Radiotherapy
Radiotherapy is used as an adjuvant to surgery following radical or local mastectomy if malignant cells have spread to the auxiliary lymph nodes. The radiation treatment is aimed at the breast and the remaining lymph nodes under the arm, above the collar bone, and along the breastbone.
Radiotherapy can also help to alleviate the pain of extensive breast cancer which cannot be cured, particularly where there is spread of cancer to the bones. It may be the treatment of choice for women who are unfit for surgery and for those in whom secondary tumours have developed in the bones and skin. The X-ray beam can be directed onto the tumour itself, making it shrink and helping to relieve any pain it was causing. If radiotherapy causes the breast tumour to shrink enough, a mastectomy may be feasible later.
Radiotherapy is given externally, or, more rarely, via an internal implant of radioactive material.
Chemotherapy
This treatment is used increasingly as an adjuvant to surgery, for all forms of breast cancer as well as for advanced cancer, for widespread metastases, and for extensive local invasion such as ulceration or fixation of the tumour to the overlying skin.
Chemotherapy agents, such as 5-fluorouracil, cyclophosphamide and methotrexate, are anti-cancer drugs which act directly on cancer cell growth and division. However, they have potentially harmful side-effects and their use needs to be carefully monitored.
For extensive breast cancer, chemotherapy and/or radiotherapy may be given first. If the tumour shrinks sufficiently, the smaller lump can then be removed surgically.
Hormone therapy
The most commonly used drug for hormone therapy is an anti-oestrogen agent called tamoxifen. It has proved over the last 20 years or so to be an effective treatment, particularly for tumours which contain oestrogen receptors, as it acts by suppressing the effects of oestrogen on breast cancer cells.
Other drugs have been used for hormone therapy, such as stilboestrol for women who are well past their menopause, but these can cause side-effects such as vaginal bleeding and masculinisation.
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