Breast Cancer Treatment in India

Brief Description

Breast Cancer Treatment cost at top hospitals in India typically starts from USD 5,000. The cost of cancer treatment depends on factors like number of chemo/radiotherapy sessions required, stage of cancer, type of cancer surgery if required, hospital type, room type in the hospital, pre surgery tests cost etc. In India, there are many good hospitals where you can expect even 10%-15% lower quotes than above mentioned cost. Enquire with us to get free exact quotes from multiple hospitals and as per your budget.
Days at Hospital 4-5
Stay outside Hospital 18-21
Total Days in India 22-26

Breast Cancer Treatment Cost in top hospitals in India starts from

$5,000

(AFN 390,000)

Overall medical travel estimate
starts from

$6,600

(AFN 514,800)

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Treatment overview

 

In cancer care, doctors specializing in different areas of cancer treatment—such as surgery, radiation oncology, and medical oncology—work together with radiologists and pathologists to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team. Cancer care teams include a variety of other health care professionals, such as physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counselors, nutritionists, and others. For people older than 65, a geriatric oncologist or geriatrician may also be involved in their care. Ask the doctor in charge of your treatment which health care professionals will be part of your treatment team and what each of them do. This can change over time as your health care needs change. You should also ask who will be coordinating your care.

A treatment plan is a summary of your cancer and the planned cancer treatment. It is meant to give basic information about your medical history to any doctors who will care for you during your lifetime. Before treatment begins, ask your doctor for a copy of your treatment plan. You can also provide your doctor with a copy of the ASCO Treatment Plan form to fill out.

The biology and behavior of breast cancer affects the treatment plan. Some tumors are smaller but grow quickly, while others are larger and grow slowly. Treatment options and recommendations are very personalized and depend on several factors, including:

·         The tumor’s subtype, including hormone receptor status (ER, PR), HER2 status, and nodal status (see Introduction)

·         The stage of the tumor

·         Genomic markers, such as Oncotype DX™ or MammaPrint™, if appropriate (See Diagnosis)

·         The patient’s age, general health, menopausal status, and preferences

·         The presence of known mutations in inherited breast cancer genes, such as BRCA1 or BRCA2

 

Even though the breast cancer care team will specifically tailor the treatment for each patient, there are some general steps for treating early-stage and locally advanced breast cancer.

For both DCIS and early-stage invasive breast cancer, doctors generally recommend surgery to remove the tumor. To make sure that the entire tumor is removed, the surgeon will also remove a small area of healthy tissue around the tumor, called a margin. Although the goal of surgery is to remove all of the visible cancer in the breast, microscopic cells can be left behind. In some situations, this means that another surgery could be needed to remove remaining cancer cells. There are different ways to check for microscopic cells that will ensure a clean margin. It is also possible for microscopic cells to be present outside of the breast, which is why systemic treatment with medication is often recommended after surgery, as described below.

For larger cancers, or those that are growing more quickly, doctors may recommend systemic treatment with chemotherapy or hormonal therapy before surgery, called neoadjuvant therapy. There may be several benefits to having other treatments before surgery:

·         Surgery may be easier to perform because the tumor is smaller.

·         Your doctor may find out if certain treatments work well for the cancer.

·         You may also be able to try a new treatment through a clinical trial.

·         If you have any microscopic distant disease, it will be treated earlier.

·         Women who may have needed a mastectomy could have breast-conserving surgery (lumpectomy) if the tumor shrinks enough before surgery.

 

After surgery, the next step in managing early-stage breast cancer is to lower the risk of recurrence and to get rid of any remaining cancer cells in the body. These cancer cells are undetectable with current tests but are believed to be responsible for a cancer recurrence as they can grow over time. Treatment given after surgery is called "adjuvant therapy." Adjuvant therapies may include radiation therapy, chemotherapy, targeted therapy, and/or hormonal therapy (see below for more information on each of these treatments).

Whether adjuvant therapy is needed depends on the chance that any cancer cells remain in the breast or the body and the chance that a specific treatment will work to treat the cancer. Although adjuvant therapy lowers the risk of recurrence, it does not completely get rid of the risk.

Along with staging, other tools can help estimate prognosis and help you and your doctor make decisions about adjuvant therapy. Depending on the subtype of breast cancer, this includes tests that can predict the risk of recurrence by testing your tumor tissue (such as Oncotype Dx™ or MammaPrint™; see Diagnosis). Such tests may also help your doctor better understand whether chemotherapy will help reduce the risk of recurrence.

When surgery to remove the cancer is not possible, it is called inoperable. The doctor will then recommend treating the cancer in other ways. Chemotherapy, targeted therapy, radiation therapy, and/or hormonal therapy may be given to shrink the cancer.

For recurrent cancer, treatment options depend on how the cancer was first treated and the characteristics of the cancer mentioned above, such as ER, PR, and HER2.

 

Descriptions of the common types of treatments used for early-stage and locally advanced breast cancer are listed below. Your care plan also includes treatment for symptoms and side effects, which is an important part of cancer care. Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Talk with your doctor about the goals of each treatment and what you can expect while receiving the treatment. These types of talks are called “shared decision making.” Shared decision making is when you and your doctors work together to choose treatments that fit the goals of your care. Shared decision making is particularly important for breast cancer because there are different treatment options. It is also important to check with your health insurance company before any treatment begins to make sure the treatment is covered.

People older than 65 may benefit from having a geriatric assessment before planning treatment. Find out what a geriatric assessment involves.

 

 

 

Surgery

Surgery is the removal of the tumor and some surrounding healthy tissue during an operation. Surgery is also used to examine the nearby axillary lymph nodes, which are under the arm. A surgical oncologist is a doctor who specializes in treating cancer with surgery. Learn more about the basics of cancer surgery.

Generally, the smaller the tumor, the more surgical options a patient has. The types of surgery for breast cancer include the following:

 

Lumpectomy

This is the removal of the tumor and a small, cancer-free margin of healthy tissue around the tumor. Most of the breast remains. For invasive cancer, radiation therapy to the remaining breast tissue is often recommended after surgery, especially for younger patients, patients with hormone receptor negative tumors, and patients with larger tumors. For DCIS, radiation therapy after surgery may be an option depending on the patient, the tumor, and the type of surgery. A lumpectomy may also be called breast-conserving surgery, a partial mastectomy, quadrantectomy, or a segmental mastectomy. Women with BRCA1 or BRCA2 gene mutations who have been newly diagnosed with breast cancer may be eligible to receive breast-conserving surgery. So may women with newly diagnosed breast cancer who carry a moderate-risk gene mutation, like CHEK2 or ATM. Your genetic mutation status alone should not determine which course of treatment may be best for you.

 

Mastectomy

This is the surgical removal of the entire breast. There are several types of mastectomies. Talk with your doctor about whether the skin can be preserved, called a skin-sparing mastectomy, or whether the nipple can be preserved, called a nipple-sparing mastectomy or total skin-sparing mastectomy. A nipple-sparing mastectomy may be a treatment option for certain women with a BRCA1 or BRCA2 gene mutation or for women with a moderate-risk gene mutation, like CHEK2 or ATM. Your doctor will also consider how large the tumor is compared to the size of your breast in determining the best type of surgery for you.

More aggressive surgery, such as a mastectomy, is not always better and may cause more complications. The combination of lumpectomy and radiation therapy has a slightly higher risk of the cancer coming back in the same breast or the surrounding area. However, the long-term survival of women who choose lumpectomy is exactly the same as those who have a mastectomy. Even with a mastectomy, not all breast tissue can be removed and there is still a chance of recurrence or a new breast cancer.

Women with a very high risk of developing a new cancer in the other breast may consider a bilateral mastectomy, meaning both breasts are removed. This includes women with BRCA1 or BRCA2 gene mutations and women with cancer in both breasts. Women with BRCA1 or BRCA2 gene mutations should talk with their doctor about which surgical option might be best for them, as they have an increased risk of developing breast cancer in the opposite breast and of developing a new breast cancer in the same breast compared to those without these mutations. ASCO recommends that women with a BRCA1 or BRCA2 gene mutation who are being treated with a mastectomy for the breast with cancer should also be offered a risk-reducing mastectomy for the opposite breast, including nipple-sparing mastectomy. This is because getting a risk-reducing mastectomy in the opposite breast is associated with a decreased risk of getting cancer in that breast. However, not everyone will be a good candidate for nipple-sparing mastectomy. For those with large breasts and little nipple projection, for example, a breast reduction may be done first to get the nipple in a better position.

To assess your risk of developing cancer in the opposite breast and determine whether you might be eligible for a risk-reducing mastectomy, your doctor will consider several factors:

·        Age of diagnosis

·        Family history of breast cancer

·        The likelihood of recurrence of your breast cancer or other cancers you may have, such as ovarian cancer

·        Your ability to have regular surveillance studies, such as breast MRI, to look for breast cancer

·        Any other diseases or conditions you might have

·        Life expectancy

Women with a moderate-risk gene mutation, like CHEK2 or ATM, should also talk with their doctor about their risk of developing breast cancer in the opposite breast and whether undergoing a risk-reducing mastectomy, including a nipple-sparing mastectomy, may be right for them.

Women with a high-risk mutation who do not have a bilateral mastectomy should have regular screening of the remaining breast tissue with an annual mammogram and breast MRI for enhanced surveillance.

For women not at very high risk of developing a new cancer in the future, having a healthy breast removed in a bilateral mastectomy neither prevents cancer recurrence nor improves a woman’s survival. Although the risk of getting a new cancer in that breast will be lowered, surgery to remove the other breast does not reduce the risk of the original cancer coming back. Survival is based on the prognosis of the initial cancer. In addition, more extensive surgery may be linked with a greater risk of problems.

 

Lymph node removal and analysis

Cancer cells can be found in the axillary lymph nodes in some cancers. It is important to find out whether any of the lymph nodes near the breast contain cancer. This information is used to determine treatment and prognosis

Sentinel lymph node biopsy. In a sentinel lymph node biopsy (also called a sentinel node biopsy or SNB), the surgeon finds and removes 1 to 3 or more lymph nodes from under the arm that receive lymph drainage from the breast. This procedure helps avoid removing a larger number of lymph nodes with an axillary lymph node dissection (see below) for patients whose sentinel lymph nodes are mostly free of cancer. The smaller lymph node procedure helps lower the risk of several possible side effects. Those side effects include swelling of the arm called lymphedema, numbness, and arm movement and range of motion problems with the shoulder. These are long-lasting issues that can severely affect a person’s quality of life. Importantly, the risk of lymphedema increases with the number of lymph nodes and lymph vessels that are removed or damaged during cancer treatment. This means that women who have a sentinel lymph node biopsy tend to be less likely to develop lymphedema than those who have an axillary lymph node dissection.

To find the sentinel lymph node, the surgeon usually injects a dye and/or a radioactive tracer behind or around the nipple. The injection, which can cause some discomfort, lasts about 15 seconds. The dye or tracer travels to the lymph nodes, arriving at the sentinel node first. If dye is used, the surgeon can find the lymph node when it turns color. If a radioactive tracer is used, it will give off radiation which helps the surgeon find the lymph node.

The pathologist then examines the lymph nodes for cancer cells. If the sentinel lymph node(s) are cancer-free, research has shown that it is likely that the remaining lymph nodes will also be free of cancer. This means that no more lymph nodes need to be removed. If only 1 or 2 sentinel lymph nodes have cancer and you plan to have a lumpectomy and radiation therapy to the entire breast, an axillary lymph node dissection may not be needed. In general, for most women with early-stage breast cancer that can be removed with surgery and whose underarm lymph nodes are not enlarged, sentinel lymph node biopsy is the standard of care. However, in certain situations, it may be appropriate to not undergo any axillary surgery. You should talk with your surgeon about whether this may be the right approach for you.

 

Axillary lymph node dissection. In an axillary lymph node dissection, the surgeon removes many lymph nodes from under the arm. These are then examined for cancer cells by a pathologist. The actual number of lymph nodes removed varies from person to person. An axillary lymph node dissection may not be needed for all women with early-stage breast cancer with small amounts of cancer in the sentinel lymph nodes. Women having a lumpectomy and radiation therapy who have a smaller tumor (less than 5 cm) and no more than 2 sentinel lymph nodes with cancer may avoid a full axillary lymph node dissection. This helps reduce the risk of side effects and does not decrease survival. If cancer is found in the sentinel lymph node, whether additional surgery is needed to remove more lymph nodes depends on the specific situation.

Most people with invasive breast cancer will have either a sentinel lymph node biopsy or an axillary lymph node dissection. However, these procedures may be optional for some patients older than 65. This depends on how large the lymph nodes are, the tumor’s stage, and the person’s overall health.

A sentinel lymph node biopsy alone may not be done if there is obvious evidence of cancer in the lymph nodes before any surgery. In this situation, a full axillary lymph node dissection is preferred. Normally, the lymph nodes are not evaluated for people with DCIS and no invasive cancer, since the risk of spread is very low. However, the surgeon may consider a sentinel lymph node biopsy for patients diagnosed with DCIS who choose to have or need a mastectomy. If some invasive cancer is found with DCIS during the mastectomy, which happens occasionally, the lymph nodes will then need to be evaluated. However, a sentinel lymph node biopsy generally cannot be performed. In that situation, an axillary lymph node dissection may be recommended.

 

Reconstructive (plastic) surgery

Women who have a mastectomy or lumpectomy may want to consider breast reconstruction. This is surgery to recreate a breast using either tissue taken from another part of the body or synthetic implants. Reconstruction is usually performed by a plastic surgeon. A person may be able to have reconstruction at the same time as the mastectomy, called immediate reconstruction. They may also have it at some point in the future, called delayed reconstruction.

For patients having a lumpectomy, reconstruction may be done at the same time to improve the look of the breast and to make both breasts look similar. This is called oncoplastic surgery. Many breast surgeons can do this without the help of a plastic surgeon at the same time as the lumpectomy. Surgery on the healthy breast at the same time as the lumpectomy may also be suggested so both breasts have a similar appearance.

The techniques discussed below are typically used to shape a new breast.

Implants. A breast implant uses saline-filled or silicone gel-filled forms to reshape the breast. The outside of a saline-filled implant is made up of silicone, and it is filled with sterile saline, which is salt water. Silicone gel-filled implants are filled with silicone instead of saline. They were thought to cause connective tissue disorders, but clear evidence of this has not been found. Before having permanent implants, a woman may temporarily have a tissue expander placed that will create the correct sized pocket for the implant. Implants can be placed above or below the pectoralis muscle. Talk with your doctor about the benefits and risks of silicone versus saline implants. The lifespan of an implant depends on the woman. However, some women never need to have them replaced. Other important factors to consider when choosing implants include:

·        Saline implants sometimes "ripple" at the top or shift with time, but many women do not find it bothersome enough to replace.

·        Saline implants tend to feel different than silicone implants. They are often firmer to the touch than silicone implants.

There can be problems with breast implants. Some women have problems with the shape or appearance. The implants can rupture or break, cause pain and scar tissue around the implant, or get infected. Implants have also been rarely linked to other types of cancer, including a type called breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). Although these problems are very unusual, talk with your doctor about the risks.

 

Tissue flap procedures. These techniques use muscle and tissue from elsewhere in the body to reshape the breast. Tissue flap surgery may be done with a “pedicle flap,” which means tissue from the back or belly is moved to the chest without cutting the blood vessels. A “free flap” means the blood vessels are cut and the surgeon needs to attach the moved tissue to new blood vessels in the chest. There are several flap procedures:

·         Transverse rectus abdominis muscle (TRAM) flap. This method, which can be done as a pedicle flap or free flap, uses muscle and tissue from the lower stomach wall.

·         Latissimus dorsi flap. This pedicle flap method uses muscle and tissue from the upper back. Implants are often inserted during this flap procedure.

·         Deep inferior epigastric artery perforator (DIEP) flap. The DIEP free flap takes tissue from the abdomen and the surgeon attaches the blood vessels to the chest wall.

·         Gluteal free flap. The gluteal free flap uses tissue and muscle from the buttocks to create the breast, and the surgeon also attaches the blood vessels. Transverse upper gracilis (TUG), which uses tissue from the upper thigh, may also be an alternative.

Because blood vessels are involved with flap procedures, these strategies are usually not recommended for a woman with a history of diabetes or connective tissue or vascular disease, or for a woman who smokes, as the risk of problems during and after surgery is much higher.

The DIEP and other flap procedures are longer procedures with a longer recovery time. However, the appearance of the breast may be preferred, especially when radiation therapy is part of the treatment plan.

Talk with your doctor for more information about reconstruction options and a referral to a plastic surgeon. When considering a plastic surgeon, choose a doctor who has experience with a variety of reconstructive surgeries, including implants and flap procedures. They can discuss the pros and cons of each procedure.

 

External breast forms (prostheses)

An external breast prosthesis or artificial breast form provides an option for women who plan to delay or not have reconstructive surgery. These can be made of silicone or soft material, and they fit into a mastectomy bra. Breast prostheses can be made to provide a good fit and natural appearance for each woman.

 

Radiation therapy

Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. There are several different types of radiation therapy:

·         External-beam radiation therapy. This is the most common type of radiation treatment and is given from a machine outside the body. This includes whole breast radiation therapy and partial breast radiation therapy, as well as accelerated breast radiation therapy, which can be several days instead of several weeks.

·         Intra-operative radiation therapy. This is when radiation treatment is given using a probe in the operating room.

·         Brachytherapy. This type of radiation therapy is given by placing radioactive sources into the tumor.

·         Although the research results are encouraging, intra-operative radiation therapy and brachytherapy are not widely used. Where available, they may be options for a patient with a small tumor that has not spread to the lymph nodes. Learn more about the basics of radiation therapy.

·         Adjuvant radiation therapy is given after surgery. Most commonly, it is given after a lumpectomy, and sometimes, chemotherapy. Patients who have a mastectomy may or may not need radiation therapy, depending on the features of the tumor. Radiation therapy may be recommended after mastectomy if a patient has a larger tumor, cancer in the lymph nodes, cancer cells outside of the capsule of the lymph node, or cancer that has grown into the skin or chest wall, as well as for other reasons.

·         Neoadjuvant radiation therapy is radiation therapy given before surgery to shrink a large tumor, which makes it easier to remove. This approach is uncommon and is usually only considered when a tumor cannot be removed with surgery.

Radiation therapy can cause side effects, including fatigue, swelling of the breast, redness and/or skin discoloration, and pain or burning in the skin where the radiation was directed, sometimes with blistering or peeling. Your doctor can recommend topical medication to apply to the skin to treat some of these side effects.

Very rarely, a small amount of the lung can be affected by the radiation therapy, causing pneumonitis, a radiation-related swelling of the lung tissue. This risk depends on the size of the area that received radiation therapy, and it tends to heal with time.

In the past, with older equipment and radiation therapy techniques, women who received treatment for breast cancer on the left side of the body had a small increase in the long-term risk of heart disease. Modern techniques, such as respiratory gating, which uses technology to guide the delivery of radiation while a patient breathes, are now able to spare the vast majority of the heart from the effects of radiation therapy.

 

Radiation therapy schedule

 

Radiation therapy is usually given daily for a set number of weeks.

After a lumpectomy. Radiation therapy after a lumpectomy is external-beam radiation therapy given Monday through Friday for 3 to 4 weeks if the cancer is not in the lymph nodes. If the cancer is in the lymph nodes, radiation therapy is given for 5 to 6 weeks. However, this duration is changing, as there is a preference for a shorter duration to be given in women who meet the criteria for shorter treatment. This often starts with radiation therapy to the whole breast, followed by a more focused treatment to where the tumor was located in the breast for the remaining treatments.

After a mastectomy. For those who need radiation therapy after a mastectomy, it is usually given 5 days a week for 5 to 6 weeks. Radiation therapy can be given before or after reconstructive surgery. As is the case following lumpectomy, some women may be recommended to have less than 5 weeks of radiation therapy after mastectomy.

 

Intensity-modulated radiation therapy

Intensity-modulated radiation therapy (IMRT) is a more advanced way to give external-beam radiation therapy to the breast. The intensity of the radiation directed at the breast is varied to better target the tumor, spreading the radiation more evenly throughout the breast. The use of IMRT lessens the radiation dose and may decrease possible damage to nearby organs, such as the heart and lung, as well as lessen the risks of some immediate side effects, such as peeling of the skin during treatment. This can be especially important for women with medium to large breasts who have a higher risk of side effects, such as peeling and burns, compared with women with smaller breasts. IMRT may also help to lessen the long-term effects on the breast tissue, such as hardness, swelling, or discoloration, that were common with older radiation techniques.

IMRT is not recommended for everyone. Talk with your radiation oncologist to learn more. Special insurance approval may also be needed for coverage for IMRT. It is important to check with your health insurance company before any treatment begins to make sure it is covered.

 

Proton therapy

Standard radiation therapy for breast cancer uses x-rays, also called photon therapy, to kill cancer cells. Proton therapy is a type of external-beam radiation therapy that uses protons rather than x-rays. At high energy, protons can destroy cancer cells. Protons have different physical properties that may allow the radiation therapy to be more targeted than photon therapy and potentially reduce the radiation dose. The therapy may also reduce the amount of radiation that goes near the heart. Researchers are studying the benefits of proton therapy versus photon therapy in a national clinical trial. Currently, proton therapy is an experimental treatment and may not be widely available or covered by health insurance

 

 

Therapies using medication

 

Systemic therapy is the use of medication to destroy cancer cells. Medications circulate through the body and therefore can reach cancer cells throughout the body. Systemic therapies are generally prescribed by a medical oncologist, a doctor who specializes in treating cancer with medication.

Common ways to give systemic therapies include an intravenous (IV) tube placed into a vein using a needle, an injection into a muscle or under the skin, or in a pill or capsule that is swallowed (orally).

The types of systemic therapies used for breast cancer include:

·        Chemotherapy

·        Hormonal therapy

·        Targeted therapy

·        Immunotherapy

Each of these therapies is discussed below in more detail. A person may receive 1 type of systemic therapy at a time or a combination of systemic therapies given at the same time. They can also be given as part of a treatment plan that includes surgery and/or radiation therapy. The medications used to treat cancer are continually being evaluated. Your doctor may suggest that you consider participating in clinical trials that are studying new ways to treat breast cancer.

Talking with your doctor is often the best way to learn about the medications that can be prescribed for you, their purposes, and their potential side effects. It is also important to let your doctor know if you are taking any other prescription or over-the-counter medications or supplements. Herbs, supplements, and other drugs can interact with cancer medications. Learn more about your prescriptions by using searchable drug databases.

 

Chemotherapy

Chemotherapy is the use of drugs to destroy cancer cells, usually by keeping the cancer cells from growing, dividing, and making more cells. It may be given before surgery to shrink a large tumor, make surgery easier, and/or reduce the risk of recurrence, called neoadjuvant chemotherapy. It may also be given after surgery to reduce the risk of recurrence, called adjuvant chemotherapy.

A chemotherapy regimen, or schedule, usually consists of a combination of drugs given in a specific number of cycles over a set period of time. Chemotherapy may be given on many different schedules depending on what worked best in clinical trials for that specific type of regimen. It may be given once a week, once every 2 weeks, once every 3 weeks, or even once every 4 weeks. There are many types of chemotherapy used to treat breast cancer. Common drugs include:

·        Docetaxel (Taxotere)

·        Paclitaxel (Taxol)

·        Doxorubicin (available as a generic drug)

·        Epirubicin (Ellence)

·        Pegylated liposomal doxorubicin (Doxil)

·        Capecitabine (Xeloda)

·        Carboplatin (available as a generic drug)

·        Cisplatin (available as a generic drug)

·        Cyclophosphamide (available as a generic drug)

·        Eribulin (Halaven)

·        Fluorouracil (5-FU)

·        Gemcitabine (Gemzar)

·        Ixabepilone (Ixempra)

·        Methotrexate (Rheumatrex, Trexall)

·        Protein-bound paclitaxel (Abraxane)

·        Vinorelbine (Navelbine)

A patient may receive 1 drug at a time or a combination of different drugs given at the same time. Research has shown that combinations of certain drugs are sometimes more effective than single drugs for adjuvant treatment. ASCO does not recommend routinely adding platinum chemotherapy (cisplatin or carboplatin) to anthracycline (doxorubicin or epiribicin) or taxane (paclitaxel or docetaxel) chemotherapy to treat people with inherited BRCA mutations before or after surgery.

 

The side effects of chemotherapy depend on the individual, the drug(s) used, whether the chemotherapy has been combined with other drugs, and the schedule and dose used. These side effects can include fatigue, risk of infection, nausea and vomiting, hair loss, loss of appetite, diarrhea, constipation, numbness and tingling, pain, early menopause, weight gain, and chemo-brain or cognitive dysfunction. These side effects can often be very successfully prevented or managed during treatment with supportive medications, and they usually go away after treatment is finished. For hair loss reduction, talk with your doctor about whether they do cold cap techniques. Rarely, long-term side effects may occur, such as heart damage, permanent nerve damage, or secondary cancers such as leukemia or lymphoma.

Many patients feel well during chemotherapy and are actively taking care of their families, working, and exercising during treatment, although each person’s experience can be different. Talk with your health care team about the possible side effects of your specific chemotherapy plan, and seek medical attention immediately if you experience a fever during chemotherapy.

 

Hormonal therapy

Hormonal therapy, also called endocrine therapy, is an effective treatment for most tumors that test positive for either estrogen or progesterone receptors (called ER positive or PR positive; see Introduction). This type of tumor uses hormones to fuel its growth. Blocking the hormones can help prevent a cancer recurrence and death from breast cancer when hormonal therapy is used either by itself or after chemotherapy.

Hormonal therapy for breast cancer treatment is different than menopausal hormone therapy (MHT). MHT may also be called postmenopausal hormone therapy or hormone replacement therapy (HRT). Hormonal therapies used in breast cancer treatment act as “anti-hormone” or “anti-estrogen” therapies. They block hormone actions or lower hormone levels in the body. Hormonal therapy may also be called endocrine therapy. The endocrine system in the body makes hormones.

Hormonal therapy may be given before surgery to shrink a tumor, make surgery easier, and/or lower the risk of recurrence. This is called neoadjuvant hormonal therapy. When given before surgery, it is typically given for at least 3 to 6 months before surgery and continued after surgery. It may also be given solely after surgery to reduce the risk of recurrence. This is called adjuvant hormonal therapy

 

Types of hormonal therapy

Tamoxifen. Tamoxifen is a drug that blocks estrogen from binding to breast cancer cells. It is effective for lowering the risk of recurrence in the breast that had cancer, the risk of developing cancer in the other breast, and the risk of distant recurrence. Tamoxifen works in women who have been through menopause as well as those who have not.

Aromatase inhibitors (AIs). AIs decrease the amount of estrogen made in tissues other than the ovaries in post-menopausal women by blocking the aromatase enzyme. This enzyme changes weak male hormones called androgens into estrogen when the ovaries have stopped making estrogen during menopause. These drugs include anastrozole (Arimidex), exemestane (Aromasin), and letrozole (Femara). All of the AIs are pills taken daily by mouth. Only women who have gone through menopause or who take medicines to stop the ovaries from making estrogen can take AIs.

Ovarian suppression or ablation. Ovarian suppression is the use of drugs to stop the ovaries from producing estrogen. Ovarian ablation is the use of surgery to remove the ovaries. These options may be used in addition to another type of hormonal therapy for women who have not been through menopause.

For ovarian suppression, gonadotropin or luteinizing releasing hormone (GnRH or LHRH) agonist drugs are used to stop the ovaries from making estrogen, causing temporary menopause. Goserelin (Zoladex) and leuprolide (Eligard, Lupron) are types of these drugs. Since they are not very effective for treating breast cancer on their own, they are typically given in combination with other hormonal therapy. They are given by injection every 4 weeks and stop the ovaries from making estrogen. The effects of GnRH drugs go away if treatment is stopped.

For ovarian ablation, surgery to remove the ovaries is used to stop estrogen production. While this is permanent, it can be a good option for women who no longer want to become pregnant, especially since the cost is typically lower over the long term

 

Info Source : Cancer.net

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