Oncological treatment of breast cancer

In certain cases oncological care with chemotherapy is performed before operation, for example in cases of inflammatory breast cancer (neo-adjuvant care).

After surgical care, a pathological analysis of all tissue sections is performed, and the final evaluation of the state of the disease is given.

The type and size of the tumour; the aggressiveness (gradus); cell invasion in neighboring tissue like small vessels, lymph ducts or nerves; immuno-histological receptor status (estrogen-, progesteron-, herseptin) and cell proliferation activity (Ki67) define the oncological after care.

After this, an oncologist plans so-called adjuvant care: possible cytostatic therapy, antioestrogen therapy and radiotherapy of the breast depending on the stage of the disease. All patients who undergo a breast conserving surgery in Savonlinna receive radiotherapy.

Adjuvant therapy for patients from abroad can be performed in Savonlinna or in other hospitals in Finland.

Postoperative chemotherapy for breast cancer (Adjuvant therapy)

A course of chemotherapy comprises a combination of various cytostatic drugs. The treatment is given in cycles because not all cancer cells are destroyed simultaneously; each cycle destroys only a certain proportion of the cancer cells. In between the cycles, the normal, healthy cells recover faster than the remaining cancer cells.

The oncologist plans the postoperative chemotherapy individually for each patient, depending on the type, size, stage and grade of the breast cancer at the time of diagnosis.

The most common form of breast cancer is treated with the CEF combination (C = cyclophosphamide, E = epirubicin, F= fluorouracil). It is administered intravenously. The treatment is begun one month after the surgery. The dosage is calculated according to the area of the patient’s skin. The treatment is repeated at three-week intervals, provided that the normal blood cells recover enough in between. Usually the treatment is repeated a total of six times.

If the breast tumour has grown relatively big and the cell morphology indicates that it is more aggressive, a cytostatic drug called Taxotere is used. It is administered intravenously. The treatment is begun one month after the surgery and is repeated three times at three-week intervals. After three cycles, the treatment is continued with the CEF combination, administered three times at three-week intervals.

Taxotere treatment is combined with Herceptin treatment if there are HER2 receptors in the breast cancer cells. Herceptin is given together with Taxotere nine times at one-week intervals. Herceptin is not a cytostatic drug but a targeted drug that blocks receptors.

When treating inflammatory breast cancer (the breast is red and swollen), three cycles of chemotherapy at three-week intervals are given already before the surgery (neoadjuvant therapy). The surgery is performed between cycles, and another 3-6 cycles of chemotherapy are given after the surgery according to the oncologist’s instructions.

Also, in the so-called “triple negative” type of breast cancer as well as in wide spread cancer cases neoadjuvant therapy will be given. There are interesting studies which develop individual, targeted treatments for different stages of the disease.

Adjuvant chemotherapy will be more and more individual depending on the cancer pathology and nature in the future.

If the white blood cell count is too low after chemotherapy, the growth of white cells is stimulated by G-CSF treatment. This medication is usually given subcutaneously under the skin.

Side effects of chemotherapy

Most of the symptoms relating to the side effects of chemotherapy can be prevented or alleviated. All of them will disappear with time.

Many normal, fast-regenerating healthy cells of the body are sensitive to cytostatic drugs. Millions of new cells are produced every day in, for example, the bone marrow, as well as in the scalp and in the mucous membranes of the mouth and the intestines.

Chemotherapy also destroys some of the healthy cells in the bone marrow, scalp and mucous membranes. Side effects related to this include low blood counts, hair loss, and digestive and intestinal problems.

Hair and chemotherapy

The regeneration of cells in the scalp can be disrupted by chemotherapy, causing hair loss in some patients. Sometimes hair comes off in large clumps. Hair loss can also occur on other parts of the body, including the eyebrows, beard, and pubic hair.
The nails are part of the skin and can also fall out. All patients receiving chemotherapy can be provided with a wig. When chemotherapy is over, hair and body hair will grow back.

Nausea caused by chemotherapy

Anti-nausea medication is given well before the beginning of chemotherapy.
It will be continued for as long as there are symptoms.

Appetite during treatments

In addition to chemotherapy, the cancer itself can cause loss of appetite and weight.
It is advisable to eat small portions at frequent intervals.
Cold food causes less nausea than hot food and might be easier to eat if mucous membranes in the mouth have been damaged.
Nutritional drinks are recommended if eating is difficult.

Mucous membranes

The body’s mucous membranes are not always regenerated fast enough during cancer treatment.
This can cause mouth ulcers, a dry mouth, nausea, diarrhoea and intestinal problems.
The symptoms will disappear after a while once chemotherapy ended.

Blood

The red blood cells transport oxygen to all organs and tissues of the body. Chemotherapy decreases the number of red blood cells in the body. This can result in a lower level of haemoglobin, which can cause tiredness and paleness.
The white blood cells protect the body against bacteria and viruses. When the body’s white blood cell count drops, susceptibility to infection increases. The risk of infection is usually the highest 7-14 days after chemotherapy. It is advisable to avoid contact with people with a cold during that time. If a patient develops a high temperature at home, she should contact the clinic.
Blood platelets (thrombocytes) help the blood to coagulate and wounds to heal.
Usually the bone marrow manages to recover, and the blood counts return to normal between cycles of chemotherapy. This will be monitored by blood tests.

Chemotherapy may be followed by hormone therapy, i.e. anti-oestrogen therapy, in order to reduce the oestrogen level as far as possible. This therapy is used if oestrogen and progesterone receptors are found in the tumour.

Breast Radiation after surgery

All breasts operated with breast conserving methods will be radiated after surgery. In most cases also armpit area, and sometimes also supraclavicular area will be included to radiation area.
In case of mastectomy, with big tumours and tumour growth in lymph nodes in armpit, radiation will be performed.
The oncologist of Clinic Helena gives the recommendation for radiation. Basic radiation takes three weeks. In young patients with wide tumours additional fourth week of radiation can be recommended.

It is important to take good care of breast skin during radiation (cream daily). Radiation can cause reddish colour, itching and superficial burn injury for the breast. It will heal within few weeks.