myTemplate

A Real World Template Design for Joomla

Google Search

Webwomens-wellness.com

Login Form



Cancer Treatment

Cancer Treatment Research

The following information was gathered through our extensive research on Breast Cancer. Please let us know of any sites and/or pages that you feel are important for others to know about and consider adding them to our pages. You can also find more links on our User Submitted Links page.

Our goal is to provide simple, understandable information in a format that follows how a women (and men) progress through their own experience (discovery, panic, surgery, treatments, etc). It will start as a simple outline and then fill in as we prepare content. If there is anything you wish covered, please contact us and let us know. Information is power and you can control your destiny through this awful disease.


II. Breast Cancer Treatment

A. Surgery

1. Partial Mastectomy
2. Total or simple Mastectomy
3. Modified Radical Mastectomy
4. Radical Mastectomy
5. Breast Reconstruction

B. Radiation Therapy
C. Chemotherapy
D. Hormonal Treatment

1. Tamoxifen

E. Cancer treatment Advances

1. Cancer Vaccines
2. Angiogenesis Inhibitors
3. Antibody
4. Agent for Chemo Resistant Breast Cancer

 



III. Breast Cancer Treatment

A treatment such as chemotherapy or radiation therapy which is given to a patient when there is no evidence that the cancer still exists is called "adjuvant therapy." This is done to prevent microscopic undetectable disease from growing and causing a recurrence.

A. Surgery

To make any kind of breast cancer surgery less painful, researchers at Duke University Medical Center are using an alternative to general anesthesia known as paravertebral block. It entails a series of injections near the spine to block the sensation of pain in the chest area during and up to 30 hours after surgery. The technique which usually involves mild sedation makes women far less likely to require narcotic pain relievers and medication for nausea following the procedure. This means patients are able to leave the hospital sooner. Not yet wide spread the technique requires highly specialized anesthesiologists.



1. Partial Mastectomy

Breast conserving surgery (also called Lumpectomy, excisional biopsy or wide excision ) is the removal of the lump in the breast and some of the tissue around it. Partial or segmental is the removal of the cancer as well as some of the breast tissue around the tumor and the lining over the chest muscle below the tumor. Usually some of the nodes under the arm are taken. Both of these methods are usually followed by radiation therapy.

2. Total or Simple Mastectomy

Total or simple mastectomy is the removal of the whole breast. Sometimes the removal of the lymph nodes.

3. Modified Radical Mastectomy

Modified radical mastectomy is the removal of the breast, some of the lymph nodes under the arm, the lining over the chest muscles, and sometimes part of the chest wall muscles. In 1997 this was the most common operation for breast cancer.

4. Radical Mastectomy

Radical Mastectomy, also called the Halsted RM is the removal of the breast, chest muscles, and all of the lymph nodes under the arm. For many years this was the operation most used, but it is used now only when the tumor has spread to the chest muscles.

5. Breast Reconstruction

Nearly every person who has had a mastectomy - radical, modified radical, total, or simple- or anyone who has had a lumpectomy and irradiation that created breast asymmetry is a candidate for some method of breast reconstruction. Though we do no think of the breast as being functional in the same way that an arm or a leg is or as being visible in the way that an ear is, the loss of a breast is a loss of a part of the body and replacing it can help in healing the physical and emotional scars.

The time period between a mastectomy and a reconstruction can range from immediately following the mastectomy to several years later. The timing of your reconstruction relates to your treatment plan and your personal goals. The procedure is done in the hospital under general anesthesia which means you sleep through the whole thing.

A breast implant can be placed under the remaining chest wall tissues to provide replacement for the missing breast volume. This is a simple procedure and is best for patients who have lost a minimal amount of skin with the mastectomy and who have small breasts.

A tissue expander is a special type of implant that can be inflated with saline to stretch the remaining breast skin. Once the skin is stretched, a permanent implant can be placed to restore the breast volume.

A reconstructed breast can also be fashioned from a flap of your own tissue. A flap is a composite of muscle, fat, and skin that is moved from a healthy area of the body to the mastectomy site and molded into a breast shape. Flaps can be used alone or an implant can be placed underneath the flap to replace breast volume or improve the shape.

If you are interested in a breast reconstruction, talking to several people will be helpful in making your decision: Your personal physician who knows your medical history, your breast cancer team, a plastic and reconstructive surgeon, and possibly a support group.

Depending on the reconstructive technique and whether surgery is performed on the opposite breast at the same time, the operation can last from two to seven hours. Following surgery, restrictive bandages are placed over the breast.

When a later operation to reconstruct the nipple and areola is desired, the surgeon generally uses skin grafts and combinations of local tissue from other parts of the body most commonly the upper inner thigh and lips of the vagina.

Thousands of women undergo successful breast reconstruction each year. Nevertheless, you should be aware of the potential risks of surgery and specific complications associated with reconstruction. Post-mastectomy reconstruction has no effect on whether or not there is a recurrence of disease in the breast, nor does it interfere with treatment if it develops. Postoperative complications, such as delayed healing, infection or localized collections of blood, may occur and can be treated. Occasionally a second operation may be indicated to revise scars or soften breasts that become too firm due to excessive scar formations called capsular contracture.

B. Radiation Therapy

Radiation therapy uses high-energy x-rays, electron beams,, or radio-active isotopes to kill cancer cells. It's usually administered by a physician called a radiation oncologist. Treatment may also include surgery and/or chemotherapy. Radiation is prescribed for one of two purposes; to help cure a cancer or to relieve symptoms of cancer.

There are two main methods of radiation delivery- external and internal.

External radiation is delivered from a machine outside the body. The machine provides doses of either low-energy or high-energy beams. The low energy beams treat the skin and the high energy beams reach well into the body. The higher the megavoltage, the greater the penetration. The site of the tumor determines the type and strength of the beam used.

Internal radiation uses special radioactive tools, such as needles or seeds that are placed directly into or around a tumor. The radiation source may be fed through hollow applicators to the target site. The radioactive isotopes stay for a pre-determined period of time during which the patient is usually in hospital isolation. This approach allows higher doses of radiation to be delivered to the target area, but limits exposure of surrounding normal tissues.

Radiation therapy, a very delicate procedure, must be rehearsed. Curative radiation is usually given 5 days a week for 2 to 6 weeks. The beam must hit the same target every day. The doctor therefore, will perform a simulation in advance of the first treatment. The target will be measured. Where the radiation beam should hit will be marked on your skin. The doctor will then practice "delivering" the radiation. Treatment may be delayed if the doctor makes special individual blocks for your treatment.

Many patients receiving radiation therapy have minimal or no side effects. But sometimes, they can be uncomfortable. The most common are fatigue, malaise, skin reactions, and ulcers or irritation of the skin. Lymphodema risk is increased and loss of appetite may occur.

C. Chemotherapy

Adjuvant chemotherapy before or after surgery is standard for most women who have large tumors or lymph node involvement. A new study shows that the addition of the anti-cancer drug Taxol (paclitaxel) to standard adjuvant chemotherapy (adriamycin and cyclophosphamide) improved survival by 26% and reduced the risk of recurrence by 22%. At two years after treatment, the women who received paclitaxel had a small but significant survival benefit- a four percent rise in disease-free survival and a two percent increase in overall survival - compared to the group without paclitaxel. Disease free survival is defined as the length of time before the cancer recurs, and overall survival is the length of life after diagnosis.

Approximately 50% of breast cancer patients are node-negative at diagnosis, meaning the cancer has not spread beyond the breast tissue into the regional lymph nodes. Of these node-negative women, about 30% will have a recurrence. A recent trial studied node-negative patients from 1989 to 1993 to determine the appropriate use of adjuvant chemotherapy. Patients were classified as high or low risk for recurrence based on tumor size, hormone receptor status, and S-phase fraction (the rate of cell division). All low risk patients were followed without adjuvant therapy. The high risk patients were randomized to a chemotherapy regimen of CMF (Cytoxan, Methotrexate, 5-FU) or CAF (Cytoxan, Adriamycin, 5-FU) with or without the addition of tamoxifen therapy for five years. CAF proved to be superior to CMF; with overall survival 92% with CAF and 90% with CMF. However, CAF is also more toxic lowering blood cell counts to a greater degree and causing more nausea and hair loss. Also, there is a small potential of cardiac toxicity with CAF but none with CMF. Tamoxifen provided additional benefit only in patients whose tumors were estrogen-receptor positive, The low risk patients did well without adjuvant treatment, validating the use of the prognostic factors (tumor size, hormone receptor status, and S-phase fraction) Parameters for low risk included tumors less than 2 centimeters, estrogen receptor positive, and low S-phase.

Here is some info I received in the Breast Cancer Survivor Nov/Dec 1999 issue Vol 3 No 3. (Breast Cancer Survivors Network) written by Laura Wiggin, PharmD, BCPS

"One kind of chemotherapy drug is called taxanes, and they include Taxol (paclitaxel) and Taxotere (docetaxel). The development of the taxanes is looked at as one of the single most improvements in chemo in this decade." The first of these to be discovered, paclitaxel, has activity against a wide variety of tumor types, with very good activity against breast cancer. Paclitaxel by itself may be as effective as many of the combination chemotherapy regimens that have long been considered standard like CAF, CMF, etc. As a result, paclitaxel has been combined with doxorubicin (Adriamycin). This appears to be the most active combinations for advanced breast cancer. Docetaxel is newer than paclitaxel and thus studies with this drug lag behind those for paclitaxel. Docetaxel also has very good activity in breast cancer, with early studies indicating that docetaxel (Taxotere) has similar activity to paclitaxel. As more information about docetaxel becomes available, some practitioners feel that docetaxel may be a better drug for breast cancer, although not all the data to support this is in. More docetaxel studies are underway as well as studies exploring schedules and dosages. A lower dosage administered every week is being investigated."

SIDE EFFECTS:

"Although they are generally well tolerated, both Taxol and Taxotere have side effects that limit the ability of some patients to take these drugs. Both drugs cause bone marrow suppression, mild to moderate nausea and vomiting, and mucositis, as well as peripheral nerve toxicity (tingling or pain in the hands and or feet). Taxol (paclitaxel) has some side effects that are unique to it: can cause rhythm changes in the heart, allergic reactions and potentially severe muscle and joint pain. Heart damage has been seen when paclitaxel is used in combination with Adriamycin. Taxotere (docetaxel) has some different side effects, the most problematic of which is fluid retention which can be severe with fluid collecting in lungs, arms and legs. Steroids, usually dexamethasone are given for five days beginning the day before the treatment."

I was on four cycles of Taxotere when I had my first reoccurrence of breast cancer. It reduced my tumor to almost nothing by the second treatment. Most women say the steroid make you energetic and happy. I had a different reaction. Mine made me meaner than a junk yard dog. I had to warn everyone around me before I began taking the steroids for the next round of Taxotere. I required Neupogen to keep my white count up.

D. Hormonal Treatment

1. Tamoxifen

A study, conducted by the Early Breast Cancer Trialists' Collaborative Group found that tamoxifen substantially reduces recurrence of breast cancer and improves 10 year survival for all women regardless of age, menopausal status or whether or not they received chemotherapy. The Group estimates that one in six women could be prevented from a recurrence and one in twelve women from dying if the drug was given to all estrogen-receptor positive breast cancer patients after surgery. The study found that young, pre-menopausal women, not just older women (>50) benefit substantially from tamoxifen therapy, even for those whose breast cancer had spread to the local lymph glands. It also found that tamoxifen reduced the incidence of new cancers in the opposite (contralateral) breast by nearly half, 47%. Over 37,000 women were involved in the study with over 15 years of data collected.

E. Cancer treatment Advances

1. Cancer Vaccines

Cancer vaccines use the immune system to fight cancer. Unlike vaccines that prevent disease, these agents stimulate the immune system to recognize and attack existing cancer cells.

Memorial Sloan-Kettering bioorganic chemists have created an anticancer vaccine by synthesizing Globo H, a carbohydrate abundant on breast-cancer cells and attaching it to a carrier protein. The Globo H vaccine is now being tested in early clinical trials to see if it can block the reappearance or progression of breast cancer.

2. Angiogenesis Inhibitors

Angiogenesis inhibitors are drugs that starve tumors to death by cutting off their blood supply. Unfortunately, the two drugs that caused all the excitement, ANGIOSTATIN and ENDOSTATIN had been tested only in laboratory mice. Studies showed remarkable results in mice, and some other angiogenesis inhibitors have shown promise in early human trials. With the recent advances in molecular biology they are now able to create much more targeted therapies with far fewer side effects. This new understanding of molecular biology and genetics has changed the way doctors will deal with cancer in the future. Today, scientists are not just targeting tumors, they are looking inside cancer cells and identifying the genes, proteins, and chemicals that make them cancerous. Using this new information, they are developing drugs and genetic tools to attack cancer at a level that could not be seen before.

Doctors at two major U. S. cancer centers have begun the first phase of a clinical trial aimed at discovering whether a tumor-shrinking drug can destroy cancers by cutting off their blood supply. Endostatin is one of the two drugs developed in the Harvard laboratory of Dr. Judah Folkman and is the first to make it to human clinical trials. Only very small groups of patients no more than six at a time are being enrolled in Phase I trials at Dana Farber Center in Boston and at the M.D. Anderson Cancer Center, in Houston the first two institutions to begin the long-awaited human study. Another Phase I trial is expected to get under way soon at the University of Wisconsin, in Madison.

A Phase I trial is not aimed at curing patients, but at deciding the most effective dose of a drug and determining what side effects - if any- are generally experienced by patients.

3. Antibody

Herceptin: Approximately 25-30% of breast cancer tumors overexpress the oncogene HER2/Neu. These tumors are associated with more rapid cancer progression and shortened survival. Genentech, Inc., has developed an anti-HER2/Neu antibody. Herceptin, which when used in combination with chemotherapy to treat metastatic breast cancer, significantly slows or stops the tumor growth.

4. Agent for Chemo Resistant Breast Cancer

In a recent trial involving metastatic breast cancer patients, XELODA, an oral anti-cancer drug, was effective in reducing tumor size in 18.5% of patients. Those patients experienced a reduction in tumor size of more than 50%. All of the patients in the trial had cancers which had proven to be resistant to paclitaxel (TAXOL). A subset of patients had disease both resistant to paclitaxel and to an anthracycline. XELODA reduced tumor size in 26% of these patients and lasted for an average of five months. Side effects included diarrhea, nausea, and fatigue. Xeloda has been approved by the FDA. Currently, legislation is pending regarding Medicare payment for oral anti-cancer drugs.

 

Disclaimer: The information presented on this site should NOT replace the advice of a qualified health care professional
and is NOT presented as qualified advice or council. Please use this information as a guide or reference point
when consulting with your private physician (s).

Copyright © Vision Technology Management
Developed, Maintained and Hosted by Vision Technology Management, LLC
All proceeds go to Vision Technology Management to help support this site.
Joomla Templates by Joomlashack