Treating Breast Cancer with Neoadjuvant Therapy, Surgery, and Adjuvant Treatment

The treatment of breast cancer includes surgery or radiotherapy or a combination of both. The treatment of systemic disease includes hormonal therapy, cytotoxic chemotherapy, biological therapy, or a combination of all of them. The choice of treatment depends on different factors including axillary lymph node involvement, pathological and clinical aspects of primary tumor, HER2 status, content of hormone receptors, presence and spread of metastasis, age, menopause, and other comorbidities. The patient's opinion is important and must be taken into consideration before initiating a treatment protocol.

Neoadjuvant Treatment

Preoperative chemotherapy or neoadjuvant treatment is an appropriate option in women with stage IIA, IIB and T3N1M0 for candidates who meet the criteria for a breast-conserving surgery which is also facilitated with other alternatives. Use of chemotherapy before surgery is only indicated in cases who have confirmed presence of invasive breast cancer. Research has shown no difference in survival between the chemotherapy before or after surgery in patients with stage II breast tumors.

In women with HER2-positive tumors, neoadjuvant therapy is recommended with the use of Herceptin (trastuzumab monoclonal antibody) due to its specificity for the receptor. Taxanes are a choice of treatment for advanced spread of breast cancer.

Surgery of Breast Cancer

The goal of locoregional surgical treatment is to achieve local disease control by getting information about prognosis, and by defining the most appropriate therapeutic protocol. Breast cancer surgery involves removing the tumor from a part of breast (lumpectomy) if the lesion is less than 4 cm. For larger tumors, surgeons perform lumpectomy or total mastectomy with axillary lymph node dissection. Sometimes it is sufficient to perform sentinel lymph node biopsy to exclude lymph node involvement. Breast reconstruction can be performed after doing lumpectomy or mastectomy in the same sitting or later.

Adjuvant Treatment

Adjuvant treatment means administration of adjuvant treatment with use of chemotherapy or endocrine therapy after the patient undergoes primary surgery. The goal of adjuvant therapy is to completely eliminate any possible existence of microscopic residual disease and thereby reduce the risk of disease recurrence or distant metastasis to other organs of the body.

Research has shown the benefits of combination of chemotherapy and endocrine therapy on outcomes of recurrence and death for women under 70 years of age and benefits of polychemotherapy and tamoxifen in all age groups. Therefore, multidrug therapy for women under 70 years of age is highly recommended. Some medical data has confirmed the relationship of adjuvant chemotherapy in women over 70 and does not recommend its use in this group of women. Therefore, it is always recommended to individualize choice of treatment. Duration of chemotherapy is usually between 4 to 6 months.