Local and Systemic Treatments

Most breast cancers are treated with a combination of local therapies, designed to eliminate cancer cells in the breast, and systemic treatments, designed to destroy cancer cells that may have spread beyond the breast to other parts of the body. Surgery and radiation are local treatments. Chemotherapy (treatment with anticancer medications) is a systemic treatment, as is the use of hormonal drugs and Herceptin to target specific types of cancer cells. It is the spread of cancer cells to other parts of the body that is life-threatening, so systemic treatment, in combination with local treatment, often is necessary.

Local treatments
The purpose of these therapies is to remove cancer cells in the breast to prevent a local recurrence, or the return of the cancer to the primary (original) site. Breast surgery (either lumpectomy or mastectomy) and radiation therapy (generally given after lumpectomy) are the most common treatments for the local control of breast cancer. Local treatment involves a collaborative effort between the surgeon, radiologist, pathologist, radiation oncologist, and, in some cases, a medical oncologist and a reconstructive plastic surgeon.

Systemic treatments
These treatments send drugs through the bloodstream to reach and destroy cancer cells that have migrated beyond the breast. Examples are chemotherapy, hormonal therapy with drugs such as oral tamoxifen, and immunotherapy with Herceptin, a monoclonal antibody designed to target specific cells.

Chemotherapy is able to destroy or eliminate cancer cells, regardless of any individual specific characteristics of the cancer cell. In contrast, hormonal treatments are often used based upon specific characteristics of the cancer that are determined once a biopsy or lumpectomy has been performed. For example, analysis of the removed cancer cells can help physicians identify whether treatment with hormones is likely to be beneficial based upon specialized study of the individual patient's breast cancer. In the case of Herceptin, a new drug, analysis of the cancer cells can predict which patients will benefit from this treatment.

Originally, doctors believed that cancer simply grew larger and outward. However, research and experience have demonstrated that even in the early stages of the disease, cancer cells can separate from the primary tumor and spread through the bloodstream and lymphatic system to start new tumors in other organs or bones.

Systemic therapy is designed to kill these microscopic deposits of metastatic cancer cells. It can be used after surgery (adjuvant therapy) to prevent recurrence, or before surgery (neoadjuvant therapy) to shrink a large tumor.

There are many factors that go into making a decision about whether adjuvant or neoadjuvant treatments are necessary. For example, if there are cancer cells that have spread to the axillary lymph nodes, often adjuvant treatments are used. If the primary breast cancer is large or has other characteristics, such as being inflamed or involving the skin, systemic therapy (neoadjuvant) treatments may be used before breast surgery is undertaken.

Next >> Breast Surgery

In This Article:
Treating Breast Cancer
Local and Systemic Treatments
Breast Surgery
Mastectomy
Surgeries That Conserve the Breast
Lymph Node Surgery
Radiation Therapy

From the Harvard Health Publications Special Health Report, Breast Cancer: Strategies for Living. Copyright 2004 by the President and Fellows of Harvard College. Illustrations by Harriet Greenfield, M.A., and Jesse Tarantino. All rights reserved. Used with permission of StayWell. Harvard Medical School does not endorse products.
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