Breast cancer treatment should not be delayed, as experience shows that many women seek medical attention when the tumor has already reached the second or later stages. Early detection and prevention are crucial in improving outcomes.

Surgery

Surgery is the primary and most effective treatment method for breast cancer. It involves either partial or complete removal of the breast.

• Lumpectomy is performed to remove a small tumor (no larger than 4 cm) within the breast tissue. Healthy surrounding tissue is also removed along with the tumor to ensure complete excision. Following the procedure, radiation or chemotherapy is typically administered to eliminate any remaining cancer cells and prevent recurrence.
• If the lymph nodes are affected, they are also removed. However, in cases of non-invasive cancer, surgeons try to preserve them, as their removal can lead to arm swelling, limited shoulder movement, and chest pain.
• To determine whether cancer has spread to the lymph nodes, a sentinel node biopsy is conducted during surgery. A single axillary lymph node is excised and examined for cancer cells. If cancer is not detected, the other lymph nodes are left intact. However, if cancer is detected, it indicates a high risk of metastasis to other organs.

All removed tissue must undergo histological analysis to confirm the cancer diagnosis and assess its characteristics.

Types of breast cancer surgery

Sectoral resection

This procedure is performed when the tumor is small (1–2 cm) and confined to the breast. An incision is made, the affected tissue is removed, and an intracutaneous suture is applied.

Central resection

Central resection is used for multiple intraductal papillomas. The incision involves all the milk ducts, and 2–3 cm of healthy tissue surrounding the tumor is also removed. This procedure prevents future lactation, meaning the woman will no longer be able to breastfeed.

Nipple resection

This surgery is performed to diagnose and treat nipple and areola cancer. It also involves removing part of the milk ducts. After healing, breastfeeding complications may arise.

Oncoplastic resection

Oncoplastic resection combines cancer removal with reconstructive surgery. It involves partial removal of the affected tissue along with surrounding healthy areas, followed by plastic surgery to restore the breast’s shape. Tissue transplantation may be used, and in some cases, surgery on the second breast is required to maintain symmetry in nipple position and breast appearance. Postoperative radiation therapy is necessary after this procedure.

Mastectomy

Mastectomy involves the complete removal of the mammary gland while preserving the lymph nodes. This procedure is performed for large non-invasive tumors, individuals with a hereditary predisposition to breast cancer, or as a preventive measure. Plastic surgery can be used to reconstruct the breast after the procedure.

Radical mastectomy

Radical mastectomy involves the removal of not only the breast but also partial or complete removal of adjacent muscles and adipose tissue. This method is used in advanced stages when multiple metastases have spread to the lymph nodes and surrounding tissues. A “radical” approach aims to eliminate all cancer cells and prevent further metastasis. Surgery is always followed by radiation therapy and chemotherapy to enhance treatment effectiveness.

Palliative mastectomy

When metastases are already present, or the tumor is so extensive that metastasis is inevitable, palliative surgery is performed to improve the patient’s quality of life. The goal is to reduce the tumor size by removing the most affected or bleeding tissue. After surgery, medications are prescribed to help manage pain and prolong life.

Breast reconstruction after cancer surgery

In some cases, reconstructive surgery is performed following a radical mastectomy to restore the breast’s appearance. This involves transplanting muscle and adipose tissue from the back to replace the removed pectoral muscles. Studies show that cancer recurrence and metastasis after radical mastectomy are relatively low, occurring in approximately 18% of patients. Additionally, reconstructive surgery does not increase the risk of metastasis. However, the patient’s prognosis depends on the tumor’s stage, age, and response to subsequent chemotherapy.

The healing process is more challenging for patients with large tumors, diabetes, obesity, or those who smoke. In such cases, simultaneous breast removal and reconstruction are not performed, as tissue transplantation complicates wound healing. Delayed healing also postpones radiation and chemotherapy, which can only begin once wounds have fully recovered.

Chemotherapy

Chemotherapy is a systemic treatment using drugs that destroy cancer cells. Medication selection is highly individualized and depends on various factors, including tumor type, extent of spread, and prior surgeries. Chemotherapy drugs are potent and often cause side effects such as nausea, vomiting, and allergic reactions. They can also have toxic effects on the heart, liver, kidneys, and other organs.

For this reason, treatment plans consider the patient’s age and existing health conditions. Antiallergic medications are often prescribed in advance to minimize adverse reactions. While chemotherapy can be administered on an outpatient basis, hospitalization is preferred to allow for close medical supervision and immediate management of side effects, such as vomiting and pain.

Biomarker analysis for personalized treatment

To select the most effective chemotherapy drug, doctors may recommend a biomarker analysis, which identifies tumor-specific genetic markers. This helps determine which drugs the cancer cells are most responsive to and highlights potential contraindications.

Most patients undergo five to seven chemotherapy cycles. Due to the side effects, additional treatments are required to manage complications and ensure the patient can complete the full course of therapy.

Hormone therapy

Approximately 75% of breast cancers are hormone-dependent, meaning the tumor cells have receptors that respond to female sex hormones. Estrogens and progesterones stimulate tumor growth, with 10% of hormone-sensitive cancers reacting only to progesterone, while the majority respond to both hormones.

This hormone dependency explains why tumor growth may accelerate during pregnancy or certain phases of the menstrual cycle. Additionally, women who have previously had breast cancer are at higher risk of developing a new tumor.

Hormone therapy is prescribed after chemotherapy for patients with estrogen-dependent tumors. The most commonly used medications include:

• Tamoxifen – Prescribed for premenopausal women to block estrogen receptors.
• GnRH Analogs – Suppress ovarian function in premenopausal women.
• Aromatase Inhibitors – Used in postmenopausal women to reduce estrogen production.

By using hormone therapy, it is possible to slow tumor growth or even shrink it. At the 31st annual San Antonio Breast Cancer Symposium, a study involving 66 women demonstrated that estrogen therapy led to positive responses in one-third of participants, despite previous resistance to anti-estrogen treatments.

Interestingly, some women initially experienced tumor progression while on estrogen therapy but later responded to anti-estrogen treatment again. When the effectiveness of anti-estrogens declined, estrogen therapy was reintroduced, and the cycle continued. This alternating treatment approach was successful in managing the disease for several years.

Mechanism of hormone therapy

Before starting estrogen therapy, and again one day after its initiation, patients underwent positron emission tomography (PET) scans. The scans showed that hormone-sensitive tumors absorbed glucose and emitted strong signals. However, the exact mechanism behind this response remains unclear.

One theory suggests that the hormone IGF-1, which promotes breast cancer growth, is suppressed by estrogen. Further research is needed to fully understand this process and optimize hormone therapy for breast cancer treatment.

Targeted therapy for breast cancer

In some women, breast cancer is associated with the expression of the HER2 gene. For these patients, treatment with monoclonal antibodies such as Trastuzumab (Herceptin) is recommended. This therapy targets and suppresses HER2 activity in tumor cells, effectively slowing tumor growth. Trastuzumab can be prescribed alone or in combination with chemotherapy, and studies have shown that this combination leads to slower tumor progression and increased life expectancy in patients.

Clinical trials have demonstrated a relatively positive outcome when trastuzumab is used as part of adjuvant therapy for one year, reducing the risk of tumor recurrence and improving overall survival rates. Other targeted therapy options are still under investigation, including:

• Signal transduction inhibitors – These antibodies block nerve signal transmission within abnormal cells, preventing their division and stopping tumor growth.
• Angiogenesis inhibitors – These antibodies target and block the formation of new blood vessels, cutting off the tumor’s oxygen and nutrient supply.
• Antagonists of other hormones or receptors – These include inhibitors that target prolactin and androgen receptors, which are found in high concentrations within certain breast tumors.

Since there are multiple types of targeted therapies, doctors can tailor an effective treatment plan for each individual patient.

Antiangiogenic therapy

A randomized clinical trial tested the drug Bevacizumab, a monoclonal antibody that blocks vascular endothelial growth factor (VEGF) receptors, preventing blood vessel formation around the tumor. The U.S. National Cancer Institute published study data in 2005, indicating that, compared to standard chemotherapy, Bevacizumab can delay tumor growth by five months or more. However, it does not significantly improve overall survival rates.

The pharmaceutical company that developed Bevacizumab has submitted an application to the U.S. Food and Drug Administration (FDA) for approval to use this drug in treating metastatic breast cancer.

Immunotherapy

The human immune system plays a crucial role in fighting cancer. One emerging treatment involves dendritic cell therapy, where a patient’s own dendritic cells are modified using oncofetal antigens and then reintroduced into the body via injections three times a month. The goal is to train T-lymphocytes to recognize these cancer-associated antigens, triggering a strong immune response. This approach could potentially enable the immune system to destroy cancer cells on its own, reversing the disease’s progression.

Chemoimmunotherapy

Harnessing the immune system to fight breast cancer is a promising and innovative treatment approach. Immunization has several advantages over traditional therapies, as it allows immune cells to “remember” how to combat abnormal cells, reducing the need for repeated treatments.

Chemoimmunotherapy aims to enhance the T-cell response to cancer antigens while generating new T-cell responses using cytotoxic drugs. Some chemotherapy drugs, such as Paclitaxel, Cyclophosphamide, and Doxorubicin, when combined with immunized dendritic cells, have shown significantly increased effectiveness in destroying cancer cells.

Previously, scientists believed that chemotherapy-induced T-cell depletion would render immunotherapy ineffective. However, recent studies have shown that after T-cell exhaustion, a phase of active immune cell regrowth follows. The drug IMP321 has been found to increase both the number and function of immune cells, including natural killer cells and cytotoxic T-lymphocytes. Clinical trials have reported a 90% success rate, with cancer progression occurring in only three patients over six months. As a result, experts anticipate that chemoimmunotherapy may soon be included in standard breast cancer treatment protocols alongside chemotherapy.

Thermochemotherapy

Combining chemotherapy with heat therapy (thermotherapy) has been shown to enhance treatment effectiveness.

• Chemotherapy alone reduces tumor size in 58.8% of cases.
• When combined with thermotherapy, the success rate increases to 88.4%.
• In 80% of cases, tumors shrink by at least 80% with thermochemotherapy, compared to only 20% of patients receiving chemotherapy alone.

This suggests that heat therapy may significantly enhance the effects of chemotherapy, providing a more effective approach to tumor reduction.