What treatments are there?

Treatment depends on the type of breast cancer, the size of the tumor, the condition of the lymph nodes under the armpit and the presence or absence of metastases. Last but not least, she takes into account the patient's needs and wishes.

There are numerous treatments for breast cancer: surgery, radiation, chemotherapy, hormone therapy and immunotherapy. Usually, some treatments are combined. For example, one can start with surgery and then receive radiation or chemotherapy. Another possibility is to start with chemotherapy and then have surgery. In the breast clinic where you will be counseled, they will determine exactly what is the best treatment for you. You are also entitled to clear information about your course of treatment, what to expect, the possible side effects of the various treatments and what can be done about them, as well as the possible results. Make sure you understand everything well and keep asking questions for as long as you feel necessary. A breast nurse will guide you through the different steps of your journey.

The treatment of breast cancer has evolved impressively and continues to evolve. New possibilities are constantly being explored in laboratories worldwide, such as the 'breast cancer vaccines' that are already showing promising results.  

We list all the possible treatments currently available for breast cancer.  

Surgery (the operations)

The surgical or surgical treatment of breast cancer has undergone a significant evolution. A century ago, people removed not only the affected mammary gland, but also the pectoral muscles and axillary glands. Much of the skin was also removed so that skin grafting was often required. Read more about surgery options here.

Radiotherapy (radiation therapy)

After surgery, cancer cells may be left behind. This may be in the breast after breast-conserving surgery or in the chest wall after a complete mastectomy, for example. Irradiating these and surrounding areas aims to eliminate the stragglers. Radiation or radiotherapy for breast cancer uses high-energy rays to damage or kill cancer cells, while sparing healthy tissue as much as possible. Cancer cells severely damaged by radiation can no longer divide and die. However, this radiation can also affect healthy cells so all possible precautions should be taken to keep healthy tissue out of the radiation field as much as possible. Therefore, a very precise picture of the area to be irradiated is made beforehand by means of a CT scan and the exact amount of radiation required is calculated. The radiation itself is done from different directions, with the suspected area receiving the maximum dose and the surrounding healthy tissue being exposed to the rays as little as possible. This is millimeter work performed by or under the direction of a radiotherapist, which is a doctor specializing in radiation therapy.

Typically, 15 to 25 radiotherapy sessions are given, with each session lasting only a few minutes. The short sessions allow the healthy cells being irradiated along with them to recover. Cancer cells themselves recover much less well because they are less resistant to this radiation.

Possible side effects of radiotherapy include fatigue, red skin with sometimes slight swelling. Lung and heart damage is rare. When the armpit area is also irradiated, the risk of a thick arm increases.  

Radiation is almost always done after surgery, but occasionally it is done beforehand. For example, in people who cannot have surgery because the tumor is too large. Radiotherapy can also be used palliatively, for example, to shrink an inconveniently large tumor.

Chemotherapy

Chemotherapy can be started for several reasons. To shrink a large tumor so that it can be operated on more easily. To stop the spread of breast cancer, by killing any metastases in the body. And finally, to maintain quality of life and prolong survival in metastatic breast cancer.  

Chemotherapy uses cell-killing drugs that aim to attack fast-dividing cells. Cancer cells often divide much faster than normal body cells. These drugs are usually administered through an IV in the hospital and sometimes as tablets. Administration is often done in cycles (chemotherapy), with rest periods in between to give the healthy cells a chance to recover. After all, chemotherapy also kills or damages normal, fast-dividing cells. Examples of healthy fast-dividing cells that can be damaged by chemotherapy are blood cells, bone marrow cells, cells in the digestive system and hair cells. The damage to these healthy cells, explains many of the possible side effects of chemotherapy, such as nausea and vomiting, diarrhea, anemia, hair loss and increased susceptibility to infections. Their occurrence depends on the type of chemotherapy, the dose and individual sensitivity. A side effect that is very common is fatigue.

A variety of means and methods exist to reduce the side effects of chemotherapy, including medication for nausea and vomiting, a cooling helmet before chemotherapy to reduce hair loss, exercise, relaxation exercises and appropriate diet.

Targeted (targeted) therapy

Some breast cancers consist of cancer cells with specific characteristics, for example, they possess molecules, receptors or enzymes, against which drugs can be used. These drugs specifically target the characteristics of the cancer cell, thereby killing it. This is called targeted therapy. Targeted therapy leaves healthy cells much more alone, so there are also fewer overall side effects compared to chemotherapy. Yet these drugs also have their unwanted effects.

Targeted therapies are not available for all breast cancers. There are for some, such as HER2-positive breast cancer, which is a cancer in which the cancer cells carry many HER2 receptors on their surface. About 15 to 20% of breast cancers are HER2-positive. Targeted therapy against these receptors has greatly improved survival for HER2-positive breast cancer.

Targeted, targeted therapies, like most chemotherapy, are administered through an IV in the hospital at regular intervals. Some exist in tablet form.

Targeted therapies can be combined with other therapies, such as chemotherapy or hormone therapy.

Hormone therapy

Most breast cancers are hormone-sensitive. This means that the cancer cells carry receptors for female hormone on their surface and grow under the influence of female hormone. Hormone therapy blocks this action and thus inhibits the growth of these breast cancers. A more accurate name would be antihormone therapy, but this treatment is known as hormone therapy. Hormone therapy can be useful at different times: before surgery (to shrink the tumor), after surgery (to prevent relapse) and in metastatic cancer (to inhibit growth).  

Hormone therapy is given for years, usually five years, and sometimes as long as seven to 10 years. It exists both as injections and in tablets, depending on the type you need. The injections are administered in the hospital or by your doctor. You simply take the tablets at home yourself.

Research is underway to determine whether hormone therapy can also be useful preventively, in women at greatly increased risk of breast cancer, for example.

Because hormone therapy is essentially anti-hormones, younger patients enter menopause abruptly, which can be accompanied by various symptoms reminiscent of menopause, such as hot flashes, night sweats, vaginal dryness, mood swings, fatigue and weight gain. The appetite for sex can also diminish significantly.

Immunotherapy (immunotherapy)

Our defense system or immune system tries to clear away cancer cells because they are recognized as "foreign material" to the body. Cancer cells often manage to escape these natural defenses by, for example, secreting substances that neutralize the immune cells. Immunotherapy aims to block cancer cells' escape routes, allowing the natural immune system to do its job better. Immunotherapy is usually given by infusion.  

It does not work for all forms of breast cancer. Immunotherapy is especially useful for treating triple-negative breast cancer. It is often combined with chemotherapy.

Common side effects include fatigue, abdominal pain, nausea, itching, dry skin, aching joints and muscles. Many side effects result from an overactive immune system, which not only attacks cancer cells but also affects healthy tissue.

Future

Scientists around the world are working on new treatments for breast cancer. In the near and distant future, new therapies, such as breast cancer vaccines, will further expand the management of breast cancer and improve the survival continue to improve.

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