- If the cancer was primarily ?in situ? but shows some evidence of spread, there is debate about whether chemotherapy or hormone therapy is used.
- If the tumor is more invasive but restricted to the breast and less than one centimeter in size, many doctors do give adjuvant treatment but some don?t.
- If the tumor was invasive and one centimeter or more in size, hormone and chemotherapy are generally advised, whether or not there is lymph node involvement.
- If there is lymph node involvement, chemotherapy or hormone therapy should always be used, even if the tumor was less than one centimeter.
Chapter eleven: Breast Reconstruction
? Breast reconstruction is an elective surgery whose purpose is entirely cosmetic. There is no compelling medical reason to have it.
? Instead of breast reconstruction, an artificial breast form, a prosthesis, can be worn
? According to the American Society of Plastic Reconstructive Surgeons, in 1998 close to 70,000 women had breast reconstruction
? Federal law requires insurance plans to pay for breast reconstruction
? Two types of breast reconstruction exist: one in which tissue from elsewhere is used to form a mound in the shape of the breast and another in which a foreign body, a prosthesis, is used.
? Nipple reconstruction is also possible to further enhance the appearance of the breast
? Breast implants can cause some discomfort.
? The appearance of the reconstructed breast is not identical to the original breast
? Breast reconstruction is now mostly done at the time of the mastectomy, when the surgeon has finished his work.
? In those cases where breast reconstruction is not done at the time of the mastectomy, it is recommended that you allow a three month period for the surgery site to heal.
? Scar tissue forms around the implant. This may result in the breast hardening.
? The TRAM flap – a type of breast reconstruction that uses tissue from the stomach, may result in a loss of muscle tone in the stomach.
? If cancer recurs after a lumpectomy in the treated breast, the breast now has to be removed. This is often referred to as a salvage mastectomy. This must be followed by chemotherapy and hormone therapy.
? Rarely, a new cancer can grow in the remaining breast tissue after a mastectomy. This carries a lower risk of spread
? Treatment should begin with removal of tumor and some surrounding healthy tissue. This might mean some bone and muscle. Radiation should then be given and the entire region operated on followed by chemotherapy and hormone treatment.
? If the cancer recurs in a ?distant site?, or other parts of the body, then palliation is the method most often adopted by doctors. Palliation means to ? relieve or lessen without curing?. Many doctors seek only to relieve symptoms and not cure the illness when treating distant site recurrence.
? There are several procedures which sometimes manage to achieve a cur, in combination or separately. They are: surgery, radiation, hormone therapy, and chemotherapy
? The following are general guidelines for treating ?distant site? recurrence
- Surgery is used to remove an isolated tumor that gets in the way of functioning, if the disease has spread
- If there is an isolated tumor, it can sometimes be cured by removing it
- Radiation can reach hard to get at locations. It can destroy tumors in parts of the body where it is not advisable to perform surgery. It is particularly useful in relieving pain in bones where cancer has metastasized.
- Hormone therapy can be used for women who have hormone positive receptors
- For some patients, high dose chemotherapy followed by bone and/or stem cell transplant offers a chance of cure.
? Women with recurrent tumors that are both estrogen and progesterone receptor positive respond to hormone treatment in seventy five percent of cases.
? Women with only one type of hormone receptor present respond to treatment in only forty percent of cases.
? Women whose tumors are not hormone receptive at all respond to hormone therapy in only ten percent of cases.
? Hormone drugs are effective only for a limited time span, so several drugs must be used in succession, with each new drug being given only when the previous one stops working.
? Chemotherapy is used to supplement hormone therapy even for those patients who respond well to hormone therapy, as this even further increases the benefits to your health.
? If the original tumor has no hormone receptors, chemotherapy is the primary method of treatment and given from the beginning.
? Chemotherapy drugs are only effective for a limited time span.
? Chemotherapy drugs are given in various combinations. The first combination is called first-line treatment, when it ceases being effective a new combination called second-line treatment is given, and following that another combination called third-line treatment is given.
? Drug combinations are always in development and advances are made constantly.
? Combinations of drugs are generally more effective than single drugs in treating breast cancer.
? It is important to overcome or minimize side effects when giving chemotherapy.
? Bone marrow or stem cell transplant- this procedure is sometimes used to treat cancer that has spread to other parts of the body.
- it sometimes produces infection in the lungs, liver damage, and other painful side effects.
- It is often used to supplement high dose chemotherapy
- The most promising use of this procedure is in women with a small number of metastic sites
- This treatment is not given to women who have previously had multiple treatments.
? Studies have shown that bisophonates, drugs that disrupt the normal process of bone building and destruction, are able to delay or prevent the spread of breast cancer to bone.
? During treatment, it is important to carefully monitor for side effects and complications.
? Best results are obtained with the most powerful and early response to recurrence. Surgery, radiation, hormone therapy, and chemotherapy, should be used in sequence or in combination.
? If cancer still recurs it may have become resistant to the drugs being used. It might be possible to prevent this by alternating different forms of chemotherapy.
? In nearly every case of recurring breast cancer, it is possible to prolong life.
? Chemotherapy is not incompatible with a high quality of life and does not necessarily cause suffering.
? Breast cancer spreads least often to the spleen, kidney, or skeletal muscle
Alternative Medicine, Prevention, Diets
? Alternative medicines are not a substitute for conventional medicine.
- Relying on alternative medicine before seeking regular medical attention can allow an otherwise treatable tumor to grow to unmanageable size.
- vitamin supplements, high carbohydrate diets are not harmful, unless they interfere with prompt or proper treatment
- imaging, enemas, macrobiotic diets, relaxation technique, deep massage, group healing,
Chapter 13
? (III) Three DietSome suggest cancer can be prevented (even cured) by diet and lifestyle changes.
? Three DietPhysicians suggest a diet low in fat, high in carbohydrates and soy-based protein and eating as many organically grown meats, vegetables and fruits, for their cancer patients.
? Three DietSupplements suggested for cancer patients include vitamin C plus bioflavonoids, beta-carotene, selenium (taken with vitamin E) and co-enzyme Q10.
? Soy products include soybeans, soy sprouts, soy nuts and textured vegetable protein. Tofu, soy flour, milk, protein powder as well as tempeh and miso are other soy sources. Soy sauce, however, is not a recommended soy source because of its high sodium content.
? The soy plant contains genistein, which has the ability to bind to unwanted estrogen in the breast and in other parts of the body.
? Cruciferous vegetables contain certain important enzymes.
? A combination of vegetables and fruit contain Vitamin A and beta-carotene.
? Eating organically grown food is recommended since, the soil has been sprayed with pesticides.
? Cancer patients should avoid junk and processed refined foods, foods with caffeine, salt, sugar, white flour, carbonated drinks, and alcohol.
? Supplements such as vitamins, minerals, and other nutrients are necessary to provide additional support for the body during and after chemotherapy and/or radiation.
? Studies have revealed that reduction in cancer incidence is associated with a diet high in vitamin C. Foods rich in vitamin C are potatoes, peppers, peas, tomatoes, broccoli, brussels sprouts, cabbage, cauliflower, kale and parsley, in addition to most fruits and melons.
? Bioflavonoids are crystalline compounds, essential for vitamin C absorption. Flavonoids in food and herbs have additional anti-inflammatory and anti-allergic effects due to their anti-oxidant properties.
Fat consumption may be lowered by using olive and canola oils only, eliminating red meat from one?s diet, increasing fish varieties, and eating fewer sweets. Complex carbohydrates containing dietary fiber include grains, nuts, seeds, and unpolished rice. are high in dietary fiber, which is said to bind to excess estrogen in the intestine and is then excreted.
Cruciferous vegetables such as broccoli, brussels sprouts, cabbage, radishes, cauliflower and kale are important because they contain an enzyme, indole-3-carbinol, which changes the way estrogen is metabolized. In addition, broccoli contains a second chemical that synthesizes enzymes which detoxifying cancer substances in the body.
A combination of yellow, orange-red and dark green vegetables and fruit containing Vitamin A and beta-carotene protect the body against oxidative damage which may lead to additional mutations
Eating organically grown food is recommended since most of the soil has been sprayed with pesticides.
A Hebrew University study revealed a drop of 30% in breast cancer, once DDT pesticides were outlawed in Israel.
Studies by Dr. Davis at the Strang Cancer Research Laboratory in New York demonstrated that DDT-like pesticides cause the body to produce a carcinoma-linked type of estrogen (16 alpha hydroxyestone).instead of natural estrogen.
A study of Japanese women living in Japan, who regularly ate soy based-protein had a lower cancer level than their American counterparts. Genistein, found exclusively in soy products. have been shown to reduce hot flashes and night sweats and hormonal fluctuations in older women.
Soy proteins play a role similar to the SERM family of hormone?like drugs that compete with estradiol for receptor sites. By blocking estradiol from binding to cell receptors, cell growth is not stimulated. Estrogen stimulation may cause painful, swollen breast sensations before menstruation. Continued breast stimulation by estrogen on a monthly basis may increase the risk of breast cancer, especially as women age.
Even though soy-based proteins are the most recommended protein source for cancer patients, it is essential that cancer patients have protein in their diet. Other forms of protein include nuts, beans, fish, organic meats and eggs.
Junk and processed foods must be avoided. When sugar is refined, all the vitamins, minerals and enzymes needed for sugar metabolism by the body, are eliminated. Sugar- refined foods have been shown to lower the immune system for several hours after intake. Calcium will also be stripped from bones to alkalinize sugar acidity in the blood. Sugar substitutes are suggested such as blackstrap molasses, pure maple syrup, and fruit sweeteners to replace sugar. Whole wheat and rye flours are preferable over white flour.
Foods with caffeine include coffee, teas, chocolate and colas. Caffeine induces breast tenderness and hot flashes.
Alcoholic beverages can depress liver function and the immune system. Body dehydration is associated with alcohol consumption. Alcohol must be avoided during chemotherapy.
Carbonated drinks contain phosphorus, a mineral that induces body calcium depletion. Chemotherapy and premature menopause may also contribute to calcium deficiency. Sugar content is also high in carbonated drinks and may lead to increased insulin secretion and blood sugar fluctuations.
We can not obtain all the necessary vitamins and minerals directly from foods. Supplements are highly recommended to provide ample support for the body, to aid in tissue repair and boost immune function during and after chemotherapy and/or radiation therapies.
Free radicals produced by chemotherapy and radiation exposure can attach to DNA and cause genetic damage. Antioxidants, such as vitamin C plus bioflavanoids, beta-carotene, selenium (taken with vitamin E) and coQ1o especially during therapy can reverse the build-up of free radicals in the body.
***Bioflavonoids are crystalline compounds that are essential for the absorption of vitamin C. Flavonoids in food and herbs have additional anti-inflammatory and anti-allergic effects due to their antioxidant properties. Bioflavonoids may also inhibit estrogen production. Bioflavonoids are common in the inner peel and pulp of citrus fruits, the skin of grapes, cherries and berries, as well as in the green tea polyphenols, quercetin, and proanthocyanidins,****
Conflicting opinions regarding anti-oxidant ability to protect cancer cells from chemotherapy and radiation effects exist. Presently, most physicians recommend that during the five to seven weeks of radiation, anti-oxidants should only be taken on weekends. For women undergoing chemotherapy, it is recommended to discontinue anti-oxidants two days prior to chemotherapy and to wait until two days after the chemotherapy cycle before resuming anti-oxidant ingestion. If the chemotherapy protocol requires oral cyclophosphamide for fourteen days, it is advised to discontinue all anti-oxidants for that period of time and for two additional days.
Beta-carotene is an antioxidant protecting lipid-containing body tissues. Beta-carotene is conv