Breast carcinoma, commonly referred to as breast cancer, can present with a variety of symptoms. It’s important to note that symptoms can vary from person to person, and some people may not experience any symptoms at all, especially in the early stages. However, common symptoms of breast carcinoma include:
- Lump in the Breast or Armpit: A new lump or mass in the breast or underarm is the most common symptom. These lumps are often painless but can be tender or painful in some cases.
- Change in Breast Shape or Size: Any noticeable change in the size or shape of the breast can be a sign of breast cancer. This includes swelling or shrinkage of the breast.
- Skin Changes: The skin over the breast may show changes such as dimpling,
The treatment of breast carcinoma (breast cancer) depends on several factors, including the type and stage of cancer, hormone receptor status, HER2 status, and the patient’s overall health and preferences. The main treatment options for breast cancer include surgery, radiation therapy, chemotherapy, hormone therapy, targeted therapy, and immunotherapy. Here’s an overview:
Surgery
Lumpectomy (Breast-Conserving Surgery): Involves removing the tumor and a small margin of surrounding healthy tissue. It is often followed by radiation therapy to destroy any remaining cancer cells.
Mastectomy: This involves removing the entire breast. There are different types of mastectomies, such as simple mastectomy, skin-sparing mastectomy, and radical mastectomy. Sometimes, reconstruction surgery is done at the same time or after mastectomy.
Sentinel Lymph Node Biopsy: A procedure where the first few lymph nodes (sentinel nodes) that drain the breast are removed and tested for cancer.
The treatment of metastatic breast cancer (stage IV breast cancer) is focused on managing the disease, alleviating symptoms, and improving or maintaining quality of life. Metastatic breast cancer is not considered curable, but it is treatable, and many patients live for years with the disease. The treatment plan is individualized based on factors such as the specific characteristics of the cancer, the sites of metastasis, previous treatments, and the patient’s overall health and preferences. Here are the main treatment options:
- Systemic Therapies
Systemic therapies treat cancer throughout the body and are the mainstay of treatment for metastatic breast cancer.
Hormone Therapy: Used if the cancer is hormone receptor-positive (ER-positive and/or PR-positive). Common medications include:
Selective Estrogen Receptor Modulators (SERMs): e.g., Tamoxifen.
Aromatase Inhibitors: e.g., Anastrozole, Letrozole, and Exemestane.
Estrogen Receptor Downregulators: e.g., Fulvestrant.
CDK4/6 Inhibitors: e.g., Palbociclib, Ribociclib, and Abemaciclib, often used in combination with hormone therapy.
Chemotherapy: Often used if the cancer is hormone receptor-negative, HER2-positive, or if the cancer has become resistant to hormone therapy. Chemotherapy drugs can be given in combination or sequentially, and common agents include:
Taxanes: e.g., Paclitaxel, Docetaxel.
Anthracyclines: e.g., Doxorubicin, Epirubicin.
Capecitabine, Vinorelbine, Eribulin, and others.
Targeted Therapy:
HER2-Targeted Therapies: Used for HER2-positive cancers.
Trastuzumab (Herceptin): A monoclonal antibody that targets the HER2 protein.
Pertuzumab: Often combined with Trastuzumab and chemotherapy.
Ado-Trastuzumab Emtansine (T-DM1): A HER2-targeted antibody-drug conjugate.
Lapatinib and Neratinib: Small molecule inhibitors that target HER2.
PI3K Inhibitors: e.g., Alpelisib, used for cancers with PIK3CA mutations in combination with hormone therapy.
mTOR Inhibitors: e.g., Everolimus, used in combination with hormone therapy for certain hormone receptor-positive breast cancers.
Immunotherapy: For triple-negative breast cancer (TNBC) with PD-L1 expression.
Checkpoint Inhibitors:* e.g., Pembrolizumab combined with chemotherapy.
- Radiation Therapy
Palliative Radiation: Used to control symptoms and reduce pain in areas where cancer has spread, such as bones or the brain.
Stereotactic Body Radiation Therapy (SBRT): High-dose radiation targeted at small metastatic tumors.
- Surgery
Surgery is less common in metastatic breast cancer but may be considered to control specific symptoms, such as removing a tumor that is causing pain or obstructing a vital organ.
- Bone-Directed Therapy
For patients with bone metastases, medications like bisphosphonates (e.g., Zoledronic acid) or RANK ligand inhibitors (e.g., Denosumab) are used to strengthen bones and reduce the risk of fractures.
- Symptom Management and Supportive Care
Pain Management: Opioids, non-opioid pain relievers, and other medications may be used to manage pain.
Psychosocial Support: Counseling, support groups, and palliative care teams to support emotional and psychological well-being.
Managing Side Effects: Medications and strategies to manage side effects of treatment, such as nausea, fatigue, or neuropathy.
- Clinical Trials
Patients with metastatic breast cancer may consider participating in clinical trials, which provide access to new therapies or combinations of therapies that are not yet widely available.
The choice of treatment depends on the biology of the cancer, previous treatments