MY TREATMENT A TO Z

LEARNING ABOUT MY DIFFERENT
TREATMENT OPTIONS

The goals of your treatment are to prevent your cancer from spreading further, to relieve some of the painful symptoms caused by cancer, and to ensure you have the best possible quality of life.

This section will help you learn more about

The Different Types Of Cancer Treatments Available And How You Take Them

How Your Doctors Measure If Treatment Is Working

The Importance Of Clinical Trials

Help With The Potential Side Effects Of Treatments

WHAT ARE THE MAIN TYPES OF TREATMENT?

The standard treatment for metastatic breast cancer (MBC) generally includes chemotherapy and radiotherapy. It rarely includes surgery. Other treatments you can get, such as anti-hormonal therapy and targeted therapies, will depend on the type of cancer you have.

There have been some significant advances in medicines for breast cancer in recent years. There are many more options available than before. Each of these forms of treatment is described below.

  • CHEMOTHERAPY

    Chemotherapy drugs act by sending toxic substances to kill cancer cells. They can, unfortunately, harm normal cells too, and this can cause side effects. Some chemotherapy drugs are given as a pill that you can take at home. Others are given by intravenous infusion and you may have to go to hospital to receive them.

    Chemotherapy is not always right for all types of MBC. Whether you receive chemotherapy will depend on your health, what medicines you have taken before and the type of cancer you have.

    There are many different types of chemotherapies, and you may be treated with a variety over time, depending on how your body responds. If you have too many side effects with one, your doctor may be able to switch you to a different one.

  • RADIOTHERAPY

    Radiotherapy is the use of high-energy rays that kill cancer cells. In MBC, radiotherapy may be given to control your cancer. It can also be used to relieve bone pain if the cancer therapy does not relieve it fast enough. It is common to radiate metastases in the bone that are causing pain.

    Radiotherapy for MBC is usually given as a single dose or as a short course over a few days. If you are well enough, you are usually given radiotherapy as an outpatient, and do not have to stay overnight in hospital. However, if you are having chemotherapy at the same time, you may need to stay in hospital. Side effects of radiotherapy will vary depending on which part of the body is being treated.

  • ANTI-HORMONAL THERAPY

    Anti-hormonal therapies are used to treat breast cancers that are sensitive to hormones, particularly oestrogen. There are a number of different hormone-based therapy drugs that work in dierent ways in the body. Anti-hormonal therapies are usually given as pills, but some are given as injections. You may take them with or without chemotherapy.

    Whether you are given anti-hormonal therapy, and what type will depend on whether you have gone through the menopause, how much time has passed since your diagnosis and what kind of treatment you took for your initial breast cancer (if this is a recurrence). If you have had anti-hormonal therapy in the past you may still take it again.

  • TARGETED THERAPIES

    Targeted therapies are drugs that work by blocking the specific ways that breast cancer cells divide and grow. Like chemotherapy and anti-hormonal therapy, their aim is to control the progression of the cancer. Since they only work on specific types of breast cancer, targeted therapies are only recommended for women with that particular type of cancer. There are several therapies that target HER2 receptors. These drugs work in people with high levels of HER2 in the cancer cells, but they do not work in cancers that do not have this protein. To find out if any targeted therapies are right for you, your doctor will have to find out exactly what kind of cancer you have.

  • BONE STABILISING AGENTS (BISPHOSPHONATES OR DENOSUMAB)

    These are drugs that are used to treat metastases in the bone. They work by helping to strengthen your bones and help reduce bone loss. They can help relieve bone pain and reduce the long-term risk of bone breaks. They are taken as pills or injections. The injections are given every three to four weeks.

  • SURGERY

    Surgery is rarely used in MBC. When it is used, it is because removing tumour tissue will substantially lower the tumour load, improve your body function, or will help to relieve pain. If you have surgery, you will also get drug therapy and/or radiation.

TREATMENTS FOR SPECIFIC CANCER TYPES

Hormone receptor-positive, HER2-negative

Can be treated with drugs that suppress the production of the hormones oestrogen and progesterone, or drugs that block the receptors for these hormones (anti-hormonal therapy).

Hormone receptor-negative, HER2-positive

Can be treated with HER2-targeted therapies and chemotherapy.

Hormone receptor-positive, HER2-positive

be treated with both HER2-targeted drugs and antihormonal therapies.

Hormone receptor-negative, HER2-negative, also called triplenegative cancer

Can be treated effectively by chemotherapy.

HOW OFTEN DO I TAKE TREATMENT AND FOR HOW LONG?

Unlike in early breast cancer, where your treatment is given for a fixed period of time, treatment for MBC is life-long. This is because ongoing treatments are needed to control your cancer and prevent it from getting worse. You may need ongoing treatment for symptoms of metastases. As a result, you may be given one drug or a combination of drugs. After some time, you may be switched to dierent drugs.

You may be given the same treatment several times, alternated with other treatments. You might stop taking one treatment temporarily, because it is controlling your cancer. Later you may need to return to it.

The medicines you take will likely include intravenous treatment you get in a doctor’s surgery or in the hospital. This is given weekly, every 3 weeks, or less often. Radiotherapy is usually given on a daily basis. You may alternate weeks with drug therapy and radiotherapy.

AGAIN, THERE IS NO SINGLE BEST WAY TO TREAT MBC. EVERY PERSON’S SITUATION IS DIFFERENT.

! Understandably, some women may be tempted to stop their treatment once they feel better, or, on the contrary, if it makes them feel sick. However, as much as possible, it is critical to keep taking your treatment for as long as it is prescribed. Talk to your doctor if you are thinking about stopping your treatment.

HOW DOES MY DOCTOR MEASURE IF MY
TREATMENT IS WORKING?

Your doctor will conduct a number of tests over time to find out if your treatment is working. These may include looking at:

  • The size of your tumour/metastases:

    Your doctor may run scans to see if your tumour or metastases are growing, shrinking or staying the same size. These may include computed tomography (CT) or magnetic resonance imaging (MRI) scans.

  • The level of tumour markers:

    Tumour markers are proteins or other substances that are often, but not always, found in the blood when tumours are active in the body. The presence of elevated tumour markers often indicates active disease. The levels of tumour markers over time can be used by your doctor to monitor the ecacy of your treatment.

  • The level of circulating tumour cells:

    Circulating tumour cells (CTCs) are cancer cells that have detached from the primary tumour and are circulating in the bloodstream. CTCs can act as ‘seeds’ for new tumours (metastases) at other sites in the body. Your doctor may monitor the level of CTCs in your blood to see how well you are responding to treatment.

  • Development of new metastases:

    Your doctor will want to make sure that cancer cells have not spread to other parts of the body. For this, imaging such as CT or MRI scans can be used. The more a cancer spreads in the body, the more serious it is and a change of treatment may be needed.

WHAT SIDE EFFECTS MAY I EXPECT FROM MY
CANCER AND TREATMENT?

Side effects depend on the particular type of treatment you are receiving – and may vary from drug to drug. Also, everyone reacts dierently to treatment, so you may not have the same side eects as someone else taking the same drugs. Always discuss any side eects you may be having with your doctor and healthcare team, so they can determine whether they are the result of the treatment or the cancer itself, and find ways to help you.

! If you find that the side effects of your treatment are too difficult to tolerate, please speak to your doctor immediately. It may be possible to change the dose of your treatment or find a different treatment that does not give you that side effect.

COMMON SIDE EFFECTS

PAIN

Cancer doesn’t always mean that you will have pain, but if you are having pain it is important to let your healthcare team know. They can give you drugs to help and recommend pain relief methods. It might help to keep a record of the frequency and the severity of your pain,

if it gets worse at night or when doing specific things. Relieving your pain eectively will have a large impact on making you feel better. It can help reduce fatigue, anxiety, depression, and improve your sleep and overall well-being. If you need strong pain medication such as morphine, please do not be afraid that you may get addicted. This will not be the case if you need the drug for your pain.

WHAT TO TELL YOUR DOCTOR:

  • How Does The Pain Feel?

  • How Long Does It Last?

  • How Does It Change Your Daily Life?

  • What Makes It Better And Worse?

  • When Does It Occur?

  • Where Exactly Is Your Pain?

Cancer pain is usually treated with medicine and complementary therapies. Therapies such as acupuncture, massage therapy, and relaxation techniques can help you to control your pain. Exercise can also help.

FATIGUE

Fatigue is so much more than feeling tired: It is complete exhaustion. It may be related to the physical eect of the cancer itself, or a side eect of treatment. Or it may be related to changes in your sleeping patterns, and added stress and anxiety.

TIPS FOR DEALING WITH FATIGUE

  • Do Regular Gentle Exercise – Even A Walk In The Fresh Air Can Help

  • Plan Your Day And Do Only What Is Most Important To You

  • Eat Regularly And Eat Healthy Foods

  • Take Naps

  • Take Short Breaks

  • Ask For Help From Friends And Family

  • Try Not To Feel Guilty If You Have To Cancel Plans – Remember, It Is Not Your Fault If You Are Too Tired

  • Tell Your Doctor/ Healthcare Team, And They May Be Able To Prescribe Medicine To Help With Fatigue

NAUSEA AND VOMITING

Untreated nausea and vomiting can make you feel very tired and can also lead to more serious problems. Tell your healthcare team if you experience these symptoms. There are many medicines available to help you control them.

TIPS TO REDUCE NAUSEA AND VOMITING:

  • Gentle Exercise And Fresh Air

  • Open The Windows In Your House

  • Avoid Spicy, Greasy Or Very Sweet Foods

  • Try Cool Foods And Bland, Easy-Todigest Foods

  • Ginger And Lemon Can Reduce Nausea

  • Eat Small Meals, Regularly

SLEEPING PROBLEMS AND INSOMNIA

A number of things can prevent you from having a good night’s sleep. Pain, stress, side eects of the treatment, anxiety, depression all make it worse. You may have trouble falling asleep, or wake up frequently in the night, or wake up very early. This can aect your ability to function on a daily basis. Tell your doctor, as medicine can be used to help you cope.

TIPS TO HELP YOU SLEEP:

  • Try To Keep To Your Normal Sleeping Pattern, Even If You Want To Sleep All The Time

  • Keep A Diary Next To Your Bed And Write Things Down If Your Thoughts Or Worries Are Keeping You Awake

  • Reduce Noise And Light In
    Your Room

  • Have A Warm Drink Before Bedtime But Avoid Drinks With Caffeine

  • Try Exercises For Your Mind, Such As Meditation And Mindfulness. See Part 2 For More Information On These And Other Relaxation Techniques Such As Yoga, Massage, And Tai Chi

LACK OF CONCENTRATION AND COGNITIVE CHANGES

This can be caused by physical or emotional changes. It may or may not be related to your treatment. It is important you report any problems with concentration to your healthcare team.

HAIR LOSS

It is likely your hair will change if you are receiving chemotherapy as a treatment. Not all chemotherapy drugs make you lose your hair, but you may experience thinning or drying of hair. Even anti-hormonal therapies can lead to hair thinning. Losing your hair can be very upsetting, and it might be a good idea to cut your hair short if you know you are going to lose it. This can help you regain some control of the situation, rather than waiting for your hair to fall out. Do what feels right for you.

WHO CAN HELP ME WITH MY HAIR LOSS?

1

Some hospitals have staff who can provide you with ideas and tips for different headwear, such as headscarves and wigs. Ask your nurse or doctor if these are available at your hospital.

2

For some but not for all chemotherapies, scalp cooling may be an effective way to prevent hair loss. Ask your doctor whether this may help for your particular treatment and whether scalp cooling is offered at your clinic.

3

Local breast cancer support groups may also be able to direct you to beauty salons in your area. Patient support groups can provide advice and support on coping with the changes in how you look.