Principal Director & Unit Head - Medical Oncology, Fortis Hospital, Shalimar Bagh, New Delhi, India
Part 7 of 8 in Diagnosis and Detection of Cancer
Breast Cancer: Prognostic Factors and Treatment Sequencing
May 19, 2024
Breast cancer generates some of the most specific and recurring treatment questions in oncology, from prognosis to how different treatments are sequenced.
What determines prognosis
Breast cancer prognosis depends on two main factors: the patient's disease stage, and the biology of the tumour itself, meaning which receptors are present (for targeted or hormonal therapy). For early breast cancer with lymph node involvement in the armpit, radiotherapy is typically given after chemotherapy to sterilise the local area.
Sequencing chemotherapy, hormone therapy and managing relapse
Chemotherapy and hormone therapy are usually not given together, since they can work against each other; hormone therapy can, however, be combined with targeted therapy or immunotherapy, and is typically started only after chemotherapy is completed. If breast cancer relapses after successful chemotherapy, and the relapse is localised to one or two sites, re-surgery or radiation to that area may be used, sometimes alongside further medical management depending on the tumour's biology. For a patient above 60 with advanced breast cancer, the treatment choice again depends on the tumour's receptor status: chemotherapy with maintenance, targeted therapy if HER2-positive, hormone therapy if hormone-receptor-positive, or immunotherapy if the tumour fits those criteria.
This article is based on a Jivo Masterclass session conducted by Dr. Mohit Agarwal, Principal Director & Unit Head, Medical Oncology, Fortis Hospital, Shalimar Bagh, New Delhi. The article has been summarised with the assistance of an AI tool from the original masterclass recording. Watch the full Masterclass recording
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This guide is based on a live Jivo Masterclass: Dr. Mohit Agarwal taught doctors across Africa on May 19, 2024.
FROM THE LIVE Q&A
Moderator
What are the best treatment options for already metastasised malignant disease?
Dr. Mohit Agarwal
It is not a one-size-fits-all approach. It depends on the individual patient, which cancer is present in the body, and which site it has metastasised to. Treatment can be chemotherapy, immunotherapy or targeted therapy depending on exactly what is being treated.
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Frequently Asked Questions
Why do brain tumours relapse so much compared with other tumours?▼
Brain tumours relapse mainly if they are high-grade or advanced-stage. Complete surgical removal of a brain tumour is nearly impossible, so high-grade or advanced tumours are more likely to recur; patients with low-grade tumours tend to be cured.
A male patient has a cystic mass with solid components draining blood-stained, chocolate-coloured, thick fluid from the left breast, with histology not yet available - what type of breast cancer is this likely to be, and what is the likely prognosis?▼
Any discharge from a male breast is not normal - it can be an infection, a malignancy, or something arising from the chest wall. The key next step is imaging and a histopathological diagnosis; this could turn out to be breast cancer, which would need immediate treatment.
What are the prognostic factors for breast cancer?▼
Two main factors: the patient's own disease stage, and the biology of the disease, meaning which receptors are present on the tumour for targeted or hormonal therapy.
If a patient responds to chemotherapy, is there any further need for radiotherapy?▼
For early breast cancer with lymph node involvement in the armpit, radiotherapy is typically given after chemotherapy to sterilise the local area. Whether radiotherapy is needed depends on the individual patient's stage and disease.
Can chemotherapy and hormonal therapy be combined for the treatment of breast cancer?▼
Usually not given together, since they can oppose each other. Hormonal therapy can be combined with targeted therapy and immunotherapy, but when combined with chemotherapy, it is typically given only after the chemotherapy is completed.
What determines breast cancer prognosis?▼
The stage of the disease and the biology of the tumour (which receptors are present, guiding targeted or hormonal therapy options).
Can chemotherapy and hormone therapy be combined for breast cancer?▼
Not usually - they can oppose each other, so hormone therapy is typically started after chemotherapy is completed, though it can be combined with targeted therapy or immunotherapy.
In This Series: Diagnosis and Detection of Cancer
- 1.Diagnosis and Detection of Cancer
- 2.Cancer Myths: Family History, Genetic Testing and Who Gets Cancer
- 3.Smoking and Other Major Cancer Risk Factors
- 4.The Seven Warning Signs of Cancer and How Biopsy Works
- 5.Cancer Staging, Tumour Markers and Screening Explained
- 6.Chemotherapy, Targeted Therapy and Immunotherapy Explained
- 7.Breast Cancer: Prognostic Factors and Treatment Sequencing
- 8.The Role of Nutrition in Cancer Prevention and Care