Breast Cancer Has a Variety of Subtypes
- Award-winning actress Julia Louis-Dreyfus, 63, has faced breast cancer like millions of other women, and with so many different subtypes of the disease, it’s important to know how different one journey can be from the next depending on your breast cancer subtype, stage, and grade.
- There have been remarkable improvements in recent years as far as treating these various types/subtypes, even with more advanced stage disease, and doctors are starting to look at these breast cancer types as completely different diseases.
- Determining the exact type of breast cancer a patient has can help doctors determine what is fueling the disease — and can help them narrow down the best way to treat it.
- The Food and Drug Administration (FDA) has just approved a drug called Truqap (generic name: capivasertib) for certain women with hormone receptor positive (HR+), human epidermal growth factor receptor negative (HER2-) breast cancer. The approval is another major step for targeted, hopefully more effective therapies in the breast cancer field.
Louis-Dreyfus had stage 2 breast cancer, but further details regarding her full diagnosis remain unclear.
Read MoreLouis-Dreyfus Was Diagnosed After Winning an Emmy
She learned of her stage 2 diagnosis following one of her biggest achievements in 2017.
“I started laughing. Well, because the night before, I had won an Emmy,” Louis-Dreyfus recalled to the outlet. “And so, I came downstairs and…the Emmy was there. It was like on the dining room table. I’m coming down to get coffee. My cell phone rings, and it’s my doctor saying, ‘Guess what, you have cancer.'”
Her laughter then turned to tears as she processed what was happening.
“Of course, I did laugh, and then I became hysterical, crying, because I was terrified, as most people are, or as all people are, if they get a diagnosis like that,” she said.
Stage 2 Breast Cancer
Stage 2 breast cancers are either larger than stage 1 tumors or have moved to a few nearby lymph nodes. Treatment will likely be some combination of surgery, radiation, and chemotherapy. If chemotherapy is also needed after surgery, the radiation is delayed until the chemo is done. The same approach is taken to hormone receptor and HER2 positive as stage 1.
After her diagnosis, Louis-Dreyfus shared the news publicly on her social media channels to an outpouring of support. For her treatment, she underwent six rounds of chemotherapy and a double mastectomy, which is the removal of both breasts.
“A double mastectomy typically takes about two hours for the cancer part of the operation, the removing of the tissue,” Dr. Elisa Port, Chief of Breast Surgery at Mount Sinai Health System, told SurvivorNet in an earlier interview.
Chemotherapy can cause several side effects, including nausea, vomiting, and hair loss. Your doctor can help you manage some of these side effects. Fortunately for hair loss, while it usually begins about three to four weeks after starting chemotherapy and continues throughout treatment, it usually regrows after treatment concludes.
By October 2018, Louis-Dreyfus announced that she was “cancer-free.”
Learning About Breast Cancer Treatment
Your doctor has many ways to treat breast cancer, including:
- Surgery
- Chemotherapy
- Radiation
- Hormone therapy
- Targeted therapy
- Immunotherapy
Surgery
Most women with breast cancer will have surgery at some point in their treatment. Depending on how far your cancer has spread and your personal preferences, you and your doctor may decide to:
- Remove just the cancer and an area of healthy tissue around it (lumpectomy)
- Remove one breast (mastectomy)
- Remove both breasts (double mastectomy)
Removing your breasts can have a dramatic effect on your self-esteem, which is why some women who opt for a mastectomy then choose breast reconstruction surgery. This is a highly personal choice, and there is no “right” answer as to whether or not to reconstruct.
Chemotherapy
Chemotherapy uses strong drugs to kill cancer all over the body. You may get this treatment to shrink a tumor before surgery, afterward to get rid of any remaining cancer cells, or on its own if you can’t have surgery.
Whether or not to have chemotherapy can also be a choice, depending on a woman’s age, type of cancer, and stage.
Radiation Therapy
Radiation therapy is the use of high-energy rays to destroy cancer cells and is typically used after surgery to lower the chance that the cancer will come back after treatment. Many women undergo radiation as part of their treatment, especially if they opt for a lumpectomy instead of a mastectomy.
Hormone Therapy
The hormones estrogen and progesterone help some breast cancers grow. Doctors refer to these types of cancers as hormone-receptor-positive breast cancers. Receptors are proteins on the surface of breast cells that receive messages from estrogen, progesterone, or both, telling them to grow. Treatments that block these hormones may help stop the tumor.
Testing the tumor sample from a biopsy helps to determine whether hormone therapies such as tamoxifen (Nolvadex) or anastrozole (Arimidex) might work against the cancer. Women with breast cancer that is fueled by estrogen may take one of these drugs as part of their treatment.
Immunotherapy and Targeted Therapy
Immunotherapy and targeted therapies are newer forms of treatment. Immunotherapy boosts your body’s own immune response to help it stop the cancer.
As their name suggests, targeted therapies target certain substances that help the cancer grow. For example, drugs like trastuzumab (Herceptin) and pertuzumab (Perjeta) treat breast cancers that have too much of a protein called HER2 on their surface.
Breast Cancer Types
The first order of business for doctors is determining their patients’ breast cancer types and subtypes so they can effectively start treating the disease with the least amount of side effects.
According to Cleveland Clinic, the most common types of breast cancer include:
- Invasive (infiltrating) ductal carcinoma (IDC), which starts in your milk ducts and spreads to nearby breast tissue. It’s the most common type of breast cancer in the United States.
- Lobular breast cancer, which is the second most common breast cancer in the U.S., starts in the lobules, the milk-producing glands in your breast and spreads to nearby breast tissue.
- Ductal carcinoma in situ (DCIS), which starts in your milk ducts like IDC. The difference between the two is DCIS doesn’t spread beyond your milk ducts.
Less common breast cancer types include:
- Triple-negative breast cancer (TNBC): This invasive cancer is aggressive and spreads more quickly than other breast cancers.
- Inflammatory breast cancer (IBC) is rare, fast-growing and looks like a rash on your breast.
- Paget’s disease of the breast is another rare cancer affecting the skin of your nipple and may look like a rash. Less than 4% of all breast cancers are Paget’s disease of the breast.
Breast Cancer Subtypes
Estrogen and progesterone help cancerous cells grow, so healthcare providers must immediately find out if the cancer is fueled by either — or both, or neither. Here is an overview of subtypes:
- ER-positive (ER+) breast cancers have estrogen receptors.
- PR-positive (PR+) breast cancers have progesterone receptors.
- HR-positive (HR+) breast cancers have estrogen and progesterone receptors.
- HR-negative (HR-) breast cancers don’t have estrogen or progesterone receptors.
- HER2-positive (HER2+) breast cancers, which have higher than normal levels of the HER2 protein. This protein helps cancer cells to grow. About 15% to 20% of all breast cancers are HER2-positive.
The Food and Drug Administration (FDA) has recently approved a drug called Truqap (generic name: capivasertib) for certain women with hormone receptor positive (HR+), human epidermal growth factor receptor negative (HER2-) breast cancer. The approval is another major step for targeted, hopefully more effective therapies in the breast cancer field.
“It’s a really, really important drug [creating] new opportunities for patients with breast cancer,” says Dr. Carlos Doti, Vice President, Head of Medical Affairs, US Oncology Business Unit for the pharmaceutical giant AstraZeneca. “One of the important parts of this is that we are expanding the number of patients that can be treated with targeted therapies in the second-line setting.”
Hormone receptor positive cancer means that the cancer needs the hormones estrogen and/or progesterone to grow. HER2 negative means that the breast cancer cells do not have high levels of the HER2 protein.
Determining the exact type of breast cancer a patient has can help doctors determine what is fueling the disease — and can help them narrow down the best way to treat it.
Questions to Ask Your Doctor After a Diagnosis
If you have been diagnosed with breast cancer, it’s a good idea to make a list of questions for your doctor. Here are a few questions to help you begin the conversation:
- What type of breast cancer do I have? What subtype?
- What treatment will I be receiving and for how long?
- What side effects are associated with this treatment?
- Are there steps I can take daily to help minimize these side effects?
- What physical activity routine do you recommend for me during treatment?
- Do I need to have a mastectomy?
- What does my genetic testing show about my cancer risk?
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