Not all Breast Cancers and tumours are the same, something I didn´t know before starting my Cancer journey. Their composition is completely different; some are fuelled by this certain hormone, but not by this other one, and besides that, tumours have their own personality. Yes, you heard me: some can be extremely aggressive, getting everywhere quickly, quietly and without permission; others stayed calm for a bit, but eventually become curious and end up getting out to investigate other areas; and some others (only a few of them) are kinder, or perhaps lazy, and remain comfy in the area they chose to camp months or even years ago. Therefore, different types of Cancer need different treatments.
There are several types of treatments out there to treat tumours:
– Chemotherapy usually destroys cancer cells or at least slows their growth. Some chemotherapy drugs are given on their own. But in most cases, they are used in combination with other drugs to destroy fast-dividing cells (cancerous and non-cancerous). Examples of Chemotherapy are *TCHP, FEC, AC.
*TCHP is Taxotere (Docetaxel), Carboplatin, Herceptin (Trastuzumab) and Perjeta (Pertuzumab). Please, note that Herceptin and Perjeta aren´t actually Chemotherapy drugs but are always given in combination with the chemo drug Taxotere.
*FEC is Fluorouracil/Epirubicin/Cyclophosphamide.
*AC is Adriamycin (Doxorubicin) and cyclophosphamide.
– Targeted therapy uses drugs to target specific molecules (for example, genes or proteins) in cancer cells to stop them from growing and spreading. Targeting only Cancer cells means that these drugs don’t damage as many normal cells as chemotherapy drugs. Examples of targeted therapy are Herceptin and Perjeta (Trastuzumab and Pertuzumab).
– Hormonal drug therapy slows the growth of cancers like breast, prostate and uterine cancer that use natural sex hormones to grow (Estrogen, Progesterone and Testosterone). Hormonal therapy stops the cancer cells from using the hormones they need to grow, or it prevents the body from making the hormones that are causing the cancer to grow. Examples of hormonal drugs are Letrozole (usually for menopausal women) and Tamoxifen (usually for women who hasn´t reached menopause yet).
– Immunotherapy helps to strengthen or restore the immune system’s ability to fight Cancer.
After the initial biopsy of a tumour, the pathology report will tell the oncologists the necessary information to properly treat your tumour. Depending on the hormone status of your lump, you will receive a specific type of chemotherapy or other treatment.
In Breast Cancer, your tumour can be of several types:
-It could be fed or not by Estrogen (so this is called Estrogen receptor positive or negative: ER+ or ER-)
-It coud be fed by Progesterone (this is Progesterone receptor positive or negative: PR+ or PR-)
-It could be hormone receptor negative (both, ER and PR -) or hormone receptor positive (both, ER and PR +); being this one the most common type of Breast Cancer (60% of all).
There is something else pathologists will check in your tumour: the Her2 gene (Epidermal Growth Factor). Cancer cells that have too many copies of the Her2 gene, that produce too much of the growth-promoting protein called Her2 are called Her2 positive cancers). Targeted therapy drugs like Herceptin and Perjeta are designed to shut down the Her2 protein, consequently slowing the growth and/or killing these cancer cells.
The oncologist will determine what kind of treatment you´ll need.
-If your tumour is ER and PR +, but negative for Her2, then you are likely to benefit from hormone therapy and may also benefit from chemotherapy (although not everyone in this group will receive chemo; it will depend on the stage of your Cancer).
-If your tumour is ER positive, PR negative and HER2 positive, you are likely to benefit from chemotherapy and may benefit from hormone therapy and targeted therapies to treat Her2.
-Some tumours are ER negative and PR negative, but HER2 positive. HER2 breast cancers are likely to benefit from chemotherapy and targeted therapy to treat Her2.
-There is the type called Triple Positive Breast Cancer, where tumours are ER positive, PR positive and Her2 positive. This Cancer will always receive chemotherapy and targeted therapy, as it is considered very agressive (grade 3).
-And there is also the Triple Negative Breast cancer, where tumours are ER negative, PR negative and Her2 negative. This type is likely to benefit from chemotherapy.
The most common type of Breast Cancer (around 60% of all cases) is ER+/PR+, which, if caught in time, nowadays can have a really easy treatment consisting in Lumpectomy+Radiotherapy, with no Chemotherapy.
– 20% of all Breast cancers will be Triple Positive, which can be treated with just TCHP or with FEC or AC plus TCHP or THP.
– 20% of all breast Cancers will be Triple Negative. These tumours do not respond to hormones, so they can become tricky, but they will be treated with FEC or AC chemotherapy, and they can respond well to these treatments.
The Triple Positive and Triple Negative Tumours will always be treated with chemotherapy. After finishing the traditional treatments (Chemo/Surgery/Radio), the Triple Positive Tumours will still be treated for years (five to ten), to avoid the risk of recurrence. Doctors will keep on giving the patient Herceptin (a targeted therapy which works fantastically well in blocking the Her2 protein) and they will also supress the Estrogen with Letrozole (in menopausal women) or Tamoxifen (in pre-menopausal women).
The Triple Negative Breast Cancers won´t benefit from supressing Estrogen, so they won´t receive hormonal therapy.