Breast Cancer Treatment

Written by : Dr.M.D.Mazumdar, MD

Inflammatory breast cancer is considered a locally-advanced breast cancer. It can be treated with different types of treatment - chemotherapy, surgery, radiation therapy, targeted therapy and hormone therapy, depending on the stage of the disease.

Treatment Options

Treatment options depend on:

• Stage of the Disease: In most cases, inflammatory breast cancer is already in Stage III by the time it is diagnosed.

• Patient's overall health: The general health of the patient determines if she can get surgery and chemotherapy or whether targetted therapy and supportive therapy will be the best option for her.

• Possible Side effects: Possible side effects of different chemotherapy drugs need to be taken into consideration.

The first line of treatment in different types of breast cancers is usually surgery ( mastectomy ). But in case of inflammatory breast cancer, treatment generally starts with chemotherapy. Chemotherapy should be started within a week or days of the diagnosis since the tumor is very aggressive and spreads fast. Chemotherapy helps in controlling the spread of the cells.

Chemotherapy also helps in shrinking the size of the tumor so that surgery can ensure complete removal of the cancerous cells. Radiotherapy may also be necessary after surgery.

So a multimodal treatment regime is used: Chemotherapy -> Surgery -> Radiotherapy.

Treatment options for IBC include:

Chemotherapy: Medicines llike Adriamycin (chemical name: doxorubicin) or Ellence (chemical name: epirubicin) may be used. Another important chemotherapy medicine is Taxol (paclitaxel) .

Chemotherapy drugs may be used alone but is usually used in combinations of two or three drugs. Common chemotherapy combinations for inflammatory breast cancer may include:

• AC or EC (doxorubicin and cyclophosphamide or epirubicin and cyclophosphamide) followed by T (paclitaxel or docetaxel)

• TAC (docetaxel, doxorubicin, and cyclophosphamide)

Targeted therapy: Targeted therapy is a treatment that targets the cancer's specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. These treatments are very focused, and they work differently than chemotherapy. This type of treatment blocks the growth and spread of cancer cells while limiting damage to healthy cells.

Tests are carried out on the tissue sample after breast biopsy to identify the specific molecular targets.

HER2 is a specialized protein found on breast cancer cells that controls cancer growth and spread. If the tissue sample tests positive for HER2 receptors, then medicines like Herceptin (chemical name: trastuzumab) may be used in addition to having chemotherapy.

Hormone Therapy: Hormone therapy, also called endocrine therapy, is an effective treatment for breast cancer that tests positive for either estrogen or progesterone receptors (called ER positive or PR positive). This type of therapy is generally prescribed for 5 years - but it may be extended to 10 years if there is a risk of recurrence of the cancer. It can be started together with either radiotherapy or after surgery. The common drugs used are:

• Tamoxifen.
  
• Anastrozole (Arimidex).
  
• Exemestane (Aromasin)
  
• Letrozole (Femara)

Surgery: Surgery may consist of simple mastectomy if the tumor is caught at a very early stage. But usually, modified radical mastectomy with removal of lypmh nodes (axillary lymph node dissection) needs to be carried out since inflammatory breast cancer invariably spreads to the lymph nodes before it is diagnosed. Surgery may be followed by chemotherapy,targetted therapy or hormone therapy.

Radiotherapy: Adjuvant radiation therapy is nearly always recommended for people with inflammatory breast cancer after mastectomy, because of the high risk of cancer cells remaining in the chest wall.

An external beam radiotherapy is given to the chest wall for 5 days every week for 5 to 6 weeks.It is aimed to destroy any cancer cells in the chest wall under the breast that was removed. It may also be needed if the inflammatory breast cancer does not respond to chemotherapy or targeted therapy.