BREAST CANCER INDIA

Listen to your body. Be Aware.

TREATMENT PLANNING IN BREAST CANCER


TREATMENT SELECTION

Basics of treamtent planning

The mainstay is to tackle the tumour which is present in the breast. That would mean 'local' treatment. 'Cancer is my breast has been addressed locally, by surgery. But what about some cells, which might have escaped into circulation. Will it seed somewhere else, and cause tumour to grow there. Besides, what is the chance that the cancer wont come back at the site where it was operated?' This is exactly the question which we answer while treatment planning.
Briefly, the treatment of a non metastatic breast cancer can be divided into the following:

LOCOREGIONAL TREATMENT

The locoregional treatment consists of measures to remove the tumour i.e. Surgery, and measures to prevent recurrence of the tumour i.e. Radiotherapy.

SYSTEMIC TREATMENT

Systemic treatment includes measures to reduce the chances of a 'recurrence' of the disease after surgery, and in some cases, to downstage a locally advanced cancer so as to make it operable, or make it possible to conserve the breast. Systemic treatment includes chemotherapy, hormonal therapy and targeted therapy.

So how is the treatment planned?

As discussed in the section on staging of breast cancers, the first step towards treatment planning is staging of the cancer. If you have not read the section on staging of breast cancer, please do it so, as it will facilitate a proper understanding of treatment planning. Let us simplify the staging and consider each treatment subsequently

OPERABLE BREAST CANCER (OBC):

This is the earliest stage of breast cancer, where the tumour is smaller than 5 cm, is localized to breast, and there may be some mobile axillary nodes. In staging, this will include combinations of T1 or T2 with N0 or N1. The standard treatment here is in the following order:

LARGE OPERABLE BREAST CANCER (LOBC)

In this stage, the tumour is more than 5 cm, but is mobile. Nodes maybe enlarged, but not matted or fixed. So staging will include T3 with N0 or N1. In this, the treamtent is in the following order:

L0CALLY ADVANCED BREAST CANCER (LABC):

Here, the disease is advanced 'locally', though not spread elsewhere on routine work up. 'Locally Advanced' implies involvement of the skin over the tumour, puckering of skin to produce an 'orange peel' appearance, fixity to underlying wall, 'matted' nodes in the axilla which are not freely mobile. In staging, this includes T4 and / or N2. All these signs imply a disease which has gone beyond the confines of routine curative treatment. There is a very high chance of latent 'metastatic' disease in such cases. After a thorough work up for metastases, and after confirming that there are no distant metastases, it is prudent to give 4 cycles of 'Neo adjuvant' chemotherapy first. The plan is as follows:

METASTATIC BREAST CANCER (MBC)

In this stage, the patient presents with a cancer which has already spread to another organ/organs. This includes M1 in staging. This represents stage 4 disease, and survival obviously is the lowest in this stage. The treatment protocols will vary depending on the site of seconday disease. The flow here would be like following:

Since metastatic breast cancer is a topic that deserves a detailed attention, a section has been given for the same where the details will be discussed.