BreastCancerTreatment

Treatment

� 2aspects1.Treatmentofthebreastitself:“LocalTreatment”2.Treatmentofthewholebody=“Systemictreatment”

LocalTreatment� Surgery+/- Radiation� Usually:a.BreastConservingSurgery(“lumpectomy”)+radiation

ORb. Mastectomy (+/- radiation)

SystemicTreatment� Medicaloncologist=drugtreatment� 3possibilities1. Hormonaltreatment2. Chemotherapy3. Biologicaltherapies

Howdowechoosewhichsystemictherapy?

� Based on features of breast cancer + risk of recurrence

2ImportantIdeas:1. For breast cancer, there are a lot of good treatment

options2. The choice of treatment depends on the risk of

recurrence and the general health of the patient

High Risk of Recurrence = Aggressive Treatment

Low Risk of Recurrence = More gentle treatments

HowdowedetermineRiskofrecurrence?

Standard � size of tumor� lymph node involvement� Grade� ER� PR� Her2� Molecular Test

StandardFactors

� Size

� Nodes

� LVI

� Grade

� ER/PR

ER� Only ER+ breast cancers benefit from hormonal

treatments like Tamoxifen

� Her2

Her2� a marker of more aggressive tumor with high risk of

recurrence � Recurrence risk is reduced 50% by using the drug

Herceptin with chemotherapy

MolecularTest

� gene assay� molecular profileØA test for DNA changes in the tumor, NOT the

patient (e.g. oncotype Dx)

OncotypeDx

� test is done on a sample of tumors� another way to determine risk of recurrence and

benefit of chemo

OncotypeDx� Recurrence Score 0–50� low, intermediate, high� low: hormonal therapy� high: hormonal + chemo� intermediate ??

Whatischemotherapy?� Drug treatment given by IV � Usually lasts three to six months � Get treatment at cancer centre and go home the same

day� Each visit is about half a day� You may need a device in your vein to get chemo� You will need to attend a chemo class before you start� Chemo is given in cycles

ChemoSchedule

ChemoSideEffectsCommon:

1.Hair loss2.Nausea + Vomiting3.Infection4.Sore Mouth5.Diarrhea or Constipation6.Headache7.Body Pain8.Numbness/tingling fingers + toes9.Fatigue10.Early Menopause11.“Chemo Brain”

ChemoSideEffectsRare:� heart muscle damage� 2nd cancer (leukemia)� skin/tissue damage at IV site

ChemoRegimens

� CMF� AC� TC� ddACT� FEC D

TamoxifenSideEffects

Common� Improved bone density� Improved cholesterol reduces risk of cancer in other

breast� Hot flashes� Vaginal discharge� Irregular periods

TamoxifenSideEffectsRare� Blood clots < 1% risk� Cancer of uterus < 1% risk

Other� Mood changes� Weight changes

AromataseInhibitorSideEffects

� Hot flashes� Joint pain� Vaginal dryness� Thinning of bones� Reduces risk of cancer in other breast

ClinicalTrialsWhy participate?Clinical trials are important for many reasons. Before you or someone you care about takes part in such a research study for a new drug or treatment approach, it’s helpful to understand both the possible benefits and the potential risks.

Possible benefits from taking part in a clinical trialYou will receive state-of-the-art cancer care from experts in the field. You may be among the first to benefit from a new and effective treatment for cancer. You may undergo an effective new treatment that has fewer side effects than standard treatment for your type and stage of cancer. You will come in contact with a wide range of health professionals and may benefit from extra follow-up care often provided for participants. Whatever the outcome of the trial, you are helping scientists answer important questions about cancer. These answers may contribute new knowledge about cancer and eventually help others with the disease.

Possible risks from taking part in a clinical trialThere’s no guarantee that any treatment – new or standard – will produce positive results.The new treatment or approach being studied may not be as good as the standard cancer treatment you would receive outside the clinical trial. There may be side effects that are worse than those associated with standard treatments.Taking part in a trial, especially one that lasts for years, may be time-consuming and inconvenient. You may require extra tests or medication and be asked to keep records or fill out detailed health questionnaires.

FeaturesofYourCancer� Tumor size _________________� Lymph Nodes ________________� LVI _________________� Grade ___________________� ER ____________________� PR ___________________� Her2 ___________________

MyTreatmentPlan