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Chemotherapy and Radiation Therapy: What comes after surgery?

Treatments for breast cancer are grouped into two major categories – local and systemic. Local therapies, meaning those therapies that treat the breast only, include surgery and radiation therapy. Systemic therapies, meaning those therapies that treat the entire body, include chemotherapy and/or hormonal therapy.

Radiation Oncology

Radiation therapy uses radiation particles, like X-Rays, to treat cancer. Radiation therapy is most commonly used in the local treatment of primary breast cancer following breast-conserving surgery. It is also a good method to control metastatic disease and alleviate symptoms (eg. radiation of the spine in the setting of bone metastasis may stop or slow growth of disease preventing damage to the spinal cord and decreasing pain).

Radiation treatments are usually given at CAROLINA RADIATION MEDICINE, a division of 21st Century Oncology, where the emphasis and concern is that you receive personal attention from your very first visit. A specialist in radiation cancer therapy will review all your records and discuss with you the available treatment options after a thorough physical exam.

Medical Oncology

Medical oncology is the study of and use of chemotherapy (drugs to treat cancer) and/or hormone therapy (drugs that interfere with the body’s hormonal stimulation of tumor growth). Chemotherapy may be given for primary breast cancer either before or after surgery. Chemotherapy may also be used as treatment for metastatic breast cancer that has spread to other organs of the body. Hormonal therapy (see below) can be given for primary or metastatic breast cancer. A medical oncologist has expertise in managing these treatments and treatment side effects and problems encountered over the course of the illness.

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy for breast cancer is usually a combination of drugs. The drugs may be given by mouth as pills or by injection through an intravenous (IV) needle. Either way, chemotherapy is a systemic therapy because the drugs enter the bloodstream and travel throughout the body to slow the growth of cancer cells or kill them. The oncologists at Physicians East ® division of Hematology and Oncology will recommend a treatment plan according to your individual case. The treatment will depend on your age, whether or not you are still having your periods, the stage of your cancer, the risk for spread or recurrence, and your general health.

Chemotherapy is used decrease the chances that cancer will come back after your breast cancer surgery. Sometimes, it is given before surgery (called neoadjuvant) in order to shrink a very large or advanced breast cancer. It can control breast cancer that has metastasized to the lungs, bones, liver, brain, or other parts of the body.

Treatment can be as short as a few months or as long as 2 years. Chemotherapy is usually given in cycles during which you have treatment for a period of time, and then you have a few weeks to recover before your next treatment. Depending on the drugs you take, you may have your chemotherapy at home, in your doctor’s office, in a clinic, in a hospital’s outpatient department, or in a hospital. How often and how long you have chemotherapy will depend on the type and stage of breast cancer, the drugs that are used and how your body responds to them, and the goals of the treatment.

Throughout chemotherapy, your oncologist and nurse will watch how you respond to the therapy. You will have frequent physical exams and blood tests. You should check with your doctor before taking any other medications during your treatment.

Chemotherapy can cause short-term and long-term side effects that are different for each patient, depending on the drugs used. The most common short-term side effects that may appear during chemotherapy include: loss of appetite, nausea, vomiting, diarrhea, constipation, fatigue, infections, bleeding, weight change, mouth sores, and throat soreness. Some of these problems may continue for some time after chemotherapy ends. Some drugs cause short-term hair loss. Hair will grow back either during treatment or after treatment is completed. Before you start chemotherapy, you may want to have your hair cut short, or buy a wig, hat, or scarves that you can wear while you are going through treatment. Serious long-term side effects may include weakening of your heart, damages to your ovaries, infertility, early menopause, or second cancers such as leukemia (cancer of the blood). These side effects may not appear until later, some time after chemotherapy is completed.

Hormonal Therapy

The female hormone estrogen is known to stimulate the growth and development of breast cancer. It does so through special receptors found on the breast cancer cells called estrogen receptor (ER) or progesterone receptor (PR). Hormonal therapy can useful if a particular person’s breast cancer makes these hormone receptors, usually designated as ER+ or PR+. It works by blocking the hormones from their receptor, thus inhibiting their growth effects on cancer cells. The most common estrogen blocker used in the treatment of breast cancer is Tamoxifen (Nolvadex®), although newer agents such as Arimidex ® and Aromasyn ® are increasingly being used.

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