Chemotherapy and hormone treatments

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Chemotherapy
Chemotherapy is a treatment of cancer by using anti-cancer drugs which kill cancer cells, or stop them from multiplying. (See separate leaflet called 'Chemotherapy' for more details.)

When chemotherapy is used in addition to surgery it is known as 'adjuvant chemotherapy'. For example, following surgery you may be given a course of chemotherapy. This aims to kill any cancer cells which may have spread from the main tumour site.

Chemotherapy is sometimes given before surgery to shrink a tumour so that surgery may have a better chance of success and also a smaller operation may be performed. This is known as 'neoadjuvant chemotherapy'. The type of chemotherapy given may depend on the type of cancer.

New gene tests are being developed to help doctors decide which women will benefit the most from chemotherapy.

Chemotherapy may also be used for some women to treat breast cancer which has spread to other areas of the body.

Hormone treatments
Some types of breast cancer are affected by the 'female' hormone oestrogen (and sometimes progestogen). These hormones stimulate the cancer cells to divide and multiply. Most oestrogen and progestogen is made by the ovaries. Treatments which reduce the level of these hormones, or prevent them from working, are commonly used in people with breast cancer. This hormone treatment works best in women with 'hormone responsive' breast cancer, but they sometimes work in cancers classed as non-hormone responsive.

Hormone treatments include:

Oestrogen blockers. Tamoxifen has been available for many years and is still widely used. It works by blocking the oestrogen from working on cells. It is usually taken for five years. Other oestrogen blocker drugs are now available.
Aromatase inhibitors. These are drugs which work by blocking the production of oestrogen in body tissues. They are used in women who have gone through the menopause. These drugs include anastrozole, letrozole and exemestane.
GnRH (gonadotrophin releasing hormone) analogues. These drugs work by greatly reducing the amount of oestrogen that you make in the ovaries. There are several GnRH analogue preparations; the commonly used one is goserelin. They are usually given by injection and may be used for women who have not yet reached the menopause.
An alternative which may be considered for women before the menopause is to remove the ovaries (or to destroy them with radiotherapy). This stops oestrogen from being made.

Trastuzumab (Herceptin)
Trastuzumab (also known as Herceptin) is a treatment that may be given to women who have a large number of HER2 receptors in their cancer. It is a type of drug called a monoclonal antibody. It works by attaching to HER2 receptors on the surface of breast cancer cells and thereby stopping the cancer cells from dividing and growing.

In summary
The treatment plan varies greatly from case to case and depends on many different factors.