Breast cancer is the most common cancer among women. A tumor can be detected by chance during a screening examination using mammography or in the presence of symptoms of a mammary gland. A radiologist will perform a micro biopsy or macro biopsy to make an accurate diagnosis.
It is an anatomopathological study of the performed biopsy that establishes the diagnosis and presence of breast cancer: either it is a ductal carcinoma, or a lobular carcinoma, or a tumor is infiltrating or not infiltrating, that is, in situ (limited to channels or lobes of the breast). Several gynecologists, a medical oncologist, surgeon, radiotherapist, oncologist, anatomical pathologist, and doctors of various specialties regularly meet at a multidisciplinary coordination meeting (RCP) to discuss therapeutic options for each case. Treatment decisions are based on national and international recommendations.
A family history is systematically requested to determine if the tumor may be hereditary breast cancer. Indeed, if there are other people with breast cancer in the family, an onco-genetic consultation will be conducted with the search for mutations in the BRCA1 or BRCA2 genes.
Symptoms of breast cancer may include:
Mass in the armpit
Palpation of mass in the chest, usually painless
The following factors are considered for treatment choice:
- stage of the disease: localized tumor or not, or locally regional tumor during menopause, hormone receptor status (positive or negative), HER2 cancer receptor status: overexpression or not, Ki 67 and Scarff Bloom Richardson tumor degree, I to III
- general condition of the patient
Surgery is the main treatment for localized tumors.
The gynecologist considers the size of the tumor relative to the size of the breast, the location of the tumor (quadrant). The sentinel node is meant to search for the first relay of the lymph node for drainage of the tumor. Breast surgery is considered conservative if the mastectomy is partial. Radiotherapy is always indicated after surgery if it has been performed while preserving the breast. In some situations, this treatment may be given after a complete mastectomy.
Hormone therapy or antihormonal therapy is indicated if the tumor expresses hormone receptors (positive) in the cells. Hormone treatment is carried out after radiation therapy for 5 years to treat breast cancer, in which hormone receptors are positive. Tamoxifen, an antiestrogen for premenopausal women and an aromatase inhibitor (anastrozole or letrozole) for postmenopausal women.
Chemotherapy is a treatment offered either before surgery (neoadjuvant) or after surgery (adjuvant) in the case of a progressive tumor, or locally regional or general lesion. It is offered in case of an aggressive tumor. Adjuvant Protocol: 3 EC cyclophosphamide and epirubicin every three weeks, then for 12 weeks, once a week, paclitaxel 80 mg / m2. The goal is to reduce the risk of relapse and metastasis.
The patient can only be prescribed targeted therapy or combine it with chemotherapy, hormone therapy, or both. Herceptin is a specific recombinant monoclonal antibody targeting the HER2 / neu receptors of tumor cells that overexpress them. Overexpression of HER2 is determined during pathology analysis using immunohistochemistry or in situ fluorescence hybridization (FISH) to estimate the number of copies of the HER2 gene present in cancer cells.
Radiotherapy reduces the risk of local and local-regional relapse after surgery. The course of treatment is usually from 3 to 6 weeks, one session per day and 5 sessions per week. Radiation therapy usually begins within 8-12 weeks after surgery. If chemotherapy and radiation therapy are indicated after surgery, radiation therapy is performed after completion of chemotherapy.
Radiotherapy is aimed at the chest itself or the chest wall with possible affecting the drainage zone, that is, the lymph nodes (internal, subclavian and supraclavicular and / or axillary mammary chain) in a total dose of 50 Gy in 25 sessions. An additional dose of 66 Gy for 33 sessions is offered on the operated area (the area where the tumor was in the chest). In older women, a shorter protocol may be proposed, for example 40 Gy from 15 fractions.