Introduction

Authors: By Morten Horsholt Kristensen, MD, Sarah Gierahn Nielsen, med. student & Hanne Melgaard Nielsen, MD

Introduction

In Denmark, oncological therapy is the non-surgical treatment of breast cancer (BC) and consists of local therapy in the form of radiotherapy (RT) and systemic therapy that includes chemotherapy, endocrine (antihormonal) therapy and biologic agents.

Oncological therapy is an important factor in the treatment of curable BC and holds an important role of palliative treatment.

Definitions

Adjuvant Therapy: Antineoplastic treatment offered following surgical removal of the tumor.

Antineoplastic Therapy: Traditionel chemotherapy with cytotoxic drugs as well as newer techniques including hormonal drugs and targeted therapies known as immunotherapy.

Loco-regional recurrence: The development of a new tumor in the breast or chest wall and/or regional lymph node on the same side as primary tumor.

Metastatic Disease: Cancer that spreads from its site of origin to other parts of the body. Cancer cells can acquire the ability to penetrate the epithelial walls of blood vessels and circulate through the bloodstream to other tissues in the body – a hematogenous spread. The cells can also circulate in the lymphatic tissue and is known as lymphatic spread.

Neo-Adjuvant Therapy: Therapy offered before the primary therapy, which often is surgery.

Palliative Care: Medical care focused on providing relief from the symptoms on incurable cancer.

Triple-negative breast cancer: An estrogen- and progesteron-receptor negative cancer, and excess HER2 protein, meaning the cancer is not fueled by these hormones or the HER2 protein.

Background

In the early 20th century, the only curable treatment of small cancers, was surgery, if the cancer were localized enough.

Radiation therapy was later on used after surgery to control the growth of small tumors, where surgery had failed to remove everything. Chemotherapy was added to line of treatment after being discovered during World War II.

When talking about oncological treatment of breast cancer, there are different types of treatments depending on the type of cancer and how advanced it is. In the interest of simplification, the oncological treatment is divided into different groups and subgroups depending on the timing of the treatment or if it is has a local or systemic effect.

It is important to have the right diagnosis before deciding on the right oncological treatment strategy.  When choosing the optimal treatment, several factors are considered:

• Patient preferences
• Co-morbidites and age of patient
• Perfomance status
• Previous treatments