The fight against breast cancer does not always follow a quick and happy scenario: diagnosis, tumor removal, recovery. Many patients struggle with cancer for years, trying to reconcile breast cancer treatment with efficient daily functioning. Fortunately, Polish women have more and more resources to fight breast cancer - we invite you to read the interview with the doctor. med. Małgorzata Chudzik - oncologist.
Fighting breast canceris one of those topics that we often avoid - we are afraid of talking about diseases that we cannot cure. Unfortunately, there are situations in which doctors know that sooner or later they will not do anything for the patient. Sometimes this struggle lasts 10 years or more and has no optimistic ending. We talk to Dr. Małgorzata Chudzik, an oncologist.
- We can better diagnose cancer …
Dr. Małgorzata Chudzik, 2nd degree specialist in clinical oncology, head of the Oncology Department at the Mazowiecki Oncological Hospital in Wieliszew near Warsaw:Yes, recently pathomorphological diagnostics has developed, which allows to distinguish various types of breast cancer, e.g. classification into hormone-dependent and hormone-dependent tumors. In the first case, steroid receptors (estrogen +/- progesterone) are registered in the neoplastic cell. The second measures the presence or absence of HER2 receptors.
- Why is this important?
Because we can choose the appropriate treatment for breast cancer, including targeted treatment that will destroy as many cancer cells as possible. The targeted treatment in hormone-dependent breast cancer is, for example, hormone therapy, i.e. the use of drugs that block estrogen and progesterone receptors. In hormone-dependent administering drugs that block the herceptin receptor.
- What can a woman who goes to an oncologist with breast cancer count on?
It depends on whether the cancer is locally advanced or has metastasized. If it is limited to the breast, regional lymph nodes, chemotherapy, hormone therapy or anti-HER2 drugs are used. They are designed to reduce the extent of the disease so that the surgeon can radicallyremove diseased tissue. In this case, we want to cure the patient or at least extend the so-called cancer-free time. However, in patients with metastases, a therapy is selected that is to reduce neoplastic changes, alleviate symptoms and extend life time, while at the same time impairing its quality as little as possible.
Immunotherapy seems to be the future of treatment in oncology. Its task is to stimulate the patient's immune system to locate and destroy the cancer cells that have hidden from research equipment.
We can use hormone therapy, that is, for example, administer drugs that block steroid receptors (eg Tamoxifen, Fpvestrant) and prevent estrogens from joining a neoplastic cell. Lowering estrogen levels leads to the death of the cancer cell and prevents the cancer from developing further. Another method is ovarian suppression. This can be done chemically - by administering drugs (LHRH analogues) in the form of an implant under the skin, or surgically - by removing the ovaries. Approx. 20% of sick, often young women are those with HER2.
Fortunately, in recent years, and even months, the availability of modern drugs used in the treatment of HER2 positive cancer has improved in Poland. Until July 2016, as part of the so-called In the drug program, we had two drugs that block this receptor: trastuzumab (Herceptin) and lapatinib (Tyverb). From July, we can also qualify patients for combined treatment with trastuzumab, pertuzumab (Perjeta) and docetaxel chemotherapy as part of the first-line treatment of generalized breast cancer. Such treatment allows not only to improve the condition, but also has the effect of extending life. As the disease progresses, you may receive another anti-HER2 treatment, lapatinib, in combination with capecitabine chemotherapy. Unfortunately, we are not yet able to combine trastuzumab and lapatinib as part of a reimbursement, or to administer another drug available in the world - trastuzumab emtansine (Kadcyla). It is also worth knowing that we can only use the latest reimbursement drugs as part of drug programs. When the disease continues to develop, only conventional chemotherapy remains, and in patients with hormone-dependent cancer - hormone therapy.
Worth knowingTwo stages of breast cancer
- Locally advanced tumor- in the case of the breast, it includes regional lymph nodes and chest structures located near the lesioncancerous. Surgical treatment is usually not possible, but sometimes after using the so-called induction treatment (chemotherapy, radiotherapy) tries to reduce the size of the tumor, which enables radical surgery.
- Generalized breast cancer- means that there are already metastases to distant organs, such as bones, lungs, brain. These are critical situations, because the patient cannot be cured, but only palliative treatment is used, which for some time slows down the progress of the disease. The goal of such treatment is to minimize symptoms, improve quality of life, but also prolong it.
This treatment is selected for a specific patient. It takes into account the biological features of the tumor and its genetic properties determined on the basis of molecular tests (genetic changes) of the tumor tissue. Thanks to this, we can try to choose the appropriate treatment for a specific patient. We currently have several tests that analyze the genetic changes in cancer cells. Unfortunately, they are very expensive, non-refundable. The usefulness of these tests is also debatable, because sometimes it turns out that the drugs indicated in the test are not available in Poland or are at the stage of clinical trials at all and we should not use them in routine clinical practice. It also happens that personalized therapy does not always bring the desired results. In some cases, the disease will go away, while others will not respond to treatment at all.
We are not able to predict which patients will spread cancer cells. Therefore, after surgery, even early breast cancer, most of them are qualified for adjuvant chemotherapy and / or targeted treatment - hormone therapy, trastuzumab, and radiotherapy. Breast cancer is thought to be a systemic disease from the beginning, cancer cells circulate throughout the body and even after many years they can settle in any organ, giving rise to metastatic tumors.
This will be useful to youBreast cancer patients are living longer and longer
Every year in Poland, breast cancer is diagnosed in almost 17 thousand. ladies of all ages. Currently, thanks to the progress of medicine, the results of treatment and prognosis are better - 3 out of 4 women survive 10 years or more after diagnosis. Although it mainly affects patients whose cancer was detected at an early stage; women with advanced breast cancer live 4 years or more.
The doctor wants to give the patient a drug to have a clear conscience that he is doing something. The patient wants to be treated, because it will help. But oncological treatment is burdened with many troublesome complications. Not all of them can be avoided by using, for example, medications that reduce pain, shortness of breath, and swelling. Therefore, at each stage of treatment, it is necessary to think together with the patient how what we can do at the moment (another chemotherapy, radiotherapy, surgery) will affect his life and whether the effect will be worth the price. I have patients who consciously withdraw from treatment, knowing that the therapy may be ineffective and its application will significantly reduce the quality of life. And they want to go somewhere else, experience something beautiful, meet their family, finish important matters. And we have to take this into account when planning palliative therapy.
Worth knowingBreast cancer does not have to prevent normal functioning
Many women with breast cancer are actively involved in family and work life. Cancer can be lived for a long time and should therefore be treated as a chronic disease. You should focus on what is happening at the moment. Patients treated for e.g. hypertension or diabetes live normally, sometimes feeling better and sometimes worse. A cancer patient, if he has enough energy, can work even during chemotherapy. More and more patients are released during treatment only on the day of chemotherapy. When they recover, they return to their daily duties or even social life.