Breast Cancer Treatment

Breast cancer treatment encompasses a range of options tailored to the patient's specific needs, including:

· Excisional biopsy and frozen section analysis, followed by definitive surgery as necessary.

· Lumpectomy: Surgical removal of breast tumor and surrounding tissue while preserving the breast

· Simple mastectomy: Surgical removal of the entire breast without removing muscle or lymph nodes

· Radical mastectomy: Extensive surgical removal of the breast, chest muscles, and lymph nodes

· Postoperative radiotherapy and chemotherapy: treatments following surgery to kill any remaining cancer cells, using radiation and medication

Lumpectomy can achieve outcomes comparable to those of a radical mastectomy. In advanced stages, the removal of axillary lymph nodes may be necessary. Radiotherapy might be recommended as an adjunct therapy in advanced cases. Reconstructive prosthetic surgery can be performed either concurrently with the initial procedure or at a later date.

Adjuvant chemotherapy plays a crucial role in reducing the risk of recurrence. Tamoxifen, taken at a daily dose of 20 mg, or raloxifene at 60 mg, can reduce the risk of contralateral breast recurrence by 50% over approximately 5 years. However, it's important to note that these medications are teratogenic during pregnancy and may lead to atrophic vaginitis. Anastrozole, an aromatase inhibitor, is generally better tolerated than tamoxifen, with a recommended dosage ranging from 1-2 mg.

Chemotherapy regimens include:

• Four cycles of adriamycin and cyclophosphamide.
• Six cycles of 5-FU, adriamycin, and cyclophosphamide.
• Six cycles of 5-FU, epirubicin, and anthracycline.
• The addition of Taxane has shown improvements in survival. Women are generally advised not to conceive for at least 2 years after completing chemotherapy.

Outcomes of Breast Cancer Cases:

Understanding Prognosis

Breast cancer prognosis hinges on several critical factors, including the stage of the disease, the presence of E2 receptors in the tissues, and the involvement of axillary lymph nodes. In cases where metastasis has occurred, chemotherapy is a key component of the treatment plan.

To prevent recurrence, ovarian ablation may be deemed necessary. It's vital to note that hormone replacement therapy (HRT) and the use of combined oral contraceptives (COC) are generally contraindicated in women undergoing breast cancer treatment. However, for those grappling with severe menopausal symptoms, low-dose therapy might be considered under close medical supervision. Raloxifene, when used cautiously, offers a safer alternative, as it does not induce endometrial hyperplasia or osteoporosis, although close monitoring is essential due to the potential risk of thrombosis.

Additionally, lactation is discouraged in women treated for breast cancer due to the elevated risk of developing cancer in the contralateral breast.

Breast Cancer During Pregnancy

Breast cancer can occur during pregnancy. Importantly, surgery and radiotherapy are not contraindicated during pregnancy, provided adequate shielding measures are in place to safeguard the developing fetus. However, if chemotherapy is contemplated postoperatively, early termination of the pregnancy may be necessary due to the teratogenic potential of certain drugs. In the later stages of pregnancy, chemotherapy can be deferred until after delivery to ensure the well-being of both the mother and child.

Prophylactic Measures

For those at risk, prophylactic measures can play a pivotal role in breast cancer prevention. Tamoxifen and raloxifene, when taken for a span of 5 years, have demonstrated significant benefits:

• Reducing the incidence of contralateral breast cancer by 50%.
• Prolonging the disease-free interval.
• Reducing the risk of recurrence.

These preventive strategies are vital for individuals seeking to reduce their risk of breast cancer and enhance their overall health.