Treatment Options for Invasive Ductal Breast Cancer

Breast cancer is the most commonly diagnosed cancer in women, making up 15% of all new cancers in the UK and 25% worldwide (Torre, 2015). One in eight women in the UK develop breast cancer and around 4,700 women and 30 men in Scotland are diagnosed with breast cancer each year (Breast Cancer Now, 2019). The most common type of breast cancer is Invasive ductal carcinoma (IDC), which accounts for 80% of all breast cancers diagnosed (nhs.uk, 2019). IDC is a cancer that has broken through the milk duct and has started to invade the tissues of the breast and over time can progress to the lymph nodes and other areas of the body (Cancerresearchuk.org, 2019). This paper will discuss treatment options for IDC.

Most women with breast cancer have more than one treatment. The choice of treatment depends on the characteristics of the cancer and patient choice. These treatments fall into two categories: Local treatments and Systemic treatments.

Local treatments for IDC include surgery and radiation therapy which treat the cancer and the surrounding areas, such as lymph nodes. Typically, women have surgery to remove the cancerous tissue first (Breast Cancer Care, 2019). Surgery is required not only to remove the cancer itself, but to confirm if it has spread to the lymph nodes. Two types of surgery can be recommended: breast-conserving surgery or a mastectomy.

Breast-conserving surgery involves removal of the cancerous tissue with a margin of healthy tissue which surrounds it. This is also known as a wide local excision or lumpectomy. A mastectomy is the removal the whole breast and is recommended when the cancer occupies a large area of the breast or when there is more than one area of cancer in the breast (Breast Cancer Care, 2019).

During surgery one or more lymph nodes may also be removed to discover if the cancer cells have travelled there. Cancer cells can travel to the lymph nodes which are the body’s system for removing bacteria and other unwanted substances, therefore offering cancer cells a route to other parts of the body (Macmillan.org.uk, 2019). If there is suspected spread of cancer to the lymph nodes, then either a Sentinel lymph node biopsy or an Axillary lymph node Biopsy will be performed during surgery (Mina et al, 2016). Knowing if the lymph nodes have cancer cells in them helps in selecting the best treatment plan. If the lymph nodes are cancer-free, it is unlikely further surgery will be necessary (Breast Cancer Care, 2019).

Following a lumpectomy or partial mastectomy, radiation therapy may be recommended. It can also be advised after a mastectomy where the tumour is large, and the lymph nodes are involved. Radiation therapy aims high-energy rays at the breast, chest, under the arm area and above the clavicle to destroy any cancer cells that may have been left behind.

Unlike local treatment, systemic treatments involve the whole body. They are used to destroy cancer cells that have spread from the original tumour and to reduce the risk of the cancer returning (Breast Cancer Care, 2019). These treatments can also be known as adjuvant treatments, as they are delivered post-surgery.

Chemotherapy is one such systemic treatment. It’s the delivery of anti-cancer drugs into the body through the bloodstream and is usually given post-surgery. As with radiation therapy, chemotherapy is used to destroy the cancer cells and is calculated carefully to have the greatest effect on the cancer cells with the least impact on the normal cells (Breast Cancer Now, 2019). It’s given in cycles, typically a day of treatment proceeded by a period of “off” days and lasts between 3 -6 months. The use of chemotherapy in treating IDC can be dependent on the oestrogen receptor and HER2 status. HER2 is a protein that enables cancer growth. Chemotherapies such as Cytoxan and Adriamycin are commonly used alongside HER2 targeted therapies, such as Herceptin, in treating HER2 positive IDC (Cancerresearchuk.org, 2019).

If the cancer tests positive for hormone receptors, some form of hormonal (endocrine) therapy is likely to be recommended in the treatment. It works by lowering the amount of oestrogen in the body or by blocking the oestrogen from signalling cancer cells to grow and divide therefore creating more cancer. This type of cancer is referred to as oestrogen receptor positive (ER+) and hormone therapy is only advised if the cancer is ER+ (Breast Cancer Care, 2019).

The treatment of invasive ductal carcinoma as shown in this paper can be very complex, varied and each treatment plan is dependent on results from a series of tests performed pre and during treatment. Every patient’s treatment is individually tailored to suit the specific characteristics of their cancer with an aim to give the patient the most beneficial outcome, to increase patient survival rates and to reduce the chance of the cancer returning.

References

Journals

• Torre, L.A., Bray, F., Siegel, R.L., Ferlay, J., Lortet-Tieulent, J. and Jemal, A., 2015. Global Cancer Statistics, 2012. CA Cancer Journal for Clinicians. Vol 65, no 2, pp. 87 – 109.

Book

• Mina, L., Storniolo, A., Kipfer, H., Hunter, C. and Ludwig, K. (2016). Breast cancer prevention and treatment.

Website

• Breast Cancer Care. (2019). Treatments: Surgery. [online] Available at: https://www.breastcancercare.org.uk/information-support/facing-breast-cancer/going-through-treatment-breast-cancer/surgery [Accessed 30 May. 2019].
• Breast Cancer Now. (2019). Are you having breast cancer treatment?. [online] Available at: https://breastcancernow.org/about-breast-cancer/are-you-having-breast-cancer-treatment [Accessed 30 May. 2019].
• Cancerresearchuk.org. (2019). Invasive breast cancer | Cancer Research UK. [online] Available at: https://www.cancerresearchuk.org/about-cancer/breast-cancer/stages-types-grades/types/invasive-breast-cancer [Accessed 3 Jun. 2019].
• Macmillan.org.uk. (2019). Secondary cancer in the lymph nodes. [online] Available at: https://www.macmillan.org.uk/information-and-support/lymph-node-cancer-secondary [Accessed 1 Jun. 2019].
• nhs.uk. (2019). Treatment. [online] Available at: https://www.nhs.uk/conditions/breast-cancer/treatment/ [Accessed 1 Jun. 2019].