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Antidepressants: Will They Help You?
What is chemotherapy?
Chemotherapy (also called chemo) is a type of cancer treatment that uses drugs to destroy cancer cells.
How does chemotherapy work?
Chemotherapy works by stopping or slowing the growth of cancer cells, which grow and divide quickly. But it can also harm healthy cells that divide quickly, such as those that line your mouth and intestines or cause your hair to grow. Damage to healthy cells may cause side effects. Often, side effects get better or go away after chemotherapy is over.
What does chemotherapy do?
Depending on your type of cancer and how advanced it is, chemotherapy can:
- Cure cancer - when chemotherapy destroys cancer cells to the point that your doctor can no longer detect them in your body and they will not grow back.
- Control cancer - when chemotherapy keeps cancer from spreading, slows its growth, or destroys cancer cells that have spread to other parts of your body.
- Ease cancer symptoms (also called palliative care) - when chemotherapy shrinks tumors that are causing pain or pressure.
How is chemotherapy used?
Sometimes, chemotherapy is used as the only cancer treatment. But more often, you will get chemotherapy along with surgery, radiation therapy, or biological therapy. Chemotherapy can:
- Make a tumor smaller before surgery or radiation therapy. This is called neo-adjuvant chemotherapy.
- Destroy cancer cells that may remain after surgery or radiation therapy. This is called adjuvant chemotherapy.
- Help radiation therapy and biological therapy work better.
- Destroy cancer cells that have come back (recurrent cancer) or spread to other parts of your body (metastatic cancer).
Breast Cancer
Taking part in cancer research
Cancer research has led to real progress in the prevention, detection, and treatment of breast cancer. Continuing research offers hope that in the future even more women with breast cancer will be treated successfully.
Doctors all over the country are conducting many types of clinical trials (research studies in which people volunteer to take part). Clinical trials are designed to find out whether new approaches are safe and effective.
Even if the people in a trial do not benefit directly, they may still make an important contribution by helping doctors learn more about breast cancer and how to control it. Although clinical trials may pose some risks, doctors do all they can to protect their patients.
Doctors are trying to find better ways to care for women with breast cancer. They are studying many types of treatment and their combinations:
- Radiation therapy: In women with early breast cancer who have had a lumpectomy, doctors are comparing the effectiveness of standard radiation therapy aimed at the whole breast to that of radiation therapy aimed at a smaller part of the breast.
- Chemotherapy and targeted therapy: Researchers are testing new anticancer drugs and doses. They are looking at new drug combinations before surgery. They are also looking at new ways of combining chemotherapy with targeted therapy, hormone therapy, or radiation therapy. In addition, they are studying lab tests that may predict whether a woman might be helped by chemotherapy.
- Hormone therapy: Doctors are testing several types of hormone therapy, including aromatase inhibitors. They are looking at whether hormone therapy before surgery may help shrink the tumor.
- Supportive care: Doctors are looking at ways to lessen the side effects of treatment, such as lymphedema after surgery. They are looking at ways to reduce pain and improve quality of life.
If you're interested in being part of a clinical trial, talk with your doctor.
The NCI Web site includes a section on clinical trials at http://www.cancer.gov/clinicaltrials. It has general information about clinical trials as well as detailed information about specific ongoing studies of breast cancer. Information specialists at 1-800-4-CANCER (1-800-422-6237) or at LiveHelp at http://www.cancer.gov/help can answer questions and provide information about clinical trials.
Breast Cancer At A Glance
- One in every eight women in the United States develops breast cancer.
- The causes of breast cancer are not yet fully known although a number of risk factors have been identified.
- Breast cancer is diagnosed with self- and physician- examination of the breasts, mammography, ultrasound testing, and biopsy.
- There are many types of breast cancer that differ in their capability of spreading (metastasize) to other body tissues.
- Treatment of breast cancer depends on the type and location of the breast cancer, as well as the age and health of the patient.
- The American Cancer Society recommends that a woman should have a baseline mammogram between the ages of 35 and 40 years. Between 40 and 50 years of age mammograms are recommended every other year. After age 50 years, yearly mammograms are recommended.
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Progress in Predicting Invasive Breast Cancer
Researchers studied nearly 1,200 women with ductal carcinoma in situ (DCIS), a noninvasive and very early form of breast cancer confined to the milk ducts. They found that a combination of three tissue biomarkers was associated with a high risk of developing an invasive breast cancer with the potential to spread eight years later.
Also, DCIS that was diagnosed from a breast lump was linked to a greater risk of subsequent invasive cancer than DCIS that was diagnosed by mammography.
There's still a long way to go before the personalized approach to treatment is ready for prime time.
There's still a long way to go before the personalized approach to treatment is ready for prime time.
"But the study gets us closer to our goal of separating women with DCIS into risk groups, so as to avoid overtreatment of women with low-risk breast lesions and undertreatment of women with high-risk lesions," study researcher Karla Kerlikowske, MD, of University of California, San Francisco, tells WebMD.
The study was published online by the Journal of the National Cancer Institute.
Overtreatment of DCIS
Currently, overtreatment of DCIS, which will be diagnosed in over 47,000 women this year, is the big problem, according to Kerlikowske.
"Since there's currently no way to predict which women with DCIS will go on to develop invasive cancer, almost all are offered radiation after the lump is removed [lumpectomy] or mastectomy and sometimes hormone therapy. But our results suggest as many as 44% of women with DCIS may not require any treatment other than removal of the lump and can instead rely on active surveillance, or close monitoring," Kerlikowske says.
The close monitoring offers these women a safety net, she says. "If a tumor comes back, we can always give radiation then."
Radiation therapy not only carries a risk of side effects such as nausea, vomiting, and fatigue but also precludes irradiating the same area of the breast a second time, Kerlikowske says. "So you want to save it for when it is really needed," she says.
Predicting Invasive Breast Tumors
The study involved 1,162 women aged 40 and older who were diagnosed with DCIS and treated with lumpectomy alone between 1983 and 1994.
Overall, their eight-year risks of developing a subsequent DCIS or a subsequent invasive cancer were 11.6% and 11.1%, respectively.
When the researchers looked at women whose DCIS was diagnosed by feeling a lump, the eight-year risk of subsequent invasive cancer was substantially higher than average, 17.8%.
Then they looked at different combinations of biomarkers using tissue that had been stored for 329 of the women when they were first diagnosed with DCIS. These biomarkers include estrogen receptor, progesterone receptor, Ki67 antigen, p53, p16, epidermal growth factor receptor-2, and cyclooxygenase-2.
The study showed that women who express high levels of three biomarkers -- p16, cyclooxygenase-2, and Ki67 -- also had a substantially higher-than-average eight-year risk of developing invasive cancer (27.3%).
The researchers stratified all 1,162 women into four risk groups. A total of 17.3% were in the lowest-risk group, with only a 4.1% chance of developing invasive cancer at eight years; 26.8% were in the next lowest risk group, with a 6.9 chance of developing invasive cancer at eight years. If the findings are validated, it is these two groups that could forgo treatment other than lumpectomy and active surveillance, Kerlikowske says.
A total of 27.6% of the women were in the high-risk group, with a nearly 20% chance of developing invasive cancer at eight years. These are the women who need more aggressive therapy with radiation and perhaps hormone therapy, she says.
Factors associated with a higher risk of having a subsequent ductal carcinoma in situ included having no cancer cells remain within 1 millimeter of the area from which the lump was removed and different combinations of biomarkers.
Unanswered Questions
Still, many questions remain.
For starters, about half of women who developed invasive cancer in the study didn't have the three biomarkers or DCIS diagnosed from a lump, so the researchers have to figure out what other factors are at play, Kerlikowske says.
Also, the approach has not been shown to actually extend lives.
Additionally, the study involved women who had undergone lumpectomy alone, which is no longer the standard of care, says Ramona Swaby, MD, a breast cancer specialist at Fox Chase Cancer Center in Philadelphia.
Recurrence rates are lower in women who also get radiation and if needed, hormone therapy, so it's important to see if the findings hold up in such women, she tells WebMD.
Craig Allred, MD, of Washington University School of Medicine in St. Louis, also calls for further study in an editorial accompanying the study. Still, "if validated, the results could optimize current therapy in certain settings: [withholding] radiation from women with low-risk DCIS, for example," he writes.
Several companies have expressed interest in helping to further develop and eventually market any tissue biomarker test, which will also need FDA approval, according to Kerlikowske.
Since it utilizes the same method and can be done at the same time doctors determine a tumor's hormone-receptor status, she doubts it will cost more than a few hundred dollars.
Funding for the research was provided by the National Cancer Institute and the California Breast Cancer Research Program.
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