The treatment of breast cancer depends on the nature and location of the tumor and stage of disease. The doctor also takes into account the patient age, hormonal status and general condition. There are several therapies, offered alone or in combination.

1. Surgery

Surgery remains the treatment most commonly practiced.

The surgeon removes the tumor, which will be analyzed by the pathologist, to specify the size, aggressiveness, the presence or absence of hormone receptors. These data are essential to the choice of therapeutic option.

The type of surgery (total removal of the mammary gland, or lumpectomy) depends essentially on the size of the tumor clinic. In the same operation, it achieves axillary dissection on the same side as the tumor, to detect any cancer foci in the lymph nodes examined. This dissection may be limited by the methods of scintigraphic study coupled with extemporaneous histological examination performed in the operating room, and shows the absence or presence of cancer cells in lymph nodes removed first (sentinel node).

It is important to examine these nodes because they filter the lymph that flows from the breast and across the organization. They represent the first sites of tumor spread. If the lymph nodes examined were positive, there may be cancer cells during migration in the body. This risk will determine the choice of treatment after surgery. All information gathered in the “staging”.

Different types of surgeries are performed in the treatment of breast cancer. The technique used depends on several factors but primarily on the size and location of the tumor:

• Lumpectomy: removal of the tumor.
• Partial mastectomy: removal of the tumor, a portion of surrounding tissue and lining the chest muscles near the tumor.
• modified radical mastectomy: removal of the breast and the lining of the pectoral muscles (keeping the muscles).
• or radical mastectomy Halsted operation: removal of the entire breast, chest muscles, and some fatty tissue and skin. It is no longer practiced today because very mutilating.

2. Radiotherapy

Radiation therapy uses high-energy radiation to destroy cancer cells and prevent their development. Like surgery, it is a local treatment, without any action on any remote metastatic sites. It can be administered in different ways:

• either from an external source of radiation;
• or from radioactive materials implanted directly into the breast. This is known as “brachytherapy”.

Both methods can be combined. External radiation therapy is most often done without hospitalization. At the end of this conventional radiotherapy, an overlay can be performed radiotherapy to the tumor site. This additional radiation therapy can also be applied by brachytherapy. In the latter case, the patient should be hospitalized for a short period.

Radiotherapy is often used to complement surgery, either before (known preoperative radiotherapy, the aim being to reduce the size of the tumor) or after (it is then postoperative radiotherapy, the aim to prevent a recurrence of the tumor).

3. Chemotherapy

It comprises a single drug or a combination of anti-tumor (most common), it is a treatment whose interests the general circulation throughout the body (treatment called “systemic” just like hormone treatments as opposed to “local” as surgery or radiotherapy). It can be administered before or after surgery.

If it is prescribed to destroy any metastatic foci after surgery, it is called “adjuvant”. Its guidance depends on a number of factors called “prognostic”.

The main drug treatments combine the molecules of doxorubicin (anthracycline family) of cyclophosphamide or fluorouracil. Molecules from a tree, yew, also made their appearance: they are the taxanes used in metastatic breast cancer and recently in an earlier stage of the disease.

4. Hormone

Hormone therapy is a “systemic”. It aims to prevent, in some cases, tumor cells receive hormones for their development. His administration is determined based on hormone receptor in tumor tissues.

This method involves inhibiting the production of hormones implicated, either by administration of anti-hormones, or by suppressing production of these hormones (definition: surgical castration or radiotherapy, or transiently: chemical castration).

The choice between chemotherapy, hormone therapy or both, is a function of patient age, hormonal status and the detection of hormone receptors. If positive, hormone therapy is usually effective.

5. Targeted therapies

Therapies targeted specifically to attack cancer cells without touching healthy cells.One therapeutic target is based on “monoclonal antibodies”. They are manufactured specifically for antibodies recognize an antigen expressed by a tumor. These monoclonal antibodies can be directly targeting the tumor or its environment.Trastuzumab (Herceptin ®) is one of these molecules, whose mode of action is to attack the tumors overexpressing (that is to say too much) a protein (HER2). It is used alone or in combination with chemotherapy.

Other targeted therapies will block the growth of blood vessels needed for tumor development. ”Hungry,” the latter, will stop proliferating or die. These are molecules called “anti-angiogenic” such as sunitinib.

The “borderline lesions. These cancers in situ or noninvasive, should be considered separately. Treatment can range from conservative surgery to mastectomy, the choice of therapy depends mainly on the histological type encountered.

In some cases, radiation therapy may be necessary after partial surgery. In contrast, treatment of inflammatory cancer chemotherapy based on early and aggressively, then surgery and / or radiotherapy, and as appropriate, hormone.

During cancer, fatigue is a very common symptom. Wrongly, it is most often overlooked, regarded as inevitable, and unsupported. But the fatigue is debilitating, affects the quality of life, promotes depression and may even motivate the cessation of treatment.

1. Cancer and Fatigue: 3 major causes

Fatigue during cancer results from three major causes: side effects of treatment, anemia and malnutrition. A depression is also a major source of fatigue. More importantly, the causes of this symptom are strongly intertwined.

2. Fatigue is a known side-effect of cancer treatment

Fatigue occurs as a result of one or more transactions, but also after chemotherapy. In the latter case, it is due to direct neurotoxicity of certain molecules and especially anemia.
As to the fatigue caused by radiation, it is increased by age, the irradiated site (abdomen, head and neck), the extension of the tumor and the combination with chemotherapy treatment.

Fatigue is also more common in cases of malnutrition. However, some treatment side effects (nausea, vomiting, intestinal disorders) cause feeding difficulties. In these circumstances, it is essential to prevent malnutrition: food variety, attractive appearance, nutritional supplements, omega-3, etc..

3. Anemia, cancer and fatigue

Anemia is common during cancer. This is a consequence of the disease and chemotherapy, while it is aggravated by radiotherapy. It is accompanied by severe fatigue, forcing patients to significantly reduce their daily activities. But anemia also contributes to tumor hypoxia (oxygen deficiency), which induces resistance to chemotherapy and radiotherapy.

Ultimately, this condition affects the quality of life, has a negative impact on the response to treatment, relapse-free survival and overall survival. It is therefore essential to detect anemia in cancer patients and to treat it.

Transfusions are effective, but accompanied by viral and bacterial risks, they are reserved for serious and urgent clinical situations. It now uses EPO (recombinant human erythropoietin), a treatment well tolerated and very effective, with a significant improvement from the third week.

4. Depression, cancer and fatigue

Emotional distress, helplessness, loss of self esteem, etc.., Are disorders that accompany cancer. Now they promote depression, fatigue while maintaining or even exacerbating the depression.

The challenge is to differentiate the psychological component of fatigue, the uncertainty due to the disease and its treatment.
If depression is suspected, a psychosocial support group or individual psychotherapy is helpful.This intervention may be associated with drug therapy.

5. In conclusion, fatigue often accompanies cancer

In conclusion, many cancer patients suffer from fatigue, but many regard it as inevitable and do not complain. It is a mistake.

We must share them with doctors and discuss it with them. They will analyze the causes and regularly assess the effects of treatment in order to adjust them.

Treating depression, malnutrition, anemia and pain help reduce fatigue, improve the quality of life and treatment efficacy.