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Article Series: Breast Cancer
Help Me Understand Breast Cancer
Breast
Cancer Preoperative Chemotherapy
This type of treatment has been utilized to
treat women with large (almost always larger than 2 cm), palpable
breast cancers. The use of chemotherapy prior to surgical removal
of the cancer has a number of real and theoretical advantages:
1.
It shrinks the size of the cancer and allows for easier
removal with a better cosmetic result. The Italians demonstrated
this and reported that a majority of women who would have required
a mastectomy due to the size of their cancer could be treated
with breast conservation surgery after preoperative chemotherapy.
Multiple studies show less than 10 percent of cancers will
grow during chemotherapy, and more than 50 percent will completely
regress, based on palpation.
2.
It allows for earlier administration of chemotherapy. Women
do not have to wait for surgery and healing to begin treatment
for possible micrometastatic cancer cells.
3.
The cancer may be much less virulent and have less angiogenesis
after preoperative chemotherapy, making surgery safer with
less risk of spreading cells. This is theoretical and unproven
to date, but frequently at the time of surgery there is little
viable cancer present.
4.
Accumulating clinical data has shown that women
who have a complete pathologic response to the preoperative
chemotherapy
have a higher cure rate compared to those women with little
or no response.
What is meant by "complete pathologic response"?
When the breast tissue is evaluated under the microscope by
the pathologist, there is no tumor left. The addition of Taxotere
to the preoperative chemotherapy regimens has resulted in a
doubling of the complete pathologic response rate in the breast
tissue. For the women who have remaining cancer in the breast
tissue or lymph nodes, doctors will often will do drug resistance
and sensitivity testing on the tissue to determine if some
type of alternative or backup chemotherapy agent might be effective.
A possible disadvantage of preoperative chemotherapy is that
the extent of lymph node involvement may not be accurately
determined. Previously, this was an important consideration
for possible candidacy for high-dose chemotherapy with BMT.
However, with the efficacy of this procedure in question, the
number of involved lymph nodes may not be as important.
Indeed, what appears to be more important is whether the lymph
nodes are cancer free when they are removed at the time of
surgery. Preoperative chemotherapy, especially the Taxotere-containing
regimens, increases the proportion of women who have negative
axillary lymph nodes. # # # # #
by SolveYourProblem.com
: 2006
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