Medications and Treatments

The good news towards the cure is that the breast cancer treatment evolved so much during the last years and still is in the improvement process. The researches and new techniques employed by the physicians contributed for increasing women health. Another conquer is concerning the understanding of the carcinogenesis process, which is when the normal cells became cancer cells.

The expectation is that the surgeries are not dispensed but become less and less invasive. Researches keep looking for intelligent drugs, antibodies oriented against a specific mechanism of the tumor cell or that stop its feeding through the blood vessels. Counting with that, the treatment can be each time more specific, more efficient and with less side effects.

Less traumatic treatment

Early diagnosis and economic surgeries put mutilation more in the past, more obsolete. Some decades ago, whenever a tumor arose, the surgeon removed the entire breast: the muscle that was below it and all ganglia in the axillary region. Therefore, the skin was undulated just over the costal grid, being possible to see the anatomy of the rib and enhancing the physical and emotional pain that the whole process caused. Today it is not like that…

There is no cake recipe, each case is individually analyzed by the specialist, so they can reach the best viable way. The search for the treatment individualization is constant. Nowadays, at most of the initial cases, the surgeon removes only small breast fragments and some ganglia under the armpit. As the microscopic lesions with 1 or 2 cm are located, there is no reason to remove the entire breast.

Today it is possible, with a minor surgery, completely remove the tissue around the malignant cells. This is such a great news! However, the mastectomy still is the solution to treat bigger tumors.

We also need to mention that the radical surgeries established an essential advance at the medicine history, because they make possible to heal a lot of women which were destined to die of cancer. It was the most modern technique at that time, and it was, with no doubt, the starting point for the most advanced treatments that we know now.

Bigger tumors and combined treatments

When the tumor is bigger than 3cm, the probability of the surgery to be the cure decreases a lot. For lesions with 4cm, 5cm or 6cm, the recurrence tumor risk increases at least in 30%. Thus, for the women in this situation there is combined treatment options to achieve the best result.

One of the alternatives is to take a support chemotherapy, aiming at reducing the size of the tumor so after three or four months a conserving surgery is viable. Another path is to join a mastectomy with a breast reconstruction plastic surgery, bringing a very good favorable aesthetic result, using the abdomen or back muscle and/or a small silicone prosthesis. In Brazil, the technique of taking the chemotherapy before a conserving surgical intervention has been employed in 60% or 70% of those cases.

Pre-Chemo!

Before starting the chemotherapy, it is needed to have a tattoo on the breast to indicate the area where the tumor is, because there is a chance that the tumor disappears due to the chemotherapy previously applied, so the surgeon needs this reference at the time of the proceeding.

Pathological analysis of the specimen already indicates the women that has recurrence risk. The tumor cell is tested for a series of risk factors. Those results can tell, for instance, if the tumor has hormonal receptors or not, what give a more accurate idea of the disease evolution and the possibility of a recurrence, since women with hormonal receptors have a lightly better prognostic, while the other that do not have them always demand a more aggressive treatment.

Radiation therapy, an important reinforcement for the surgery

Radiation therapy is comprised by high voltage X rays which go through the breast and end killing the malignant cells focus that were not removed during the surgery. Because of that, conserving-breast surgeries are always complemented with the radiation therapy treatment. However, even if the post-surgery radiation therapy banishes the breast recurrence risk, it does not decrease the risk of the disease to spread to other organs.

The objective of the chemotherapy is to avoid metastasis to arise, which is the presence of tumors in organs other than where the disease originated. It is comprised by a treatment with drugs that circulate in the blood and attack the malignant cells at their microscopic phase and it is free from clinic manifestations. The effect is extensive to another organ that has one of those cells: bones, lungs, liver, etc.

Chemotherapy treatment results have been exciting, it can decrease the amount of cancer recurrence and heal many more women.

Less side effects during Chemo

Chemotherapy is a really powerful treatment, and for 25 years the effects were strong and practically impossible to avoid. Today, however it is not an easy treatment, it can be bearable and a good part of the patients submitted to it can maintain a life quality and keep on with their normal activities.

It is already possible to avoid nausea, for instance. Those complications would persist for days and make women extremely debilitated. Until now, some women can feel sick for two or three days after the chemo session, but the rest of the time they do not present any symptoms.

Metastatic Cancer does not mean death

Normally, women with disseminated disease are not curable anymore. It does not mean that they will soon die from cancer. There are patients with metastasis that live years and years, having an excellent life quality, because the disease is practically non-symptomatic.

That happens for many reasons. First, because the disease can have a progression characteristic really slow and demands a minimal treatment. Then, because we have hormone therapy for women with positive receptors. Those people can have the metastatic disease controlled for a long time with a simple hormonal treatment. Besides, chemotherapy is a type of treatment which can also be applicable in cases the disease is already advanced.

And more: nowadays we have intelligent weapons against cancer, since we are already able to unveil the great complexity of the tumor cell and, at a lab, to plan molecules capable of interfere in the intimate mechanism they use to grow. For instance, we are being able to create antibodies or small molecules that, when ingested orally can act on this mechanism. They are treatments efficient to contain the cancer practically without adverse side effects.

Breast cancer treatment

The treatment can vary accordingly with the disease stage, its biological characteristics, as well as the patient’s condition (age, menopausal status, general health and preferences). Breast cancer prognostic depends on the disease extension (staging), as well as the tumor characteristics. Whenever the disease is early diagnosed, the treatment has a bigger healing potential. When there are metastatic evidences (distant disease) that the treatment has as main objective to extend survival and improve the life quality.

The breast cancer treatment modalities can be divided in:

– Local treatment: surgery and radiation therapy (plus mammary reconstruction)

– Systemic treatment: chemotherapy, hormone therapy and biological therapy

The normal protocol is comprised by a surgery, which can be conserving, only removing the tumor; or mastectomy, with breast removal and mammary reconstruction. The axillary lymph nodes evaluation has only prognostic purposes.

After the surgery, radiation therapy complementary treatment can be indicated in some situations. The mammary reconstruction can Always be considered in the mastectomy cases.

Systemic treatment will be determined accordingly with the recurrence risk (patient’s age, lymph node impairment, tumor size, differential level), as well as the tumor characteristics which will set the most appropriate therapy.

It is essential that the therapeutic decision searches for the balance between the tumor response and the possible survival extension, taking into consideration the potential side effects incurring from the treatment [7]. The main method at this stage is the systemic, and the local treatment is reserved for restricted indications.

Breast cancer treatment, as provided in the Cancer Control and Prevention National Policy, can be realized by one of the High-Complexity Oncology Care Services (Unacon) and the High-Complexity Oncology Care Centers (Cacon), which are part of the service industry hospitals. This type of attention needs to be able to perform the differential and definitive cancer diagnosis to determine its extension (staging), treat it (surgery, radiation therapy, clinical oncology and palliative care), follow up and ensure the quality of the oncologic care.

Unacon and Cacon qualification is periodically d, accordingly with the need and the states nomination, based on standards and parameters published in the Decree # 140, of February 27^th, 2014.

It is up to the state and city secretaries to organize the patients’ assistance flow at the assistance net, establishing the patients reference to Unacon or Cacon.

SUS oncologic treatment

To get the cancer treatment by the Integrated Public Health System (SUS), the patient must go the nearest unit when presenting a symptom or health complain. Besides that, it is essential to have some tests that can prove the cancer.

Once the disease is diagnosed, the patient can be referred to a hospital or clinic that is a High-Complexity Oncology Care Services (UNACON), able to treat the most common cancer types in Brazil, or to a High-Complexity Oncology Care Centers (CACON), which can treat any type of cancer.

Another option is to be referred to an excellence center, such as the Brazilian National Cancer Institute (INCA) at Rio de Janeiro or the Cancer Institute (ICESP), but the patient needs that another reference unit sends them to be accepted there. 

The waiting time at the excellence units can reach 30 days. As of this moment, the patient starts the wait for a vacancy in the radiation therapy, chemotherapy and surgery. The wait can reach up to three months.