Adjuvant Therapy



Following surgery your results will be discussed by the multidisciplinary team (MDT), which comprises experts in surgery, radiology, pathology, oncology, radiotherapy and nursing. This allows for a full review of your preoperative and operative course and determination of your optimal postoperative treatment. There are many ongoing clinical trials comparing the benefit of different combinations of treatments & you may be asked to take part in these. If so, the trial will be explained to you & if you decided not to take part this will not affect your treatment.

Hormonal Treatment


Whilst Tamoxifen remains the most commonly used hormonal treatment there are several alternatives which may be used depending on your individual circumstances. These include:

  • Selective Oestrogen receptor modulators (SERMs): (eg Tamoxifen) Tamoxifen is a drug that blocks the action of oestrogen, the female hormone, on breast cancer cells. Although it has an anti-oestrogenic effect on breast cells it has a weak oestrogenic action on other organs such as the womb, bones and heart. This group of compounds are known as selective oestrogen receptor modulators (SERMs). Side effects other than vasomotor menopausal symptoms are rare (1%) and include deep vein thrombosis and endometrial cancer. Tamoxifen is taken for 5 years although a continued benefit is seen for a further 5 years after completion of the treatment (known as the 'tail' effect).
  • Aromatase inhibitors (AIs): (eg, Anastrozole & Letrozole) which block oestrogen formation in sites other than the ovaries and are therefore only used in postmenopausal women, even if the menopause was induced by chemotherapy. Both SERMs and AIs reduce the chance of developing cancer in the other breast.
  • Pure Antioestrogens (eg, Fulvestrant)
  • Progestins (eg, Megestrol Acetate)


Radiotherapy


Radiotherapy is well tolerated without significant side effects; in particular it will not cause hair loss or sickness. The radiotherapy treatment lasts for up to five weeks requiring you to attend hospital every weekday, although only for a matter of minutes. The radiotherapy 'sterilises' the remaining breast tissue reducing the chance of future cancer in this breast to about 5% at five years. Whilst radiotherapy is almost always recommended following breast conserving surgery it is only occasionally needed after a mastectomy.

Chemotherapy


Chemotherapy drugs interfere with the process of cell division/multiplication so the cells can't divide and as a result die off. The idea is to decrease the total number of cancer cells to a number small enough for your immune system to deal with.

Different drugs interfere in this process at different points, so often more than one kind of drug is used at a time. Unfortunately this effect is not very selective. It acts on all cells which are rapidly dividing, not just cancer cells: including hair follicles, bone marrow, ovaries and stomach. The bone marrow produces red blood cells, white blood cells and platelets and chemotherapy slows this down. Chemotherapy is given in cycles to allow the bone marrow to recover as well as to target different populations of cancer cells.

Commonly used chemotherapy agents in the treatment of breast cancer are anthracyclines (eg Doxorubicin, Epirubicin), cyclophosphamide, methotrexate, and 5-FU, given in combinations such as CMF, FEC or AC. Taxol (Taxotere) may be used in conjunction with these regimes and Trastuzumab (Herceptin) may be offered if the tumour expressed the herceptin (cerbB2) receptor.