Adjuvant and Systemic Treatment

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Used after local treatment to kill any cancer cells that may have spread from the breast to other parts of a woman’s body, adjuvant therapy includes chemotherapy, hormone therapy and biological therapy. Chemotherapy and hormone therapy are both also systemic treatment as they affect the entire body.

As with most aspects of a disease as complex as breast cancer, there is no simple answer as to who should have adjuvant treatment. When deciding whether to give it or not, doctors will try to predict the likelihood that the patient’s tumor will recur.

Chemotherapy

Chemotherapy involves using drugs to kill cancer cells that may be in a woman’s body. The treatment is given one or two times a month for 3 to 6 months. Years of testing and research have proved chemotherapy to be an effective cancer treatment. It may be the only treatment required, or it may be used in combination with other treatments, such as surgery and radiation therapy.

Chemotherapy works by killing rapidly dividing cells. These cells include cancer cells, which continuously divide to form more cells, and healthy cells that divide quickly, such as those in your bone marrow, gastrointestinal tract, reproductive system and hair follicles. Healthy cells usually recover shortly after chemotherapy is complete.

Side effects can include hair loss, nausea, dry mouth, nausea, fatigue, loss of appetite and liver damage for a short period of time. Long-term side effects, although rare, may include organ damage, nerve damage, and blood in urine or other cancers such as Hodgkin’s disease.

What’s the purpose of chemotherapy?

Chemotherapy can serve varying goals. One of chemotherapy’s main advantages is that, unlike radiation which treats only the area of the body exposed to the radiation, chemotherapy treats the entire body. As a result, any cells that may have escaped from the original cancer are treated.

Depending on what type of cancer you have and whether it has spread, your doctor may use chemotherapy to:

  • Eliminate all cancer cells in your body, even when cancer is widespread.
  • Prolong your life by controlling cancer growth and spread.
  • Relieve symptoms and enhance your quality of life.

Hormone therapy

There are certain hormones that can attach to cancer cells and can affect their ability to multiply. Hormone therapy involves using drugs to prevent your body’s hormones, especially estrogen, from promoting the growth of any cancer cells that may remain after surgery. The therapy may involve taking a drug, such as tamoxifen, for several years, or it may involve other drugs to decrease the body’s production of estrogen.

With breast cancer, the female hormones estrogen and progesterone can promote the growth of some breast cancer cells. So in these patients, hormone therapy is given to block the body’s naturally occurring estrogen and fight the cancer’s growth. Side effects may include hot flashes, vaginal dryness, weight gain and depression, and depending on the drugs used, the risks may differ from one to another.

There are two types of hormone therapy for breast cancer:

  • Drugs that inhibit estrogen and progesterone from promoting breast cancer cell growth.
  • Drugs or surgery to turn off the production of hormones from the ovaries.

Who gets treated with hormone therapy?

As part of the diagnosis process, tests are done to determine if the cancer cells have estrogen or progesterone receptors. If so, that means that growth of the cancer can be stimulated with these hormones. If a cancer is found to have these receptors, hormone therapy is recommended as part of the treatment plan.

Biological therapy

Biological therapy involves using the body’s immune system to fight cancer and reduce the side effects that are caused by other treatments. Biological therapy is sometimes called biological response modifier therapy or immunotherapy.

Although biological therapy and chemotherapy are may seem alike, they work in different ways. Biological therapy helps the immune system fight cancer, while chemotherapy attacks the cancer cells directly.

Doctors are not sure how biological therapy can help the immune system fight cancer, but they think it may:

  • Stop or slow the growth of cancer cells.
  • Make it easier for your immune system to destroy, or get rid of, cancer cells.
  • Keep cancer from spreading to other parts of your body.

Biological therapy is relatively new and many are still being studied in clinical trials.

Radiation therapy

Radiation therapy involves using high energy X-rays to destroy cancer cells in the breast, chest and axillary lymph nodes. Treatment is given regularly over a period of time to have the greatest effect on the cancer cells while limiting the damage to normal cells.

It is most often used with breast conserving surgery, but may also be recommended after a mastectomy for women with four or more positive lymph nodes or women with breast cancers over 5 cm in size or those with close or positive margins (cancer cells close to or at the edge of the surgically removed breast.)

Side effects may include fatigue, soreness and swelling in the breast area and lymphedema that may develop later. It is a local treatment because it treats a small area of the body.

What is radiotherapy used for, and when?

  • After surgery to get rid of any remaining cancer cells in the breast area. This reduces the risk of the cancer coming back. If you have a lump or part of the breast removed you’ll usually have radiotherapy to the remaining breast tissue. If you have a mastectomy, you may be given radiotherapy to the chest area, particularly if the tumor is large or cancer cells have spread to the under the arm.
  • After surgery to treat the lymph nodes above the collarbone and in the armpit. This will depend on the surgery you’ve had and whether or not the lymph nodes contained cancer cells. If all the lymph nodes have been removed, you’ll not usually need radiotherapy to the armpit area.
  • Before surgery to reduce the size of a large tumor. This is very uncommon.
  • Before, after or during courses of chemotherapy. Radiotherapy is most commonly given after chemotherapy.
  • To treat advanced stages of breast cancer. Radiotherapy can help to control previously untreated disease in the breast or help relieve cancer-related symptoms, such as pain caused by the cancer spreading to other parts of the body (secondary breast cancer).