Understanding Post-Surgery Options

What you should know about Hormonal Therapy, Biological Therapy and Chemotherapy

Even though surgery plus radiation (known as local treatment) is often completely effective at getting rid of breast cancer, adjuvant therapy (which simply means "something that's added on") often can improve your chances of long-term survival even more.

The major categories of adjuvant therapy are hormonal therapy, biological therapy and chemotherapy. A medical oncologist will determine the best strategy for your case—taking into account your age, tumor size, lymph node involvement and "tumor markers" (hormone receptors and tumor gene profile, including Her2 and possibly Oncotype Dx).

These extra treatments affect tissues throughout your entire body, and that means they can lead to a number of troublesome side effects. Unfortunately, some patients needlessly abandon adjuvant therapy—or become hit-and-miss about complying—largely because of those side effects. Don't let this happen to you!

Medications are now available to counter troublesome side effects—and if cost is an issue, your doctor may be able to help you get assistance from your insurance company. Sticking with your prescribed therapy could literally save your life. So don't quit!

Hormonal therapy

What it does: Blocks the production or action of female hormones. Cancer cells with positive hormone receptors are stimulated to multiply by estrogen and/or progesterone.

Who it's best for: Women whose tumors are hormone receptor-positive, meaning they have an abundance of receptors for estrogen or progesterone.

How it works: Drugs like tamoxifen block hormone receptors and are standard therapy for premenopausal women who have positive estrogen receptors. They are typically taken for five years. Aromatase inhibitors (AIs) interfere with the conversion of other hormones into female hormones, and are used only in postmenopausal women.

How it's delivered: Orally.

Common side effects: In addition to sometimes causing nausea, muscle aches and joint pain, AIs can weaken bones in some women. In addition to checking bone density, women on AIs should take calcium and vitamin D3, and, in some cases, special medication to protect their bones.

Biological therapy

What it does: Zeroes in on a molecular trait (specific fragment of DNA) specific to a particular kind of cancer cell. The chief example in breast cancer is Herceptin. Tykerb is a backup drug for Herceptin. They may be given at the same time as, or after, chemotherapy.

Who it's best for: The 20% to 25% of women whose breast cancer has a lot of receptors called HER2. These receptors respond to a specific protein that stimulates cancer cells to grow.

How it works: Herceptin is a targeted antibody that latches onto and inactivates HER2 receptors, destroying cancer cells and reducing the risk of recurrence as much as 50%.

How it's delivered: Herceptin is given by intravenous (IV) infusion. Tykerb is given orally in pill form.

Common side effects: In a very small percentage of women, Herceptin can weaken the heart muscle. Heart function should be tested before—and monitored during—treatment.


What it does: In general, chemotherapy (chemo) drugs kill dividing cells—especially cancer cells—throughout the body.

Who it's best for: Any woman who has invasive cancer that's at risk of spreading, plus women who want to slow the growth of cancer that's already metastasized.

How it works: Travels throughout the body, interfering with the replication of cells and causing them to die. Typically, a combination of drugs is used to hit the cancer cells in several ways. The regimen is given in cycles, every two or three weeks for three to six months.

How it's delivered: Usually into a vein, either by injection or IV drip. Alternatively, doctors may surgically implant a small port to avoid frequent needle sticks. Some chemo drugs are taken orally.

Common side effects: These can include a variety of problems that occur when naturally dividing cells—such as cells in hair follicles—are damaged by chemo drugs.

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