Breast cancer

Breast cancer is the most common type of cancer in women with almost 50,000 new cases diagnosed every year in the UK. Rarely, men, can also get breast cancer.

Breast cancer is often divided into non-invasive and invasive types.

Non-invasive breast cancer is commonly referred as ductal carcinoma in situ (DCIS). This cancer is found in the ducts of the breast and hasn't developed the ability to spread outside the breast. This form of cancer is normally discovered on a mammogram.

Treatment is usually recommended in the form of a local surgical excision and may be followed by a course of local radiotherapy to the breast. Sometimes hormonal treatment using oral tablets may be recommended.

Invasive cancer has the ability to spread outside the breast and may be subdivided into early or advanced (secondary) breast cancer.

Early breast cancer is when the disease is confined to the breast and local (regional) lymph glands.

Initial treatment is normally surgical either by wide local excision or sometimes removal of the whole breast (mastectomy). This is normally combined with examination of the glands in the axilla (sentinel node biopsy) or sometimes complete removal of the lymph glands (axillary clearance).

Surgery is usually followed by chemotherapy or radiotherapy or, in some cases, hormone or biological treatments. Again, the treatment depends on the type of breast cancer. Chemotherapy or hormone therapy can sometimes be the first treatment before surgery.

When deciding what the next best treatment for the individual patient, the following are considered:

  • The stage and grade of the cancer (how big it is and how far it's spread) 
  • General health 
  • Expression of tumour receptors.

Breast cancer comes in different types and several different factors affect the response to treatment. From studies involving many thousands of women we know that the response to treatment is affected by the size and type of the cancer at diagnosis and whether the cancer has spread to involve the lymph nodes. The expression of markers such as the estrogen receptor (ER) and human epidermal growth factor receptor 2 (HER2) is also important.

In order to guide treatment decisions clinicians use online prognostication and treatment benefit tools such as Adjuvant on line or Predict. These will often be shared with the patient to indicate the level of benefit that may be gained from chemotherapy, hormone therapy or biological treatments in minimising the risk of recurrence developing elsewhere in the body (adjuvant systemic therapy). In this way an individualised treatment plan can be developed for each patient.

Recently Oncotype DX™ a prognostic model based on a test of gene expression profiles in tumours has been recommended by NICE (DG10) for use in women with oestrogen receptor positive (ER+), lymph node negative (LN−) and human epidermal growth factor receptor 2 negative (HER2−) early breast cancer to guide chemotherapy decisions if the person is assessed as being at intermediate risk. This requires the tumour to be sent to a laboratory in the United States for analysis.

Adjuvant Chemotherapy is normally given following the surgery for a period of 3 - 4.5 months. Occasionally it may be recommended before the surgery (Neoadjuvant chemotherapy). This is given as an outpatient usually as an intravenous injection.

Radiotherapy to the breast or chest wall is recommended in order to reduce the risk of a local recurrence. This is normally given following the chemotherapy or surgery as a 3 week course of short daily treatments. An extra week of treatment may be given to the area where the breast cancer developed (tumour bed boost). Occasionally treatment to the regional nodes is also given.

Adjuvant Hormone treatment is given for patient with oestrogen receptor positive (ER+) tumours, as a daily tablet for a period of 5 -10 years. In younger women presenting before the menopause this may be combined with stopping the periods (ovarian suppression) by injections or removing the ovaries surgically (laparoscopic oophorectomy).

Biological therapy for HER2 positive patient is normally administered by subcutaneous or intravenous injection of Trastuzumab (Herceptin) 3 weekly for a period of 6-12 months.

Advanced or secondary breast cancer is when the breast cancer has spread to other parts of the body (known as metastasis). Secondary cancer, also called "advanced" or "metastatic" cancer, isn't curable and treatment aims to achieve remission (where the cancer shrinks or disappears), and to improve patient symptoms to enable them to feel normal and enjoy life to the full for many years.

Treatment is tailored for each individual circumstance but may involve hormone therapy chemotherapy, biological agents and radiotherapy.

Cambridge Oncology Partners offers a full range of oncological treatments for breast cancer. Patients can access a full range of chemotherapy and targeted treatments including, where appropriate, new drugs which target HER-2 amplification and angiogenesis (new blood vessel formation). Radiotherapy is undertaken at Addenbrooke’s Hospital with fully equipped state of the art linear accelerators as well as advanced radiotherapy technologies such as intensity modulated radiotherapy (IMRT) and image guided radiotherapy (IGRT). Cambridge is a national leader in the development of new techniques and regimes for breast irradiation.

Useful Links

http://www.nhs.uk/Conditions/Cancer-of-the-breast-female/Pages/Introduction.aspx
http://www.cancerresearchuk.org/about-cancer/type/breast-cancer/
http://www.macmillan.org.uk/information-and-support/breast-cancer/understanding-cancer