The main therapeutic effects are divided into local-regonar (surgical intervention, radiation therapy) and systemic (chemotherapy, hormone therapy).
Treatment of breast cancer includes an integrated approach and involves surgical intervention, chemotherapy and radiation therapy, hormone treatment. The choice of method depends on many circumstances, in particular, the structure of the tumor, the rate of its development, the presence of metastases, the age of the patient, the functioning of the ovaries, etc. The treatment regimen is prescribed only by an experienced specialist after a complete examination. In the early stages, malignant neoplasm can be completely cured. The following methods are used in treatment:
- Lamectomy. The tumor is removed along with the adjacent unaffected tissues, while the breast is partially preserved. This procedure is performed exclusively at the zero stage of malignant neoplasm and is combined with radiation therapy methods in women at a young age.
- Sectoral resection of the affected organ involves partial removal of the mammary gland and complete removal of lymph nodes in the armpits, performed at the zero and first stages of the disease, combined with the conduct of radiotherapy sessions.
- When carrying out the mastectomy, the mammary gland and a part of the lymph nodes with the pectoral muscle retained. With an expanded mastectomy, along with the gland, lymph nodes in the subclavian and axillary regions are removed. When performing an extensive radical mastectomy with the mammary gland and lymph nodes, the ribs, sternum and pectoral muscle are partially removed. This procedure is carried out in cases when the tumor grows into surrounding tissues.
- Chemotherapy for breast cancer contributes to the elimination of atypical cells that could spread to other areas. Such treatment is usually given, usually from two weeks to two months after surgery for three months to six months.
- Hormonal therapy is necessary in order to stop the influence of sex hormones (mainly estrogens) on malignant cells, which contributes to their development. For these purposes, women are prescribed tamoxifen, in some cases the ovaries are removed.
- Radiation therapy has a local effect and the pathway of the lymph drainage. Before the operation, a radiotherapy session is prescribed in order for the tumor to shrink in size and disappear the most aggressive cells. In the postoperative period, radiation therapy contributes to the elimination of tumor cells, which could remain in the affected area and outside it. Side effects of radiation therapy are fraught with burns of the skin, the development of pneumonia, fracture of the ribs.
Treatment of breast cancer in stages
The choice of method of treatment depends mainly on the stage of the disease.
In stages I and IIa, surgical treatment is indicated without additional therapies.
The volume of surgical treatment:
- Radical mastectomy according to Holstel-Meier.
- Extended radical mastectomy.
- Operation Poethy is a radical mastectomy with the preservation of a large pectoral muscle.
- Mastectomy with removal of axillary lymph nodes.
- Radical resection of the mammary gland in combination with parasternal lymphadenectomy (in the endoscopic version).
With malignant neoplasm in stages III, IIIa and IIIb, combined treatment is indicated - radical mastectomy with preoperative radiation or chemotherapy.
Radiation therapy irradiates the mammary gland and the zones of regional metastasis.
When carrying out chemotherapy, it is recommended to apply the following regimens:
- CMF (Cyclophosphamide, Methotrexate, 5-Fluorouracil);
- AS (Doxorubipine, Cyclophosphamide);
- RAS (5-Fluorouracil, Doxorubipine, Cyclophosphamide);
- ICE (Ifosfamide, Carboplatin, Etoposide);
With malignant neoplasm in stage IIIc complex treatment is used: preoperative radiotherapy, radical mastectomy and hormonal therapy.
The principle of hormonal action is to act on hormonal receptors, inhibit the development of tumor cells or cause their regression. Hormonal therapy can be carried out by the following methods:
- operative removal of the source of hormones (ovariectomy, adrenalectomy, hypophysectomy) or suppression of organ function through radiation exposure;
- the introduction of hormones to suppress the function of the endocrine gland (estrogens, androgens, corticosteroids);
- introduction of antagonists of hormones competing at the cellular level (antiestrogens - tamoxifen, bromocriptine).
In stage IV, especially in the presence of multiple distant metastases, treatment includes hormone and chemotherapy.
In recent years, worldwide trends in organ-preserving operations have begun to prevail in the treatment of breast cancer.
It is proved that patients with the stage of the T1-2, N0-1 process are suitable for carrying out the organ-preserving treatment.
The volume of surgery should correspond to the methods of ablastics, that is, sufficient to remove the entire tumor with adjacent tissues. Practice in regional lymph nodes remains controversial. Conducted in the postoperative period, adjuvant polychemotherapy can increase the chances of disease-free flow.