancer develops in that breast.
A lumpectomy or partial mastectomy is usually performed in cancers that are stage 1 or 2. The surgeon removes the cancerous lump and a margin of healthy tissue around it, but spares the breast. Some axillary lymph nodes may be removed as well to prevent the metastasis of the cancer. This type of surgery is often followed up with radiation.
ALND, also called axillary lymphadenectomy, is when a surgeon removes some of the lymph nodes of the axilla (armpit) region (2). This is done to avoid cancer spread as breast cancer may first metastasize to these axillary lymph nodes and then spread to elsewhere in the body.
Radiation Therapy Treatment:
Radiation therapy for breast cancer is typically in the form of external beam radiation to the chest wall. The radiation is provided in low doses over a long period of time, such as six or so weeks. Folks who elect to have breast-conserving surgeries will often also have radiation treatment as an adjunct and some folks who had MRM surgery will still need to undergo radiation.
Chemotherapy Treatment:
Chemotherapy, often shortened to “chemo,” is a cancer treatment that uses powerful and toxic drugs to kill the cancer cells that are present. These chemicals are toxic to cancer cells therefore help rid the body of cancer, but they can also be harmful to normal, healthy cells, as well. This is why there are many side effects associated with chemo treatment. Chemo may be used before or after surgical management of breast cancer. The dose and time of treatment will be specific to the patient and is determined by the oncologist. The goal of chemotherapy is to kill cancer cells, but sometimes these cells retreat into a dormant-like state rather than dying. This is why folks who have had chemotherapy treatment are monitored for years after their cancer has gone into remission. Some patients continue to take certain medications for years after they are deemed “cancer-free,” in case these dormant cells “wake up.”
Endocrine Therapy Treatment:
Certain breast cancers are hormone-receptor positive. These cancers grow in response to certain hormones, such as estrogen or progesterone (1). Endocrine therapy may be indicated for folks who have hormone-receptor positive breast cancer. One way of reducing the presence of estrogen in the body is by blocking ovarian function. This can be achieved either through surgery or medication (3). Oophorectomy, the surgical removal of the ovaries, is an option.
Each of the main treatment types for breast cancer comes with its own side effects and some of them have long term effects that can alter one’s quality of life. We’ll talk about these next time as we dig into how physical therapy plays a role in breast cancer rehabilitation. The most important part of breast cancer treatment is resolving the cancer and prolonging life. After that, physical therapy can be a huge help in restoring function and returning to the highest quality of life possible.
XOXO,
Your Pelvic Bestie
References:
1. Irion JM Irion G. Women’s Health in Physical Therapy. Wolters Kluwer Health/Lippincott Williams & Wilkins; 2010.
2. Toomey AE, Lewis CR. Axillary Lymphadenectomy. Updated 2023 Jul 24.
3. American Cancer Society. https://www.cancer.org/cancer/types/breast-cancer/treatment/hormone-therapy-for-breast-cancer.html
*The information contained in this article is for educational and informational purposes only and is not intended as health or medical advice. Always consult a qualified health provider regarding any questions you may have about a medical condition or health objectives
