Individualized Breast Cancer Treatment
Breast cancer is the most commonly diagnosed cancer in the United States, with roughly 250,000 new cases diagnosed in women, and nearly 3,000 in men, each year. But at Rocky Mountain Cancer Centers, we know that each of those cancers is unique – just as each cancer patient is unique. That is why we carefully analyze each tumor, and create a breast cancer treatment plan that will most effectively fight that specific disease, and best meet each patient’s personal needs and goals. Our physicians also participate in multidisciplinary conferences and tumor boards to ensure patients receive the most comprehensive care possible.
At Rocky Mountain Cancer Centers, patients and physicians work together, developing relationships that continue throughout treatment and through years of follow-up care.
Clinical research trials represent some of the most advanced treatment options
Typing and Staging Breast Cancer
Breast cancer is many diseases, and each may respond differently to treatment. That’s why the first step is to pinpoint the size, type and characteristics of each patient’s tumor. We use that information to chart a treatment course that reflects the patient’s goals, personal desires, and the unique characteristics of their particular form of breast cancer.
Some types of breast cancer grow with the help of hormones; those cancer cells have special proteins inside, called hormone receptors. When hormones attach to hormone receptors, the cancer cells with these receptors grow. Through a biopsy, we will analyze tumor tissue to determine whether the tumor is hormone-receptor positive or negative.
Hormone receptor-positive breast cancers can be treated with hormone therapies that either reduce the amount of estrogen or block estrogen from helping cancer cells grow. After surgery, patients with hormone receptor-positive tumors may take hormone therapies, often for several years, to help prevent recurrence. These therapies include tamoxifen and aromatase inhibitors.
Hormone treatment is not effective for hormone-receptor negative cancers.
In addition, we evaluate each breast tumor to determine whether it is positive or negative for too many receptors of a gene called HER-2
HER-2 is short for human epidermal growth factor receptor 2. HER2 proteins are receptors on breast cells. Normally, HER2 receptors help control how a healthy breast cell grows, divides, and repairs itself. But if the HER2 gene doesn’t work correctly and produces too many copies of itself, it leads to uncontrolled growth of breast cancer cells.
HER-2 positive breast cancer accounts for about 25 percent of all breast cancers. There are a number of targeted therapy options for HER-2 positive cancers, including:
- Herceptin, which works by blocking cancer cells’ ability to receive the signals that tell them to grow.
- Kadcyla, which works by attaching a chemotherapy agent (emtansine) to Herceptin, which then carries the chemotherapy drug to the HER2-positive cancer cells.
- Perjeta, which works by blocking cancer cells’ ability to receive growth signals.
- Tykerb, which prevents certain proteins from triggering uncontrolled cell growth.
HER-2 Negative breast cancers, unlike HER-2 positive disease, do not have an excess of HER-2 proteins. Her-2 Negative tumors do not respond to targeted therapy.
Breast Cancer Types and Treatments
Ductal carcinoma, the most common type of breast cancer, forms in the cells of the milk ducts.
- Ductal carcinoma in situ (DCIS) is cancer that has not spread from the ducts to the surrounding tissue (in situ means in the original place). Ductal carcinoma in situ is highly treatable.
For many patients, radiation, which is the use of high-energy rays, such as X-rays, to kill cancer cells or shrink tumors, and breast-preserving surgery, such as lumpectomy, are treatment options for DCIS.
- Invasive ductal carcinoma is cancer that has spread from its origins in the milk ducts to surrounding breast tissue. Invasive ductal carcinoma accounts for 70 percent to 80 percent of newly diagnosed cases. It also is the most common type of breast cancer in men.
Along with the type of cancer, the patient’s age and other characteristics, the size of the tumor and how much it has spread will determine the best treatment.
Treatment options for invasive ductal carcinoma include:
- Lumpectomy – a procedure in which the tumor is removed, along with any affected surrounding tissue, but the breast is preserved.
- Mastectomy– surgical removal of the entire breast and, depending on the stage of the disease, possibly surrounding lymph nodes and tissue as well.
- Radiation– We offer advanced, precision radiation treatments. When lumpectomy is an option, our radiation oncologists can use partial breast radiation, which allows a short 5 day treatment with fewer side effects. Radiation is given only to the portion of breast where the tumor was.
- Chemotherapy drugs, which destroy cancer cells, may be used, particularly if cancer has spread.
- Targeted therapies, including hormone therapies, may be part of treatment, depending on whether the tumor is hormone-receptor positive.
Lobular Carcinoma is cancer that occurs in the milk-producing glands, called lobulars. Lobular carcinoma can be diagnosed in situ (LCIS), meaning that it hasn’t spread (in situ means in the original place) or as invasive, meaning it has begun to spread.
Triple-Negative Breast Cancer gets its name because its growth is not fed by the hormones estrogen and progesterone, or HER-2 receptors. Because the cancer cells test negative for all three, the cancer is known as triple-negative.
This type of cancer accounts for about 10 percent to 20 percent of breast cancer diagnoses. It is more common in:
- Younger women; especially those under 40
- African-American and Hispanic women
- Women with the BRCA-1 genetic mutation
Triple-Negative breast cancer is usually treated with surgery and chemotherapy. In some cases, chemotherapy is given after surgery. Other times, chemotherapy is given before surgery, in order to shrink the tumor before removing it. Because Triple-Negative breast cancer cells do not rely on hormones to grow, they do not respond to hormonal therapies such as tamoxifen or therapies that target HER2 receptors. Triple-Negative breast cancer does, however, often respond well to chemotherapy.
Inflammatory Breast Cancer is a highly aggressive disease that accounts for only about 1 percent of breast cancer diagnoses. While other forms of breast cancer originate as lumps, inflammatory breast cancer may appear as reddening of the breast, or a feeling of heaviness, and swelling.
Treatment often involves chemotherapy to shrink the tumor before surgery. If the cancer is Her-2 positive, chemotherapy might include targeted therapies such as Herceptin.
Following chemotherapy, a surgeon usually performs a mastectomy or radical mastectomy. Because inflammatory breast cancer can spread rapidly, breast-conserving surgery or lumpectomy is rarely used.
Radiation treatment often follows surgery, in order to kill any cancer cells that might have been left behind during surgery.
BREAST CANCER: PREVENTION AND RISK ASSESSMENT CLINIC
Genetic abnormalities account for about 10 percent of diagnosed cases of breast cancer. Researchers have identified several changes in genes, called mutations, which may increase risk of developing breast cancer.
If one or more close family members has been diagnosed with breast cancer, you may benefit from our Genetic Counseling, Prevention, and Risk Assessment Clinic to help you accurately evaluate your own cancer risk. Our collaborative program uses personal history, family history, and genetic testing to help build a customized program of assessment and surveillance.
Our program is unique because it includes a collaborative approach to surveillance and risk reduction involving both a medical oncologist and a board certified genetic counselor. Our team of experts will develop a personalized medical management plan which may include more frequent or younger ages of mammograms or breast MRI’s, lifestyle modification strategies or medications.
Breast Cancer Clinical Trials
At Rocky Mountain Cancer Centers, advancing cancer care through research and innovation is part of our mission, and we are committed to providing patients access to the latest therapies available through clinical trials.
We are committed to providing patients access to the latest therapies available through clinical trials. Learn more about the breast cancer clinical research trials we offer.
Supportive Care for Breast Cancer Patients
At Rocky Mountain Cancer Centers, we are committed to a partnership between patients and caregivers, and we believe in treating the whole person, not just the disease. We offer emotional support programs designed to help patients and caregivers cope with issues surrounding cancer treatment. Another resource is the Pink Ribbon Survivors Network, an online education and support resource for cancer survivors and primary care providers who care for breast cancer survivors.