Treatment
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DID YOU KNOW?
An estimated 19,540 new cases of breast cancer are expected to occur among African American women in 2009.
The overall incidence rate of breast cancer is 10% lower in African American women than white women.
More Facts.....
An estimated 19,540 new cases of breast cancer are expected to occur among African American women in 2009.
The overall incidence rate of breast cancer is 10% lower in African American women than white women.
More Facts.....
Chemotherapy
Chemotherapy (often called just "chemo") is the use of cancer-killing drugs. These drugs can be put into a vein, given as a shot, or taken as a pill or liquid. They enter the bloodstream and go throughout the body, making this treatment useful for cancers that have spread to distant organs. While these drugs kill cancer cells, they also damage some normal cells, which can lead to side effects.
When is chemo used?
There are several cases where chemo may be used.
Adjuvant chemo
Treatment given to patients after surgery who do
not seem to have any spread of cancer is called
adjuvant therapy. When used this way after
breast-conserving surgery or mastectomy,
chemo reduces the risk of the breast cancer
coming back. Even in the early stages of the
disease, cancer cells can break away from the
first breast tumor and spread through the
bloodstream. These cells don't cause symptoms,
they don't show up on an x-ray, and they can't be
felt during a physical exam. But if they are allowed
to grow, they can form new tumors in other places
in the body. Adjuvant chemo can be given to find
and kill these cells.
Chemotherapy (often called just "chemo") is the use of cancer-killing drugs. These drugs can be put into a vein, given as a shot, or taken as a pill or liquid. They enter the bloodstream and go throughout the body, making this treatment useful for cancers that have spread to distant organs. While these drugs kill cancer cells, they also damage some normal cells, which can lead to side effects.
When is chemo used?
There are several cases where chemo may be used.
Adjuvant chemo
Treatment given to patients after surgery who do
not seem to have any spread of cancer is called
adjuvant therapy. When used this way after
breast-conserving surgery or mastectomy,
chemo reduces the risk of the breast cancer
coming back. Even in the early stages of the
disease, cancer cells can break away from the
first breast tumor and spread through the
bloodstream. These cells don't cause symptoms,
they don't show up on an x-ray, and they can't be
felt during a physical exam. But if they are allowed
to grow, they can form new tumors in other places
in the body. Adjuvant chemo can be given to find
and kill these cells.
Questions for your doctor about your breast cancer treatment
As you can see on the right, there are a range of treatments for breast cancer and these are usually used in combination. It is important that you understand which treatments you are undergoing.
Below are some key questions that you may want to ask your doctor when they are discussing your treatment.
What are my options for treatment?
Why have you decided to use those treatments for my breast cancer?
What are the benefits of these treatments?
What are the potential negative consequences of these treatments?
Are there any alternatives to the treatments I am going to undergo?
What are the strengths and weaknesses of other treatments?
Remember: You are going to be undergoing the treatment and you should feel confident that you have all the information you need.
As you can see on the right, there are a range of treatments for breast cancer and these are usually used in combination. It is important that you understand which treatments you are undergoing.
Below are some key questions that you may want to ask your doctor when they are discussing your treatment.
What are my options for treatment?
Why have you decided to use those treatments for my breast cancer?
What are the benefits of these treatments?
What are the potential negative consequences of these treatments?
Are there any alternatives to the treatments I am going to undergo?
What are the strengths and weaknesses of other treatments?
Remember: You are going to be undergoing the treatment and you should feel confident that you have all the information you need.
Dose-dense chemo
Doctors have found that giving the cycles of chemo closer together can lower the chance that the cancer will come back and improve survival in some women. This usually means giving the same chemo that is normally given every 3 weeks but giving it every 2 weeks. A drug called a growth factor is also given to help boost the white blood cell count. This approach can lead to more side effects and be harder to take, so it is only used for adjuvant treatment in women with a higher chance of the cancer coming back after treatment.
Possible side effects
The side effects of chemo depend on the type of drugs used, the amount given, and the length of treatment. You could experience some of these short-term side effects:
» Hair loss
» Mouth sores
» Loss of appetite
» Nausea and vomiting
» A higher risk of infection
(from low white blood cell counts)
» Changes in menstrual cycle
(this could be permanent)
» Easy bruising or bleeding
(from low blood platelet counts)
» Being very tired (called fatigue,
often caused by low red blood cell
counts or other reasons)
Most of these side effects go away when
treatment is over. For example, your hair
will grow back and your blood counts will
return to normal. If you have any problems
with side effects, be sure to tell your doctor
or nurse because there are often ways to help.
Doctors have found that giving the cycles of chemo closer together can lower the chance that the cancer will come back and improve survival in some women. This usually means giving the same chemo that is normally given every 3 weeks but giving it every 2 weeks. A drug called a growth factor is also given to help boost the white blood cell count. This approach can lead to more side effects and be harder to take, so it is only used for adjuvant treatment in women with a higher chance of the cancer coming back after treatment.
Possible side effects
The side effects of chemo depend on the type of drugs used, the amount given, and the length of treatment. You could experience some of these short-term side effects:
» Hair loss
» Mouth sores
» Loss of appetite
» Nausea and vomiting
» A higher risk of infection
(from low white blood cell counts)
» Changes in menstrual cycle
(this could be permanent)
» Easy bruising or bleeding
(from low blood platelet counts)
» Being very tired (called fatigue,
often caused by low red blood cell
counts or other reasons)
Most of these side effects go away when
treatment is over. For example, your hair
will grow back and your blood counts will
return to normal. If you have any problems
with side effects, be sure to tell your doctor
or nurse because there are often ways to help.
Chemotherapy
Chemotherapy (often called just "chemo") is the use of cancer-killing drugs. These drugs can be put into a vein, given as a shot, or taken as a pill or liquid. They enter the bloodstream and go throughout the body, making this treatment useful for cancers that have spread to distant organs. While these drugs kill cancer cells, they also damage some normal cells, which can lead to side effects.
When is chemo used?
There are several cases where chemo may be used.
Adjuvant chemo
Treatment given to patients after surgery who do
not seem to have any spread of cancer is called
adjuvant therapy. When used this way after
breast-conserving surgery or mastectomy,
chemo reduces the risk of the breast cancer
coming back. Even in the early stages of the
disease, cancer cells can break away from the
first breast tumor and spread through the
bloodstream. These cells don't cause symptoms,
they don't show up on an x-ray, and they can't be
felt during a physical exam. But if they are allowed
to grow, they can form new tumors in other places
in the body. Adjuvant chemo can be given to find
and kill these cells.
Chemotherapy (often called just "chemo") is the use of cancer-killing drugs. These drugs can be put into a vein, given as a shot, or taken as a pill or liquid. They enter the bloodstream and go throughout the body, making this treatment useful for cancers that have spread to distant organs. While these drugs kill cancer cells, they also damage some normal cells, which can lead to side effects.
When is chemo used?
There are several cases where chemo may be used.
Adjuvant chemo
Treatment given to patients after surgery who do
not seem to have any spread of cancer is called
adjuvant therapy. When used this way after
breast-conserving surgery or mastectomy,
chemo reduces the risk of the breast cancer
coming back. Even in the early stages of the
disease, cancer cells can break away from the
first breast tumor and spread through the
bloodstream. These cells don't cause symptoms,
they don't show up on an x-ray, and they can't be
felt during a physical exam. But if they are allowed
to grow, they can form new tumors in other places
in the body. Adjuvant chemo can be given to find
and kill these cells.
Chemotherapy
Chemotherapy (often called just "chemo") is the use of cancer-killing drugs. These drugs can be put into a vein, given as a shot, or taken as a pill or liquid. They enter the bloodstream and go throughout the body, making this treatment useful for cancers that have spread to distant organs. While these drugs kill cancer cells, they also damage some normal cells, which can lead to side effects.
When is chemo used?
There are several cases where chemo may be used.
Adjuvant chemo
Treatment given to patients after surgery who do
not seem to have any spread of cancer is called
adjuvant therapy. When used this way after
breast-conserving surgery or mastectomy,
chemo reduces the risk of the breast cancer
coming back. Even in the early stages of the
disease, cancer cells can break away from the
first breast tumor and spread through the
bloodstream. These cells don't cause symptoms,
they don't show up on an x-ray, and they can't be
felt during a physical exam. But if they are allowed
to grow, they can form new tumors in other places
in the body. Adjuvant chemo can be given to find
and kill these cells.
Chemotherapy (often called just "chemo") is the use of cancer-killing drugs. These drugs can be put into a vein, given as a shot, or taken as a pill or liquid. They enter the bloodstream and go throughout the body, making this treatment useful for cancers that have spread to distant organs. While these drugs kill cancer cells, they also damage some normal cells, which can lead to side effects.
When is chemo used?
There are several cases where chemo may be used.
Adjuvant chemo
Treatment given to patients after surgery who do
not seem to have any spread of cancer is called
adjuvant therapy. When used this way after
breast-conserving surgery or mastectomy,
chemo reduces the risk of the breast cancer
coming back. Even in the early stages of the
disease, cancer cells can break away from the
first breast tumor and spread through the
bloodstream. These cells don't cause symptoms,
they don't show up on an x-ray, and they can't be
felt during a physical exam. But if they are allowed
to grow, they can form new tumors in other places
in the body. Adjuvant chemo can be given to find
and kill these cells.
Neoadjuvant chemo
Chemo given before surgery is called neoadjuvant therapy. The major benefit of this approach is that it can shrink large cancers so that they are small enough to be removed by lumpectomy instead of mastectomy. Another possible advantage is that doctors can see how the cancer responds to the chemo. If the tumor does not shrink, then different drugs may be needed. So far, it is not clear that neoadjuvant chemo improves survival, but it works at least as well as adjuvant therapy after surgery.
Chemo for advanced breast cancer
Chemo can also be used as the main treatment for women with cancer that has already spread outside the breast and underarm area at the time it is found, or if it spreads after the first treatments.
How is chemo given?
In most cases chemo works best if more than one drug is used. Doctors give chemo in cycles, with each round of treatment followed by a rest period. The time between treatments is most often 2 or 3 weeks and varies according to the drug or combination of drugs being used. The total course of treatment usually lasts for 3 to 6 months. Treatment may be longer for advanced breast cancer.
Chemo given before surgery is called neoadjuvant therapy. The major benefit of this approach is that it can shrink large cancers so that they are small enough to be removed by lumpectomy instead of mastectomy. Another possible advantage is that doctors can see how the cancer responds to the chemo. If the tumor does not shrink, then different drugs may be needed. So far, it is not clear that neoadjuvant chemo improves survival, but it works at least as well as adjuvant therapy after surgery.
Chemo for advanced breast cancer
Chemo can also be used as the main treatment for women with cancer that has already spread outside the breast and underarm area at the time it is found, or if it spreads after the first treatments.
How is chemo given?
In most cases chemo works best if more than one drug is used. Doctors give chemo in cycles, with each round of treatment followed by a rest period. The time between treatments is most often 2 or 3 weeks and varies according to the drug or combination of drugs being used. The total course of treatment usually lasts for 3 to 6 months. Treatment may be longer for advanced breast cancer.
Menstrual changes
For younger women, changes in menstrual periods are another possible side effect of chemo. Permanent side effects can include early change of life (menopause) and not being able to become pregnant (infertility). But being on chemo does not always prevent pregnancy and getting pregnant while on chemo can lead to birth defects. If you are having sex, you should discuss birth control with your cancer doctor. If you are pregnant when you get breast cancer, you still can be treated. Chemo can be safely given during the last 2 trimesters of pregnancy.
Neuropathy
Some drugs used to treat breast cancer can damage nerves. This can sometimes lead to symptoms (mainly in the hands and feet) such as pain, burning or tingling, sensitivity to cold or heat, or weakness. In most cases this goes away once treatment is stopped, but it may be long-lasting in some women.
Heart damage
Some of the drugs may cause heart damage if used for a long time or in high doses. Doctors are careful to control the doses of these drugs and watch for signs of problems.
For younger women, changes in menstrual periods are another possible side effect of chemo. Permanent side effects can include early change of life (menopause) and not being able to become pregnant (infertility). But being on chemo does not always prevent pregnancy and getting pregnant while on chemo can lead to birth defects. If you are having sex, you should discuss birth control with your cancer doctor. If you are pregnant when you get breast cancer, you still can be treated. Chemo can be safely given during the last 2 trimesters of pregnancy.
Neuropathy
Some drugs used to treat breast cancer can damage nerves. This can sometimes lead to symptoms (mainly in the hands and feet) such as pain, burning or tingling, sensitivity to cold or heat, or weakness. In most cases this goes away once treatment is stopped, but it may be long-lasting in some women.
Heart damage
Some of the drugs may cause heart damage if used for a long time or in high doses. Doctors are careful to control the doses of these drugs and watch for signs of problems.
Chemo brain
Many women who have had chemo notice a change in concentration and memory. This is often called "chemo brain." It may last a long time. Still, most women function well after chemo. In studies that have found chemo brain to be a side effect of treatment, the symptoms most often go away in a few years.
Increased risk of leukemia
Very rarely, years after treatment for breast cancer, certain chemo drugs may cause another cancer called acute myeloid leukemia (AML). But for most women the benefit of treating the breast cancer far outweighs the risk of this rare event.
Feeling unwell or tired
Many women do not feel as healthy after having chemo as they did before. Extreme tiredness, called fatigue, can be another long-lasting problem for women who have had chemo. This may last for many years, but it can be helped. Talk to your doctor if fatigue is a problem for you. You can also get more information in our document.
Hormone therapy
Hormone therapy is another form of systemic therapy. It is most often used to help reduce the risk of the cancer coming back after surgery, but it may also be used for breast cancer that has spread or come back after treatment. The female hormone estrogen promotes the growth of breast cancer cells in some women (those who have ER-positive cancers). For these women, things are done to block the effect of estrogen or lower its levels in order to treat breast cancer.
Many women who have had chemo notice a change in concentration and memory. This is often called "chemo brain." It may last a long time. Still, most women function well after chemo. In studies that have found chemo brain to be a side effect of treatment, the symptoms most often go away in a few years.
Increased risk of leukemia
Very rarely, years after treatment for breast cancer, certain chemo drugs may cause another cancer called acute myeloid leukemia (AML). But for most women the benefit of treating the breast cancer far outweighs the risk of this rare event.
Feeling unwell or tired
Many women do not feel as healthy after having chemo as they did before. Extreme tiredness, called fatigue, can be another long-lasting problem for women who have had chemo. This may last for many years, but it can be helped. Talk to your doctor if fatigue is a problem for you. You can also get more information in our document.
Hormone therapy
Hormone therapy is another form of systemic therapy. It is most often used to help reduce the risk of the cancer coming back after surgery, but it may also be used for breast cancer that has spread or come back after treatment. The female hormone estrogen promotes the growth of breast cancer cells in some women (those who have ER-positive cancers). For these women, things are done to block the effect of estrogen or lower its levels in order to treat breast cancer.
Chemo brain
Many women who have had chemo notice a change in concentration and memory. This is often called "chemo brain." It may last a long time. Still, most women function well after chemo. In studies that have found chemo brain to be a side effect of treatment, the symptoms most often go away in a few years.
Increased risk of leukemia
Very rarely, years after treatment for breast cancer, certain chemo drugs may cause another cancer called acute myeloid leukemia (AML). But for most women the benefit of treating the breast cancer far outweighs the risk of this rare event.
Feeling unwell or tired
Many women do not feel as healthy after having chemo as they did before. Extreme tiredness, called fatigue, can be another long-lasting problem for women who have had chemo. This may last for many years, but it can be helped. Talk to your doctor if fatigue is a problem for you. You can also get more information in our document.
Hormone therapy
Hormone therapy is another form of systemic therapy. It is most often used to help reduce the risk of the cancer coming back after surgery, but it may also be used for breast cancer that has spread or come back after treatment. The female hormone estrogen promotes the growth of breast cancer cells in some women (those who have ER-positive cancers). For these women, things are done to block the effect of estrogen or lower its levels in order to treat breast cancer.
Drugs used to change hormone levelsTamoxifen® and toremifene (Fareston®)
Drugs like tamoxifen can be given to counter the effects of estrogen. Tamoxifen is taken in pill or liquid form, usually every day for up to 5 years after surgery, to reduce the risk the cancer will come back. This drug helps women with early breast cancer if their cancer has estrogen receptors (is ER-positive). It is also used to treat breast cancer that has spread and to reduce the risk of breast cancer in women who are at high risk. This drug has side effects. The most common ones are tiredness, hot flashes, vaginal discharge, and mood swings. Some studies have shown an increase of early stage cancer of the lining of the uterus among women taking tamoxifen. But this cancer is usually found at a very early stage and is almost always cured by surgery. If you are taking tamoxifen and have any unusual vaginal bleeding you should tell your doctor right away. Blood clots are another possible side effect of tamoxifen. Still, for most women with breast cancer, the benefits of tamoxifen far outweigh the risks.
Fulvestrant
Fulvestrant (Faslodex®) is a drug that acts by damaging the estrogen receptor instead of blocking it. It often works even if the breast cancer is no longer responding to tamoxifen. It is given as a shot once a month. Hot flashes, mild nausea, and tiredness are the major side effects. Right now it is only used in post-menopausal women with advanced breast cancer that no longer responds to tamoxifen or toremifene.
Aromatase inhibitors
These are drugs that stop the body from making estrogen. They only work for women who are past menopause and whose cancers are hormone-receptor positive. These drugs may be used after, or even instead of tamoxifen to reduce the chance of the breast cancer coming back. These drugs are taken daily as pills. For women after menopause, most doctors now recommend using an aromatase inhibitor at some point during adjuvant therapy. But it's not yet clear if starting adjuvant therapy with one of these drugs is better than giving tamoxifen and then switching to an aromatase inhibitor. And if tamoxifen is given first, it's not clear how long it should be given. The best length of treatment with aromatase inhibitors is not clear. Studies now being done should help answer these questions.These drugs don't cause uterine cancer and very rarely cause blood clots. But they can cause bone thinning and fractures because they remove estrogens from the body. The most common side effect of these drugs is joint stiffness and/or pain like the feeling of having arthritis in many different joints at one time.
Surgery to change hormone levelsRemoving the ovaries (ovarian ablation)
In pre-menopausal women, the ovaries are the main source of estrogens. Removing them or shutting them down takes away almost all the estrogen and makes the woman post-menopausal. This may allow some other hormone therapies to work better. Ovarian ablation can be done permanently by taking out the ovaries in surgery. It also can be done with drugs. Both of these methods can cause a woman to have symptoms of menopause, including hot flashes, night sweats, vaginal dryness, and mood swings.Other ways to change hormone levelsAndrogens (male hormones) may be used after other hormone treatments for advanced breast cancer have been tried. They sometimes work, but they can cause women to develop male traits, like an increase in body hair and a deeper voice.
Targeted therapy
As we have learned more about the gene changes that cause cancer, researchers have been able develop newer drugs that are aimed right at these changes. These targeted drugs do not work the same as standard chemo drugs. They often have different and less severe side effects. At this time, they are most often used along with chemo.
Trastuzumab (Herceptin®)
This is a monoclonal antibody -- a man-made version of a very specific immune system protein. It attaches to the growth-promoting protein called HER2/neu. HER2/neu is found in small amounts on the surface of normal breast cells and in large amounts on some breast cancer cells. Breast cancers that have too much of this protein are called HER2/neu-positive. The protein makes them grow and spread faster. Herceptin can stop this protein from causing breast cancer cell growth. It may also help the immune system to better attack the cancer. Herceptin is given into a vein (IV), usually once a week or as a larger dose every 3 weeks. Doctors do not yet know how long it should be given, but studies are looking at this. The side effects of this drug are fairly mild. They may include fever and chills, weakness, nausea, vomiting, cough, diarrhea, and headache. These side effects are less common after the first dose. But some women may develop heart damage during treatment. For most (but not all) women, this effect has been short-term and bets better when the drug is stopped. If you are getting Herceptin, you should tell your doctor right away if you have any shortness of breath, swelling, or trouble with physical activities.
Lapatinib (Tykerb®)
This is another drug that targets the HER2/neu protein. This drug is given as a pill, most often along with chemo. It is used for some women with cancer that is no longer helped by chemo and Herceptin. The most common side effects with this drug include diarrhea, nausea, vomiting, rash, and hand-foot syndrome, which may include numbness, tingling, redness, swelling, and pain in the hands and feet. Diarrhea is common and can be bad. It is very important to let your health care team know about any changes in your bowel habits as soon as they happen.
Bevacizumab (Avastin®)
This is another monoclonal antibody that may be used in patients with breast cancer that has spread. It is always used along with other chemo drugs. This antibody helps to keep tumors from making new blood vessels to feed the tumor. Avastin is given by intravenous (IV) infusion. There can be some rare, though serious, side effects and high blood pressure is very common. It very important that your doctor watches your blood pressure carefully during treatment and that you let your health care team know about any changes in how you feel.
Bisphosophonates
Bisphosphonates are drugs that are used when breast cancer has spread to the bones. These drugs can strengthen bones that have been weakened by invading breast cancer cells and reduce the risk of fractures or breaks. Bisphosphonates may also help prevent bone thinning (osteoporosis) that can result from treatment with aromatase inhibitors (see above) or from early menopause caused by chemo. These drugs are given into a vein (IV).Bisphosphonates can have side effects, including flu-like symptoms and bone pain. A rare but serious side effect from bisphosphonates is damage in the jaw bone. It can be triggered by having a tooth pulled while being treated with the bisphosphonate. It often appears as an open sore in the jaw that won't heal. Doctors don't know why this happens. Some cancer doctors recommend that patients have a dental check-up and have any tooth or jaw problems treated before they start taking bisphosphonates.
High-dose chemo with bone marrow or peripheral blood stem cell transplant
In the past, it was thought that very high doses of chemo followed by a stem cell transplant might offer some women the best chance for a cure -- especially those women with a high risk of the cancer coming back or with advanced cancer. But doctors have found that the women who had high-dose therapy did not live any longer than women who had standard dose chemo. And high-dose chemo with stem cell support can cause serious side effects. Research in this area is still going on. For now, experts in the field suggest that women get this treatment only as part of a clinical trial.
Many women who have had chemo notice a change in concentration and memory. This is often called "chemo brain." It may last a long time. Still, most women function well after chemo. In studies that have found chemo brain to be a side effect of treatment, the symptoms most often go away in a few years.
Increased risk of leukemia
Very rarely, years after treatment for breast cancer, certain chemo drugs may cause another cancer called acute myeloid leukemia (AML). But for most women the benefit of treating the breast cancer far outweighs the risk of this rare event.
Feeling unwell or tired
Many women do not feel as healthy after having chemo as they did before. Extreme tiredness, called fatigue, can be another long-lasting problem for women who have had chemo. This may last for many years, but it can be helped. Talk to your doctor if fatigue is a problem for you. You can also get more information in our document.
Hormone therapy
Hormone therapy is another form of systemic therapy. It is most often used to help reduce the risk of the cancer coming back after surgery, but it may also be used for breast cancer that has spread or come back after treatment. The female hormone estrogen promotes the growth of breast cancer cells in some women (those who have ER-positive cancers). For these women, things are done to block the effect of estrogen or lower its levels in order to treat breast cancer.
Drugs used to change hormone levelsTamoxifen® and toremifene (Fareston®)
Drugs like tamoxifen can be given to counter the effects of estrogen. Tamoxifen is taken in pill or liquid form, usually every day for up to 5 years after surgery, to reduce the risk the cancer will come back. This drug helps women with early breast cancer if their cancer has estrogen receptors (is ER-positive). It is also used to treat breast cancer that has spread and to reduce the risk of breast cancer in women who are at high risk. This drug has side effects. The most common ones are tiredness, hot flashes, vaginal discharge, and mood swings. Some studies have shown an increase of early stage cancer of the lining of the uterus among women taking tamoxifen. But this cancer is usually found at a very early stage and is almost always cured by surgery. If you are taking tamoxifen and have any unusual vaginal bleeding you should tell your doctor right away. Blood clots are another possible side effect of tamoxifen. Still, for most women with breast cancer, the benefits of tamoxifen far outweigh the risks.
Fulvestrant
Fulvestrant (Faslodex®) is a drug that acts by damaging the estrogen receptor instead of blocking it. It often works even if the breast cancer is no longer responding to tamoxifen. It is given as a shot once a month. Hot flashes, mild nausea, and tiredness are the major side effects. Right now it is only used in post-menopausal women with advanced breast cancer that no longer responds to tamoxifen or toremifene.
Aromatase inhibitors
These are drugs that stop the body from making estrogen. They only work for women who are past menopause and whose cancers are hormone-receptor positive. These drugs may be used after, or even instead of tamoxifen to reduce the chance of the breast cancer coming back. These drugs are taken daily as pills. For women after menopause, most doctors now recommend using an aromatase inhibitor at some point during adjuvant therapy. But it's not yet clear if starting adjuvant therapy with one of these drugs is better than giving tamoxifen and then switching to an aromatase inhibitor. And if tamoxifen is given first, it's not clear how long it should be given. The best length of treatment with aromatase inhibitors is not clear. Studies now being done should help answer these questions.These drugs don't cause uterine cancer and very rarely cause blood clots. But they can cause bone thinning and fractures because they remove estrogens from the body. The most common side effect of these drugs is joint stiffness and/or pain like the feeling of having arthritis in many different joints at one time.
Surgery to change hormone levelsRemoving the ovaries (ovarian ablation)
In pre-menopausal women, the ovaries are the main source of estrogens. Removing them or shutting them down takes away almost all the estrogen and makes the woman post-menopausal. This may allow some other hormone therapies to work better. Ovarian ablation can be done permanently by taking out the ovaries in surgery. It also can be done with drugs. Both of these methods can cause a woman to have symptoms of menopause, including hot flashes, night sweats, vaginal dryness, and mood swings.Other ways to change hormone levelsAndrogens (male hormones) may be used after other hormone treatments for advanced breast cancer have been tried. They sometimes work, but they can cause women to develop male traits, like an increase in body hair and a deeper voice.
Targeted therapy
As we have learned more about the gene changes that cause cancer, researchers have been able develop newer drugs that are aimed right at these changes. These targeted drugs do not work the same as standard chemo drugs. They often have different and less severe side effects. At this time, they are most often used along with chemo.
Trastuzumab (Herceptin®)
This is a monoclonal antibody -- a man-made version of a very specific immune system protein. It attaches to the growth-promoting protein called HER2/neu. HER2/neu is found in small amounts on the surface of normal breast cells and in large amounts on some breast cancer cells. Breast cancers that have too much of this protein are called HER2/neu-positive. The protein makes them grow and spread faster. Herceptin can stop this protein from causing breast cancer cell growth. It may also help the immune system to better attack the cancer. Herceptin is given into a vein (IV), usually once a week or as a larger dose every 3 weeks. Doctors do not yet know how long it should be given, but studies are looking at this. The side effects of this drug are fairly mild. They may include fever and chills, weakness, nausea, vomiting, cough, diarrhea, and headache. These side effects are less common after the first dose. But some women may develop heart damage during treatment. For most (but not all) women, this effect has been short-term and bets better when the drug is stopped. If you are getting Herceptin, you should tell your doctor right away if you have any shortness of breath, swelling, or trouble with physical activities.
Lapatinib (Tykerb®)
This is another drug that targets the HER2/neu protein. This drug is given as a pill, most often along with chemo. It is used for some women with cancer that is no longer helped by chemo and Herceptin. The most common side effects with this drug include diarrhea, nausea, vomiting, rash, and hand-foot syndrome, which may include numbness, tingling, redness, swelling, and pain in the hands and feet. Diarrhea is common and can be bad. It is very important to let your health care team know about any changes in your bowel habits as soon as they happen.
Bevacizumab (Avastin®)
This is another monoclonal antibody that may be used in patients with breast cancer that has spread. It is always used along with other chemo drugs. This antibody helps to keep tumors from making new blood vessels to feed the tumor. Avastin is given by intravenous (IV) infusion. There can be some rare, though serious, side effects and high blood pressure is very common. It very important that your doctor watches your blood pressure carefully during treatment and that you let your health care team know about any changes in how you feel.
Bisphosophonates
Bisphosphonates are drugs that are used when breast cancer has spread to the bones. These drugs can strengthen bones that have been weakened by invading breast cancer cells and reduce the risk of fractures or breaks. Bisphosphonates may also help prevent bone thinning (osteoporosis) that can result from treatment with aromatase inhibitors (see above) or from early menopause caused by chemo. These drugs are given into a vein (IV).Bisphosphonates can have side effects, including flu-like symptoms and bone pain. A rare but serious side effect from bisphosphonates is damage in the jaw bone. It can be triggered by having a tooth pulled while being treated with the bisphosphonate. It often appears as an open sore in the jaw that won't heal. Doctors don't know why this happens. Some cancer doctors recommend that patients have a dental check-up and have any tooth or jaw problems treated before they start taking bisphosphonates.
High-dose chemo with bone marrow or peripheral blood stem cell transplant
In the past, it was thought that very high doses of chemo followed by a stem cell transplant might offer some women the best chance for a cure -- especially those women with a high risk of the cancer coming back or with advanced cancer. But doctors have found that the women who had high-dose therapy did not live any longer than women who had standard dose chemo. And high-dose chemo with stem cell support can cause serious side effects. Research in this area is still going on. For now, experts in the field suggest that women get this treatment only as part of a clinical trial.
Drugs used to change hormone levelsTamoxifen® and toremifene (Fareston®)
Drugs like tamoxifen can be given to counter the effects of estrogen. Tamoxifen is taken in pill or liquid form, usually every day for up to 5 years after surgery, to reduce the risk the cancer will come back. This drug helps women with early breast cancer if their cancer has estrogen receptors (is ER-positive). It is also used to treat breast cancer that has spread and to reduce the risk of breast cancer in women who are at high risk. This drug has side effects. The most common ones are tiredness, hot flashes, vaginal discharge, and mood swings. Some studies have shown an increase of early stage cancer of the lining of the uterus among women taking tamoxifen. But this cancer is usually found at a very early stage and is almost always cured by surgery. If you are taking tamoxifen and have any unusual vaginal bleeding you should tell your doctor right away. Blood clots are another possible side effect of tamoxifen. Still, for most women with breast cancer, the benefits of tamoxifen far outweigh the risks.
Drugs like tamoxifen can be given to counter the effects of estrogen. Tamoxifen is taken in pill or liquid form, usually every day for up to 5 years after surgery, to reduce the risk the cancer will come back. This drug helps women with early breast cancer if their cancer has estrogen receptors (is ER-positive). It is also used to treat breast cancer that has spread and to reduce the risk of breast cancer in women who are at high risk. This drug has side effects. The most common ones are tiredness, hot flashes, vaginal discharge, and mood swings. Some studies have shown an increase of early stage cancer of the lining of the uterus among women taking tamoxifen. But this cancer is usually found at a very early stage and is almost always cured by surgery. If you are taking tamoxifen and have any unusual vaginal bleeding you should tell your doctor right away. Blood clots are another possible side effect of tamoxifen. Still, for most women with breast cancer, the benefits of tamoxifen far outweigh the risks.
Fulvestrant
Fulvestrant (Faslodex®) is a drug that acts by damaging the estrogen receptor instead of blocking it. It often works even if the breast cancer is no longer responding to tamoxifen. It is given as a shot once a month. Hot flashes, mild nausea, and tiredness are the major side effects. Right now it is only used in post-menopausal women with advanced breast cancer that no longer responds to tamoxifen or toremifene.
Aromatase inhibitors
These are drugs that stop the body from making estrogen. They only work for women who are past menopause and whose cancers are hormone-receptor positive. These drugs may be used after, or even instead of tamoxifen to reduce the chance of the breast cancer coming back. These drugs are taken daily as pills. For women after menopause, most doctors now recommend using an aromatase inhibitor at some point during adjuvant therapy. But it's not yet clear if starting adjuvant therapy with one of these drugs is better than giving tamoxifen and then switching to an aromatase inhibitor. And if tamoxifen is given first, it's not clear how long it should be given. The best length of treatment with aromatase inhibitors is not clear. Studies now being done should help answer these questions.These drugs don't cause uterine cancer and very rarely cause blood clots. But they can cause bone thinning and fractures because they remove estrogens from the body. The most common side effect of these drugs is joint stiffness and/or pain like the feeling of having arthritis in many different joints at one time.
Surgery to change hormone levelsRemoving the ovaries (ovarian ablation)
In pre-menopausal women, the ovaries are the main source of estrogens. Removing them or shutting them down takes away almost all the estrogen and makes the woman post-menopausal. This may allow some other hormone therapies to work better. Ovarian ablation can be done permanently by taking out the ovaries in surgery. It also can be done with drugs. Both of these methods can cause a woman to have symptoms of menopause, including hot flashes, night sweats, vaginal dryness, and mood swings.Other ways to change hormone levelsAndrogens (male hormones) may be used after other hormone treatments for advanced breast cancer have been tried. They sometimes work, but they can cause women to develop male traits, like an increase in body hair and a deeper voice.
Targeted therapy
As we have learned more about the gene changes that cause cancer, researchers have been able develop newer drugs that are aimed right at these changes. These targeted drugs do not work the same as standard chemo drugs. They often have different and less severe side effects. At this time, they are most often used along with chemo.
Trastuzumab (Herceptin®)
This is a monoclonal antibody -- a man-made version of a very specific immune system protein. It attaches to the growth-promoting protein called HER2/neu. HER2/neu is found in small amounts on the surface of normal breast cells and in large amounts on some breast cancer cells. Breast cancers that have too much of this protein are called HER2/neu-positive. The protein makes them grow and spread faster. Herceptin can stop this protein from causing breast cancer cell growth. It may also help the immune system to better attack the cancer. Herceptin is given into a vein (IV), usually once a week or as a larger dose every 3 weeks. Doctors do not yet know how long it should be given, but studies are looking at this. The side effects of this drug are fairly mild. They may include fever and chills, weakness, nausea, vomiting, cough, diarrhea, and headache. These side effects are less common after the first dose. But some women may develop heart damage during treatment. For most (but not all) women, this effect has been short-term and bets better when the drug is stopped. If you are getting Herceptin, you should tell your doctor right away if you have any shortness of breath, swelling, or trouble with physical activities.
Fulvestrant (Faslodex®) is a drug that acts by damaging the estrogen receptor instead of blocking it. It often works even if the breast cancer is no longer responding to tamoxifen. It is given as a shot once a month. Hot flashes, mild nausea, and tiredness are the major side effects. Right now it is only used in post-menopausal women with advanced breast cancer that no longer responds to tamoxifen or toremifene.
Aromatase inhibitors
These are drugs that stop the body from making estrogen. They only work for women who are past menopause and whose cancers are hormone-receptor positive. These drugs may be used after, or even instead of tamoxifen to reduce the chance of the breast cancer coming back. These drugs are taken daily as pills. For women after menopause, most doctors now recommend using an aromatase inhibitor at some point during adjuvant therapy. But it's not yet clear if starting adjuvant therapy with one of these drugs is better than giving tamoxifen and then switching to an aromatase inhibitor. And if tamoxifen is given first, it's not clear how long it should be given. The best length of treatment with aromatase inhibitors is not clear. Studies now being done should help answer these questions.These drugs don't cause uterine cancer and very rarely cause blood clots. But they can cause bone thinning and fractures because they remove estrogens from the body. The most common side effect of these drugs is joint stiffness and/or pain like the feeling of having arthritis in many different joints at one time.
Surgery to change hormone levelsRemoving the ovaries (ovarian ablation)
In pre-menopausal women, the ovaries are the main source of estrogens. Removing them or shutting them down takes away almost all the estrogen and makes the woman post-menopausal. This may allow some other hormone therapies to work better. Ovarian ablation can be done permanently by taking out the ovaries in surgery. It also can be done with drugs. Both of these methods can cause a woman to have symptoms of menopause, including hot flashes, night sweats, vaginal dryness, and mood swings.Other ways to change hormone levelsAndrogens (male hormones) may be used after other hormone treatments for advanced breast cancer have been tried. They sometimes work, but they can cause women to develop male traits, like an increase in body hair and a deeper voice.
Targeted therapy
As we have learned more about the gene changes that cause cancer, researchers have been able develop newer drugs that are aimed right at these changes. These targeted drugs do not work the same as standard chemo drugs. They often have different and less severe side effects. At this time, they are most often used along with chemo.
Trastuzumab (Herceptin®)
This is a monoclonal antibody -- a man-made version of a very specific immune system protein. It attaches to the growth-promoting protein called HER2/neu. HER2/neu is found in small amounts on the surface of normal breast cells and in large amounts on some breast cancer cells. Breast cancers that have too much of this protein are called HER2/neu-positive. The protein makes them grow and spread faster. Herceptin can stop this protein from causing breast cancer cell growth. It may also help the immune system to better attack the cancer. Herceptin is given into a vein (IV), usually once a week or as a larger dose every 3 weeks. Doctors do not yet know how long it should be given, but studies are looking at this. The side effects of this drug are fairly mild. They may include fever and chills, weakness, nausea, vomiting, cough, diarrhea, and headache. These side effects are less common after the first dose. But some women may develop heart damage during treatment. For most (but not all) women, this effect has been short-term and bets better when the drug is stopped. If you are getting Herceptin, you should tell your doctor right away if you have any shortness of breath, swelling, or trouble with physical activities.
Lapatinib (Tykerb®)
This is another drug that targets the HER2/neu protein. This drug is given as a pill, most often along with chemo. It is used for some women with cancer that is no longer helped by chemo and Herceptin. The most common side effects with this drug include diarrhea, nausea, vomiting, rash, and hand-foot syndrome, which may include numbness, tingling, redness, swelling, and pain in the hands and feet. Diarrhea is common and can be bad. It is very important to let your health care team know about any changes in your bowel habits as soon as they happen.
Bevacizumab (Avastin®)
This is another monoclonal antibody that may be used in patients with breast cancer that has spread. It is always used along with other chemo drugs. This antibody helps to keep tumors from making new blood vessels to feed the tumor. Avastin is given by intravenous (IV) infusion. There can be some rare, though serious, side effects and high blood pressure is very common. It very important that your doctor watches your blood pressure carefully during treatment and that you let your health care team know about any changes in how you feel.
Bisphosophonates
Bisphosphonates are drugs that are used when breast cancer has spread to the bones. These drugs can strengthen bones that have been weakened by invading breast cancer cells and reduce the risk of fractures or breaks. Bisphosphonates may also help prevent bone thinning (osteoporosis) that can result from treatment with aromatase inhibitors (see above) or from early menopause caused by chemo. These drugs are given into a vein (IV).Bisphosphonates can have side effects, including flu-like symptoms and bone pain. A rare but serious side effect from bisphosphonates is damage in the jaw bone. It can be triggered by having a tooth pulled while being treated with the bisphosphonate. It often appears as an open sore in the jaw that won't heal. Doctors don't know why this happens. Some cancer doctors recommend that patients have a dental check-up and have any tooth or jaw problems treated before they start taking bisphosphonates.
High-dose chemo with bone marrow or peripheral blood stem cell transplant
In the past, it was thought that very high doses of chemo followed by a stem cell transplant might offer some women the best chance for a cure -- especially those women with a high risk of the cancer coming back or with advanced cancer. But doctors have found that the women who had high-dose therapy did not live any longer than women who had standard dose chemo. And high-dose chemo with stem cell support can cause serious side effects. Research in this area is still going on. For now, experts in the field suggest that women get this treatment only as part of a clinical trial.
This is another drug that targets the HER2/neu protein. This drug is given as a pill, most often along with chemo. It is used for some women with cancer that is no longer helped by chemo and Herceptin. The most common side effects with this drug include diarrhea, nausea, vomiting, rash, and hand-foot syndrome, which may include numbness, tingling, redness, swelling, and pain in the hands and feet. Diarrhea is common and can be bad. It is very important to let your health care team know about any changes in your bowel habits as soon as they happen.
Bevacizumab (Avastin®)
This is another monoclonal antibody that may be used in patients with breast cancer that has spread. It is always used along with other chemo drugs. This antibody helps to keep tumors from making new blood vessels to feed the tumor. Avastin is given by intravenous (IV) infusion. There can be some rare, though serious, side effects and high blood pressure is very common. It very important that your doctor watches your blood pressure carefully during treatment and that you let your health care team know about any changes in how you feel.
Bisphosophonates
Bisphosphonates are drugs that are used when breast cancer has spread to the bones. These drugs can strengthen bones that have been weakened by invading breast cancer cells and reduce the risk of fractures or breaks. Bisphosphonates may also help prevent bone thinning (osteoporosis) that can result from treatment with aromatase inhibitors (see above) or from early menopause caused by chemo. These drugs are given into a vein (IV).Bisphosphonates can have side effects, including flu-like symptoms and bone pain. A rare but serious side effect from bisphosphonates is damage in the jaw bone. It can be triggered by having a tooth pulled while being treated with the bisphosphonate. It often appears as an open sore in the jaw that won't heal. Doctors don't know why this happens. Some cancer doctors recommend that patients have a dental check-up and have any tooth or jaw problems treated before they start taking bisphosphonates.
High-dose chemo with bone marrow or peripheral blood stem cell transplant
In the past, it was thought that very high doses of chemo followed by a stem cell transplant might offer some women the best chance for a cure -- especially those women with a high risk of the cancer coming back or with advanced cancer. But doctors have found that the women who had high-dose therapy did not live any longer than women who had standard dose chemo. And high-dose chemo with stem cell support can cause serious side effects. Research in this area is still going on. For now, experts in the field suggest that women get this treatment only as part of a clinical trial.
