Sunday, April 5, 2009

Neoadjuvant chemotherapy for breast cancer

This site is called adjuvant chemotherapy, meaning chemo in addition to whatever surgical procedure is used to remove the breast or colon or what not cancer in patients. What is neoadjuvant chemotherapy? In certain cases, a patient will have an outsized growth, while not metastatic (i.e. it hasn't yet "spread"), is just so big that it's too hard to remove by surgery alone. It may have bulged into tissue that's surrounding it, and removal would incur great damage because of the need to excise lots of tissue around any one particular tumor. This is where neoadjuvant chemotherapy comes in. The latin word "neo" means new, and in this case, for a new tumor one is targeting it with chemo before hitting it with surgery. The purpose of this is to attempt to shrink the tumor. Of course, any patient who undergoes neoadjuvant chemotherapy is still going to suffer from chemotherapy side effects such as sickness and hairloss and fatigue. Success with this kind of therapy is if the tumor shrinks, and then becomes easier for the surgeon to remove. For a patient, this is probably a harrowing time, since any patient who has cancer probably wants to get the thing excised as soon as possible. Now with the physician telling him or her to wait out a few months taking chemotherapy must be nerve wracking. Basically, the idea is to get the tumor to shrink.

There are certain kinds of breast cancer for which neoadjuvant chemotherapy is indicated. For example, inflammatory breast cancer (IBC) is characterized by inflammation of breast tissue, and growth in sheets rather than solid masses. This makes the cancer difficult to localize for surgical removal, and as such, drugs would be most suitable for treating this type of disease manifestation. Some symptoms of IBC are given by:

* Changes in skin surface of breast, such as localized thickening
* Extra warmth, due to blood vessels dilating in response to inflammation
* Pain, sharp or dull
* Color changes of the areola
* Itchiness
* Sudden swelling, sometimes a cup size in a few days
* Erythema, with texture like skin of an orange
* Nipple retraction
* Nipple discharge

Worse still, IBC may not be detectable via traditional imaging methods such as ultrasound or mammography because of its diffuse, nonsolid nature. Physicians are usually advised to be cautious in interpreting imaging of breasts that have the above associated symptoms. A needle biopsy may show more definitive results than using ultrasound or mammograms. Finally, IBCs have been known to progress to more aggressive cancers at a higher rate than solid mass tumors. This is not well understood, but is thought to be due to the complex nature of the inflammation. Inflammation of tissues is usually associated with deranged signaling processes of the cells, which can trigger changes that lead to cancer metastasis. Metastasis is the dreaded "spread" of the cancer from its primary site to far, secondary sites. For example, a tumor in the breast may break off in pieces and lodge itself in the lungs, giving rise to lung cancer. Such metastatic cancers are difficult to treat with surgery, and one must rely completely on the efficacy of neoadjuvant chemotherapy in wiping them out.

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