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Bularreko minbizia ebakuntza baten bidez tratatzen da normalean eta gero, kimioterapia, radioterapia edo biekin. Antigorputz monoklonalak edo beste tratamendu inmunologiko batzuk erabili daitezke metastasi batzuen kasuan.
=== SurgeryEbakuntza === ▼The management of breast cancer depends on various factors, including the stage of the cancer and the age of the patient. Increasingly aggressive treatments are employed in accordance with the poorer the patient's prognosis and the higher the risk of recurrence of the cancer following treatment.
Ebakuntzan tumorea kentzen da inguruko ehun apur batekin batera. Nodulu linfatiko batzuk ere ken daitezke biopsia egiteko edota kaltetuta daudelako. Ebakuntza ohikoetan zera egiten da:
* Masektomia: bular osoaren erauzketa.
* Kuadrantektomia: bularraren laurden baten erauzketa.
* Tumorektomia: bularraren zati txiki baten erauzketa.
Behin tumorea kenduta, bularraren errekonstrukzioa egin daiteke gaixoaren nahien arabera. Kirurgia plastikoa egin ezean badira protesiak erabiltzen dituzten emakumeak, arroparen azpian bularraren itxura izateko. TIti buruaren protesiaak eta errekonstrukzioak ere badaude.
=== RadiationBotikak === ▼Breast cancer is usually treated with surgery, which may be followed by chemotherapy or radiation therapy, or both. A multidisciplinary approach is preferable. Hormone receptor-positive cancers are often treated with hormone-blocking therapy over courses of several years. Monoclonal antibodies, or other immune-modulating treatments, may be administered in certain cases of metastatic and other advanced stages of breast cancer.
Ebakuntzaren ostean erabilitako botikak, botika laguntzaileak deitzen dira. Gaur egun honelako hiru botika talde nagusi daude: agente hormona blokeatzaileak, kimioterapia eta antigorputz monoklonalak.
Chest after right breast mastectomy
Surgery involves the physical removal of the tumor, typically along with some of the surrounding tissue. One or more lymph nodes may be biopsied during the surgery; increasingly the lymph node sampling is performed by a sentinel lymph node biopsy.
Standard surgeries include:
* Mastectomy: Removal of the whole breast.
* Quadrantectomy: Removal of one-quarter of the breast.
* Lumpectomy: Removal of a small part of the breast.
Once the tumor has been removed, if the patient desires, breast reconstruction surgery, a type of plastic surgery, may then be performed to improve the aesthetic appearance of the treated site. Alternatively, women use breast prostheses to simulate a breast under clothing, or choose a flat chest. Nipple prosthesis can be used at any time following the mastectomy.
=== Medication ===
Drugs used after and in addition to surgery are called adjuvant therapy. Chemotherapy or other types of therapy prior to surgery are called neoadjuvant therapy. Aspirin may reduce mortality from breast cancer.
There are currently three main groups of medications used for adjuvant breast cancer treatment: hormone-blocking agents, chemotherapy, and monoclonal antibodies.
'''Hormone blocking therapy'''
: Some breast cancers require estrogen to continue growing. They can be identified by the presence of estrogen receptors (ER+) and progesterone receptors (PR+) on their surface (sometimes referred to together as hormone receptors). These ER+ cancers can be treated with drugs that either block the receptors, e.g. tamoxifen, or alternatively block the production of estrogen with an aromatase inhibitor, e.g. anastrozole or letrozole. The use of tamoxifen is recommended for 10 years. Letrozole is recommended for 5 years. Aromatase inhibitors are only suitable for women after menopause; however, in this group, they appear better than tamoxifen. This is because the active aromatase in postmenopausal women is different from the prevalent form in premenopausal women, and therefore these agents are ineffective in inhibiting the predominant aromatase of premenopausal women. Aromatase inhibitors should not be given to premenopausal women with intact ovarian function (unless they are also on treatment to stop their ovaries from working).
'''Chemotherapy'''
: Chemotherapy is predominantly used for cases of breast cancer in stages 2–4, and is particularly beneficial in estrogen receptor-negative (ER-) disease. The chemotherapy medications are administered in combinations, usually for periods of 3–6 months. One of the most common regimens, known as "AC", combines cyclophosphamide with doxorubicin. Sometimes a taxane drug, such as docetaxel, is added, and the regime is then known as "CAT". Another common treatment is cyclophosphamide, methotrexate, and fluorouracil (or "CMF"). Most chemotherapy medications work by destroying fast-growing and/or fast-replicating cancer cells, either by causing DNA damage upon replication or by other mechanisms. However, the medications also damage fast-growing normal cells, which may cause serious side effects. Damage to the heart muscle is the most dangerous complication of doxorubicin, for example.
'''Monoclonal antibodies'''
: Trastuzumab, a monoclonal antibody to HER2 (a cell receptor that is especially active in some breast cancer cells), has improved the 5-year disease free survival of stage 1–3 HER2-positive breast cancers to about 87% (overall survival 95%). When stimulated by certain growth factors, HER2 causes cellular growth and division; in the absence of stimulation by the growth factor, the cell will normally stop growing. Between 25% and 30% of breast cancers overexpress the HER2 gene or its protein product, and overexpression of HER2 in breast cancer is associated with increased disease recurrence and worse prognosis. When trastuzumab binds to the HER2 in breast cancer cells that overexpress the receptor, trastuzumab prevents growth factors from being able to bind to and stimulate the receptors, effectively blocking the growth of the cancer cells. Trastuzumab, however, is very expensive, and its use may cause serious side effects (approximately 2% of patients who receive it suffer significant heart damage). Further, trastuzumab is only effective in patients with HER2 amplification/overexpression.
Internal radiotherapy for breast cancer
Radiotherapy is given after surgery to the region of the tumor bed and regional lymph nodes, to destroy microscopic tumor cells that may have escaped surgery. It may also have a beneficial effect on tumor microenvironment. Radiation therapy can be delivered as external beam radiotherapy or as brachytherapy (internal radiotherapy). Conventionally radiotherapy is given ''after'' the operation for breast cancer. Radiation can also be given at the time of operation on the breast cancer. Radiation can reduce the risk of recurrence by 50–66% (1/2 – 2/3 reduction of risk) when delivered in the correct dose and is considered essential when breast cancer is treated by removing only the lump (Lumpectomy or Wide local excision).
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