Breast Cancer Treatment
The Path to Conquering Breast Cancer
Pooja Gadireddy and Dr.Lopamudra Das Roy
Published 2020
@BreastCancerHub, All Rights Reserved
Background Information
Breast cancer is a disease caused by an abnormal growth of cells in the breast area (typically the ducts or lobules located within the breast). This form of cancer is the second most prevalent in women while being uncommon in men, with over 200,000 cases yearly in the US alone. This form of cancer spreads when the cancer cells penetrate adjacent organs or other parts of the body or when breast cancer cells move to other parts of the body through the blood vessels and/or lymph vessels. This is called metastasis.
Now, onto the anatomy of the breast. Knowing the basic anatomy of the breast will better help patients understand why a certain course of treatment for them at their particular stage. The breast consists of multiple different types of tissues (fatty, fibrous, dense, etc.). Within the breast, there are small, tubular structures called lobules. These lobules contain mammary ducts also known as milk ducts. These mammary ducts connect to the glands, lobules, and lobes, carrying milk from the lobes to the nipple which is located in the middle of the areola (the darker area that surrounds the nipple).
Throughout the breast, lymph fluid and blood run to nourish the cells and to get rid of waste products. The lymph vessels are connected to lymph nodes to fight infection. Clusters of lymph nodes are located in various parts of the body, such as in the neck, groin, and abdomen. The lymph nodes near the breast, for example, the lymph nodes present under the arm, are known as regional lymph nodes.
Breast cancer can be labeled either invasive or non-invasive. Invasive breast cancer is when the cancer spreads into surrounding tissues and/or distant organs while non-invasive breast cancer is when the breast cancer cells don’t go beyond the milk ducts or lobules located within the breast. Furthermore, there are multiple types of breast cancer, all of which fall under the invasive or non-invasive category with some being common and some being rather rare.
The most common types are invasive ductal carcinoma and invasive lobular carcinoma. Invasive ductal carcinoma makes up about 70-80% of all breast cancers. Ductal carcinoma in situ is a non-invasive cancer that is contained within the duct. Another type of invasive breast cancer is triple-negative which is an aggressive type of invasive breast cancer that accounts for about 15% of all breast cancers, making it very difficult to treat. The only remaining invasive breast cancer is inflammatory breast cancer which is a rather uncommon form of invasive breast cancer as it only accounts for about 1% to 5% of all breast cancers. Following the uncommon theme, sarcomas of the breast make up less than one percent of all cases. Angiosarcomas start in cells along blood/lymph vessels. It can involve the breast tissue or the skin of the breast. Some may be related to prior radiation therapy in that area. Another form of breast cancer is named Paget disease. It starts in the ducts and spreads to the nipple and areola (the dark circle around the nipple). It is rare, accounting for only about 1-3% of all cases of breast cancer. The last form of breast cancer is present as phyllodes tumors which are rare breast tumors. They develop in the tissue of the breast. Most cases of phyllodes tumors are benign, but not all [1,2,3].
Steps to Treating Breast Cancer
Aside from the vast assortment of breast cancer, doctors label them by stages depending on the extensiveness of the breast cancer. These stages range from 0-4 with 0 being non-invasive and stage 4 being extremely invasive. Determining the stage at which the cancer is at, it crucial to coming up with a beneficial and impactful treatment plan. Along with the stage of breast cancer, there are still other factors needed to piece together a course of treatment. These other factors include the patient's overall health and ability to go through with certain treatments, the rate at which the cancer is spreading, and whether or not the patient has the HER2 protein and/or hormone receptors. Treatment typically ranges from $20,000 to $100,000 but it varies greatly depending on the course of treatment (dictated by the stage the breast cancer is at), insurance, post-surgical costs, medicines. Overall, there are many factors that go into treatment and it’s so specific based on the person that there is no set way to put an average cost or a cost efficiency rate. The more important thing is making sure you are receiving quality care [4,5].
The Stages
All cancers, including breast cancer, are denoted by a certain numerical stage depending on the extensivity of the cancer. Breast cancer is scaled from stage 0 to stage 4. Stage 0 means that the cancer is limited to the inside of the milk duct and is non-invasive. Following stage 0 is stage 1 which is defined when the breast cancer is still contained within a small area and/or has little to no cancerous cells on the sentinel lymph node (the first lymph node to which cancer is likely to spread). As the cancer progresses, it can be denoted as stage 2 which is when the cancer has begun to spread to lymph nodes. Stage 3 follows stage 2 and can be labeled as when the tumors are larger or are growing into nearby tissues (the skin over the breast or the muscle underneath), or they have spread to multiple nearby lymph nodes. The most advanced stage of breast cancer is stage four and is defined when the cancer cells have spread beyond the breast and nearby lymph nodes and have started to attack other nearby parts of the body. Now, onto the typical treatments, a patient might expect to hear from a doctor or oncologist. Common treatments include surgery and various therapies. Depending on the stage, it could be a lumpectomy, mastectomy, or double mastectomy.
Surgical Treatments
The suffix -ectomy means the surgical removal of something, therefore, lumpectomy is the surgical removal of the lump of cancerous cells, a mastectomy is the surgical removal of one breast, and a double mastectomy is the removal of both breasts. Based on the stage of breast cancer, there are both safe and conservative treatments. For example, if you were diagnosed with stage 1 cancer that is contained within a small lump, the safe option would be a single mastectomy but, the more common and conservative choice would be to receive a lumpectomy while risking the chance of recurrence or not being able to get rid of all the cancerous cells [6].
Therapeutic Treatments
Common therapies performed on cancer patients include radiation, drug, and chemotherapy. Radiation therapy is commonly used before surgery if the tumor is not easily accessible in efforts to shrink the tumor. Drug therapy is typically done at stage 4 to lessen the chance of recurrence and chemotherapy is done by injecting or ingesting anti-cancer drugs to either shrink the tumor or to kill off any remaining cancer cells after surgery. Along with the three other therapies previously mentioned, immunotherapy and target therapy are also commonly used when treating cancer, including breast cancer. Immunotherapy works by injecting drugs that render the immune system to attack and destroy the cancer cells. Similar to immunotherapy, hormone therapy is done by injecting certain drugs into the body to stop hormones (estrogen and progesterone) from attaching to receptors (proteins) that help the cancerous cells flourish [7,8].
Complications and Symptoms
As with any medical procedure or treatment, there are always possible complications that a person might experience. While undergoing treatment, it is important to understand that not everything is 100% guaranteed but with that in mind, it’s crucial to keep an optimistic view of life and to always think of the possibilities. These complications can vary based on the type of treatment (Surgical, Therapy, etc.) and also from patient to patient.
Surgical Complications
If you were to treat cancer surgically, some possible complications and symptoms that you might experience include seromas, hematomas, and lymphedemas. Seromas are when there is a build-up of fluid under the skin, not blood because then it would be classified as a hematoma. Seromas and hematomas will typically go away on their own but sometimes, if it’s causing discomfort or is present for a prolonged period of time, it will most likely be aspirated with a needle.
Lymphedema is the most common surgical complication when dealing with breast cancer that is caused by lymphatic fluid accumulating in the tissues. To check if you have lymphedema after surgery, look for swelling of the arm or hand on the side of the surgery. It can occur if the breast cancer tumor is big enough or in a location that blocks the lymph system. Depending on the location and accessibility, some lymph nodes or vessels that carry lymph fluid might be removed for better access to terminate the cancerous cells in the breast. Radiation treatment might also damage the lymph vessels. Lymphedema can be broken into two types: primary and secondary. Primary lymphedema occurs when lymphatic vessels are missing or damaged whereas secondary lymphedema occurs as a result of lymph vessels and/or nodes being either removed or damaged.
Although lymphedema is a common complication of treating breast cancer surgically, there is, unfortunately, no cure for it. On the bright side, there are many ways to help cope or lessen the visibility/effect or pain caused. For example, your doctor might recommend draining the lymph fluid if it is overly painful or irritative. There are also compression bandages and sleeves that can be worn to minimize the appearance of the lymphedema temporarily and can also be helpful in trying to eradicate some of the pain. There are also many exercises that one can do to reduce the pain and effects of lymphedema as well as possibly preventing it. For these exercises, it is recommended that you pair it with daily or routine use of compression sleeves/bandages. Exercises can be as simple as squeezing a stress ball or just simply moving your arm around. To help reduce the effects and lessen the pain of post-surgical lymphedema, squeezing a stress ball for 5-7 minutes, either standing or sitting is a great and simple way as well as performing elbow flexions to work the upper arm (can be done simultaneously with ball squeezes). Another simple exercise you can do is shoulder abductions [11] (spread your arms to be at your side, extend your arms horizontally as shown in figure A), flexions [12] (put your arms at your side and lift them to be over your head yet, in front of you as pictured in figure B), and adductions [13] (spread your arms to be at your side, extend your arms horizontally and bring them inwards as denoted in figure C). Once again, it is recommended to do all these exercises with compression dressings/sleeves along with holding a small weight but nothing too heavy as the weight is just to create slight tension.
Source: References 11, 12, 13
In addition to lymphedema, there are other complications and side effects that are possible when undergoing breast cancer treatment that doesn’t occur to only those receiving surgical treatments. For instance, there are universal symptoms like pain and nausea which can luckily be treated with medicines. Neutropenia, a decrease in the number of white blood cells, which are the body’s main defense against infection, is another probable complication of cancer treatment. It is frequently seen in patients receiving chemo because chemotherapy drugs work by killing fast-growing cells in the body (cancer cells and healthy white blood cells). Neutropenia increases the chance of catching an infection so it is very important to maintain cleanliness and good health. On a side note, it is good to be aware of the signs of infection: chills, fever, stiffness, shortness of breath, etc [9,10].
A widely told myth is that if you are diagnosed with cancer, you will lose your hair but, it’s crucial to know that you don’t lose hair because of cancer, you lose hair as a result of undergoing chemotherapy; hair loss due to chemotherapy can be lessened with the use of cold caps. These cold caps induce scalp hypothermia which is expected to lessen hair loss because the cold will constrict the blood vessels in the scalp thus, reducing the amount of chemo that reaches the cells of the hair follicles. Chemotherapy also puts patients at a higher risk for blood clots, especially deep vein thrombosis which is when a blood clot either gets lodged or forms deep within a vein or bundle of veins. Doctors have also noted that there may be neurological deficits after or during treatment which is titled “chemo brain.” Although the cause for “chemo brain” is unknown, it is believed that the drugs used to treat cancer can cause some people to have trouble concentrating or remembering things thus, resulting in what we call “chemo brain.”
Treatments Around the World
We’ve discussed both surgical and therapeutic treatments but is it the same everywhere? The short answer to this question is, yes. These surgical treatments (lumpectomy, mastectomy, double mastectomy) and therapies (chemotherapy, radiation, immuno, target, and drug therapy) are available all around the world depending on whether or not the area has the resources needed. Although the sole type of breast cancer treatment is through surgical or therapeutic intervention, many patients also practice alternative medicine/holistic remedies alongside typical treatment.
These alternative medical treatments originated from all across the world making it more popular in its area of origin yet still practiced in other parts of the world. Common holistic practices would include going on a special diet with antioxidant supplements. This diet should include larger quantities of fruits and vegetables while refraining from consuming foods high in fat, foods that have been pickled, smoked, or salt-cured. Along with a healthy and nutrient-packed diet, some cancer patients opt to take antioxidant supplements such as vitamins A, C, and E, beta carotene (keeps lungs healthy and slows down cognitive decline). Some choose to take these supplements as pills but, they are also found in many fruits and vegetables. These supplements can be found in foods such as goji berries, wild blueberries, dark chocolate, pecans, legumes, etc. Apart from a healthy diet to boost the immune system during treatment, there are many holistic approaches that deal with the mind, soul, and body therapies - this is where we get more into the global perspective of cancer treatments.
India
Both yoga and meditation are great holistic therapies to implement into conventional breast cancer treatments as it can help improve a person's mental well-being. Yoga and meditation are said to originate from India thousands of years ago. Yoga can also help reduce fatigue and stress while improving sleep and physical function all while potentially reducing the risk of recurrence (the chance of getting cancer again). Some good yoga poses to do either while or after cancer treatments are the seated spinal twist (helps with digestion and nausea), Viparita Karani (aids with nausea) which is done by propping your legs up onto the wall, and Supta Baddha Konasana (reduces fatigue and stress) which is done by sitting cross-legged while gradually moving your back to the floor. While these are only some yoga poses, these are recommended by osteopathic doctors for cancer patients; although, any form/poses of yoga will help calm the body and mind down with meditation [14].
China
Acupuncture originates from traditional Chinese medicine and has been proven to help relieve the symptoms of breast cancer and the side effects of treatment. Acupuncture requires a practitioner to place thin needles into acupuncture points — specific points on your skin — then gently move them to stimulate your nervous system. Acupuncture can help reduce fatigue, stress, pain, vomiting, nausea, and can also help control heat flashes some patients experience as a result of certain treatments. However, there are also some risks associated with this practice such as infection, bleeding, and even lymphedema.
Japan
Reiki, meaning “universal life energy,” is a Japanese form of therapy that is delivered through the hands. Reiki practitioners believe that energy surrounds and moves through the human body. This form of therapy attempts to balance the flow of this energy and stimulate the body's healing abilities. Although there are no scientific studies showing that Reiki is effective in treating any disease, a Reiki treatment may be able to bring about feelings of relaxation and can reduce stress while undergoing treatment [15].
While there are many osteopathic and holistic approaches to dealing with the symptoms and complications of cancer, some proved and some not, it is very important to learn what is best for you at your stage and the rate of progression of the cancer. Always consult with your doctors and oncologists before taking any new supplements as it can mess with the cancer medications (Arimidex, tamoxifen, letrozole, etc.) prescribed for you. Also ask if yoga, acupuncture, reiki, or any other treatment is suitable for you to both, know if it is okay for you and to know what exactly needs to be done.
Conclusion
In conclusion, the treatment plan for breast cancer can greatly vary depending on the stage which it is as, the overall health, and the values of the patient, among others. While cost always seems to factor into our decisions, it is key to focus on receiving proper treatment and quality care. Treatments can include the typical conventional methods like surgery and drug-based therapies but there are also many osteopathic and holistic therapies/treatments such as yoga and acupuncture that patients choose to do alongside the conventional treatment. As with any treatment and medication, there are always possible side effects and complications. Luckily, there are many ways to cope with those side effects. Breast cancer treatment is a long road and takes an understanding mind and a fighting mindset to conquer the cancer but, with the right information, you will know what is best for you (along with your doctor’s recommendations)
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