In a chapter of his brother’s 2002 book, “Q: The Autobiography of Quincy Jones,” Lloyd Jones describes his battle with kidney cancer and the way the disease moved through his body. “The cancer had metastasized. It was growing like a weed,” he wrote.
Although the jazz legend’s brother was describing cancer that had started in a different part of the body than breast cancer does, part of what makes cancer cancer is its unchecked and unwelcome growth. Just like a weed in an otherwise pristine flower bed, cancer can spread quickly to other parts of the garden and crowd out what should be living there.
[See: What Not to Say to a Breast Cancer Patient.]
Taking this analogy a step further, Dr. Harold Burstein, institute physician at the Dana-Farber Cancer Institute in Boston and associate professor of medicine at Harvard Medical School, says he often describes the modern approach to treating breast cancer as similar to caring for a particularly complex garden. He starts with basic weeding and climbs the ladder from there.
Surgery
“If you have a weed in the garden, the first thing you do is yank it out, and that’s what the surgery does. Usually the first step is surgical removal of the cancer,” Burstein says. Surgery for certain types of breast cancer, where the goal is to preserve as much breast tissue as possible, involves a lumpectomy to remove the tumor or lump. Surgery may also include the removal of local lymph nodes if there’s a concern that the cancer has spread.
In some cases, your doctor may determine that completely removing one or both breasts — a mastectomy or double mastectomy — is the best way to approach removing the cancerous tissue. These procedures are often followed with reconstructive surgery that helps restore the size and shape of the breast tissue that was removed.
Choosing which type of surgery is best for your case will depend on several factors, including the type of cancer, location of the tumor, whether it has spread to other parts of the body and chances of recurrence.
Although it might be tempting to assume that more is better when it comes to surgery, Dr. Tari King, chief of breast surgery at Dana-Farber/Brigham and Women’s Cancer Center, says “bigger surgery is not necessarily better surgery. There’s a perception that if I remove [one or both breasts], I’ll improve my chances of surviving or treating my breast cancer. We understand very well now that survival and chance of recurrence are dictated strongly by the biology of the tumor, not by the surgery.”
Radiation
Once the initial tumor has been removed, Burstein says you need to take steps to keep it from regrowing, and a common way to do that is by using radiation treatment. “If you want to make sure the weed doesn’t come back in the exact same spot, then you take a trowel or one of those forked things and dig around in the soil to break apart any roots. That’s kind of like what the radiation does,” he says.
During a radiation treatment, the radiation oncologist will either point a high-energy beam of light and X-rays at a targeted area of the breast or insert a pellet or seed that contains radioactive material into the breast. No matter how it’s applied, the radiation damages DNA in the cells, making it more difficult for these cells to continue dividing and increasing the size of the tumor. Cancer cells are more susceptible to the damaging power of radiation, meaning that healthy cells next to cancer cells are more likely to be able to repair themselves, while the cancer cells are more likely to die.
Radiation therapy is a highly-targeted way of killing cancer cells in and around the site of the tumor. Breastcancer.org reports that most patients tolerate it well, and side effects are usually limited to the local area where the radiation is applied.
Drug Therapies
In addition to surgery and radiation, some breast cancers respond to targeted drug therapies. Drug therapies can be classified into two main categories: antiestrogen therapies and chemotherapy.
[See: Breast Pain? Stop Worrying About Breast Cancer.]
Antiestrogen Therapy
Burstein describes antiestrogens as mulch in his gardening analogy. “What if some seeds from the weed had already scattered across the flower bed? Or what if there was a distant root far away that might sprout another weed? To prevent that, we use mulch,” or antiestrogens, sometimes called hormone therapy, which block cancer cells from using your body’s own estrogen to grow.
“We think these cancers need estrogen to grow, just like a weed would need light and water, so in the garden, you use mulch to prevent light and water and other things from reaching the seed and the root, and in breast cancer, we use antiestrogens to prevent the growth of those little tiny seeds or the distant root,” Burstein says.
Chemotherapy
Lastly, in certain cases, a more systemic approach is needed — chemotherapy, which Burstein relates to weed killer.
Chemotherapy is a broad term that refers to several different types of medicine that weaken or kill cancer cells throughout the body. Although the term “chemotherapy” can technically refer to any drug-based disease treatment, the word has become so closely associated with cancer that it has lost virtually all other connotations.
In some cases, chemotherapy is used before surgery to shrink the tumor before it’s removed. In other cases, it’s applied after surgery to be sure any cancerous cells that could have been left behind are killed. “Sometimes you need it, and when you do, it can be a powerful tool, but it’s usually used in addition” to other measures, Burstein says.
Chemotherapy is notorious for causing painful and unpleasant side effects. The mix of drugs administered during a chemo treatment — typically via an intravenous drip, a port implanted in the chest, an injection or orally in pill form — can cause patients to feel nauseous, fatigued and sore all over. Perhaps the most obvious side effect of chemotherapy treatment is the complete loss of hair many patients experience during treatment.
Breastcancer.org reports that this hair loss happens because chemotherapy targets all rapidly dividing cells, both healthy and cancerous. “Hair follicles, the structures in the skin filled with tiny blood vessels that make hair, are some of the fastest-growing cells in the body. If you’re not in cancer treatment, your hair follicles divide every 23 to 72 hours. But as the chemo does its work against cancer cells, it also destroys hair cells. Within a few weeks of starting chemo, you may lose some or all of your hair.”
Such was the case for Mindy Bowens, an oncology nurse in northern New Jersey, who says all her hair fell out during aggressive chemotherapy to treat her Stage II cancer. To hide just how sick she was while at work during the several months she was receiving chemotherapy, she says, “I wore a wig. I did my eyebrows. I wore false eyelashes. During treatment I lost my fingernails, but for the most part, I was able to cover up the reaction to the chemo so that people didn’t know I had cancer.”
[See: 7 Innovations in Cancer Therapy.]
Personalized Approach
While the overall approach to treating breast cancer tends to follow this well-established series of steps, Dr. Erica Mayer, senior physician at the Susan F. Smith Center for Women’s Cancers at the Dana-Farber Cancer Institute, says each of those steps must be carefully selected for the individual case. “Treatment for breast cancer in 2017 is incredibly personalized and tailored to the specific tumor and the person. No two treatment plans will be exactly alike.”
Therefore, after careful analysis of your cancer, a risk assessment of your potential for recurrence and consideration of your preferences and expectations, your team of doctors will select the right therapy. And Mayer says it’s important to remember that the road to health after a breast cancer diagnosis is a team effort. “Breast cancer is not cared for by one doctor. It requires a multi-disciplinary team of doctors.”
More from U.S. News
16 Health Screenings All Women Need
Breast Pain? Stop Worrying About Cancer
7 Innovations in Cancer Therapy
Treatment Options Once You Know You Have Breast Cancer originally appeared on usnews.com
