Breast Cancer. Breast Cancer Page 1

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1 Breast Cancer Summary Breast cancers which are detected early are curable by local treatments. The initial surgery will give the most information about the cancer; such as size or whether the glands (or lymph nodes) under the arm are involved These gives clues to the chance of it recurring. The primary treatment is surgery if the cancer is confined to the breast. The two main options are a lumpectomy or mastectomy, depending on the size of the tumour compared to the breast. A mastectomy removes the whole breast. A lumpectomy removes only the breast lump. With both operations the glands under the arm are either removed or sampled. Anything less than a mastectomy is followed by local radiotherapy to the breast and the outcomes are the same as a full mastectomy. After mastectomy if there is still a high risk of recurrence, based on the size or aggressiveness of the tumour, radiation to the chest wall may be given. Reconstruction of the breast can occur immediately or in stages following surgery and initial treatment. Breast cancer is most likely to spread to the liver, lung, bones and brain which will be assessed upon diagnosis. Breast cancer can recur in the local area and is treated with radiotherapy or surgery. Widespread disease is treated with hormones or chemotherapy. Hormones can be used if the tumour is likely to be responsive which can be determined by measuring hormone receptors on its surface. Hormones include Tamoxifen, aromatase inhibitors such as Anastrazole or Letrozole, Megesterol Acetate or Zoladex. Chemotherapy is used if the cancer is not responsive to hormones or is found in important organs such as the liver or lungs where a rapid response to therapy is desirable. Progression in bones may be slowed by adding drugs called bisphosphonates. Chemotherapy or hormone therapy can also be given after the local surgery or radiotherapy to try to prevent recurrence. This is called adjuvant therapy. Common drugs and drug combinations used in these situations are: Breast Cancer Page 1

2 CMF which comprises Cyclophosphamide (which can be given orally or intravenously, Methotrexate and 5-Fluorouracil. Side effects of treatment Metallic taste Loss of appetite Bladder problems (take oral medication in the morning and drink 8-12 cups of fluids a day while taking Cyclophosphamide) Lung or heart problems (which are rare) Infertility Skin or nail changes Kidney problems Sores in the mouth and gut Blurred vision Skin reactions Nervous system effects such as confusion, dizziness, drowsiness, headache Liver or lung problems Minor hair loss Fever Pain on swallowing Skin rash Difficulty with balance (which is rare). Another drug combination is AC which comprises Cyclophosphamide and Doxorubicin, used if there is a high risk of recurrence or for widespread disease Side Effects of this treatment Redness Pain and tissue damage at the injection site if doxorubicin accidentally leaks from vein during injection Hair loss Serious heart problems at high doses of doxorubicin Red coloured urine (not harmful) Infertility Allergic reaction. Breast Cancer Page 2

3 Other drugs used alone or in combinations in both adjuvant and widespread disease are Docetaxel or Paclitaxel. Side Effects of these drugs Hair loss Fatigue Nervous system effects (such as tingling in fingers or toes) Allergic reaction Skin reactions Fluid retention which is alleviated by giving steroids before chemotherapy. Mild nausea or vomiting Sore mouth Muscle/joint pains Alopecia Cardiac effects Liver function changes. Another drug is Capecitabine This is a tablet which can be used if the injectable drug treatments are no longer effective or first up for frail patients Side Effects include Mouth ulcers Skin rash or sun sensitivity Red painful hands and feet Mild hair loss Fatigue Nausea (That is temporary lowering the blood counts) Breast Cancer Page 3

4 An older drug combination is Vinblastine Mitomycin C. Side Effects of this combination include Redness Pain and tissue damage if accidentally leaks from vein during injection Kidney or lung problems Skin reactions Sores in the mouth Hair loss Numbness or tingling in fingers or toes Tiredness or weakness Haemolytic anaemia Fever Stomach cramps and severe constipation Another type of therapy in breast cancer is hormone therapy. The most common of these is: Tamoxifen Side effects of Tamoxifen Hot flushes Vaginal bleeding and itching Nausea; High blood calcium levels (which is rare) Lowering of the blood count Tumour pain Light headedness. Breast Cancer Page 4

5 Other hormones include Aromatase Inhibitors such as (Anastrozole and Letrozole): Side effects of this treatment includes Chest pain Shortness of breath Swelling of the legs Nausea Loss of appetite Bone pain Flushing Sweating Rash Itch Vaginal bleeding or dryness Stomach pain Cough Weight gain Depression Stomach ache Mild hair loss A further hormone treatment is Megesterol Acetate Side effects of this treatment include Chest pain Shortness of breath Swelling of legs Nausea Loss of appetite Bone pain Flushing Sweating Rash Itch Vaginal bleeding or dryness Stomach pain Cough Weight gain Depression Stomach ache Mild hair loss Breast Cancer Page 5

6 A different type of hormone treatment are the LHRH ANALOGUES such as (Zoladex) Side effects include Hot flushes Blurred vision Pain at injection site Decreased libido Dizziness Headache Breast swelling Feet swelling Weight gain Difficulty sleeping Irregular heartbeat Bone pain Rash Allergic reaction Mood changes Menstrual irregularity Constipation Breast Cancer Page 6

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