Types of Breast Cancer

“NOT-SO-NICE” PERSONALITY HER2-POSITIVE BREAST CANCER

These cancer cells overproduce a protein called HER2Neu. Some of them may also be sensitive to estrogen and progesterone and others not. They tend to have higher cell division rates and are considered slightly more aggressive. This is why chemotherapy may be recommended before surgery for this type of breast cancer. The chemotherapy should ideally also be combined with a
special drug that targets the Her2 receptor but this may not be available at all hospitals and chemotherapy alone is used instead. Once chemotherapy is completed, surgery will be performed and may or may not be followed by radiation.

“SOMETIMES-LAZY-OR-SNEAKY” PERSONALITY HORMONE RECEPTOR-POSITIVE (ER/PR POSITIVE) BREAST CANCER:

The “lazy” cancers are called Luminal A cancers. They are very sensitive to hormones and have a slow growth rate. A hormone blocker tablet will be started and surgery will be planned. Most of these cancers only need the operation (with or without radiation depending on the type of operation) and hormone blockers as treatment. The “sometimes sneaky” cancers are called Luminal B cancers. They are also very sensitive to hormones but have a higher growth rate. A hormone blocker tablet will be started and surgery will be planned but some of these cancers will also require  hemotherapy before or after surgery. It will be different for each patient depending on many factors.

“NASTY” PERSONALITY TRIPLE NEGATIVE BREAST CANCER:

Cells lack sensitivity for hormones and HER2 and often have a high cell division rate. This makes them particularly tricky to target but luckily they often respond well to chemotherapy which is why this is a crucial first step in treating them. This will then be followed by surgery ( and sometimes radiation). A small number of patients will also require different type of chemotherapy after the surgery.

Why Surgery Alone is Not Enough

Many patients struggle to understand why just removing the cancer with surgery is not enough to cure it. Many years ago, doctors also did not realise that an operation alone is not enough and most patients were only treated with surgery. The survival rate for breast cancer in those days were not very good and we only understood why when the discovery of the different personalities and behaviour of breast cancer cells were discovered.

Think of cancer in your breast as the “mothership”. The headquarters where the trouble started. An operation and radiation treatment are excellent for wiping out the headquarters and taking out the “mothership”. The trouble is, breast cancer cells seems to like to travel. So, while the headquarters sits in the breast, some of the cells may “jump off” like little tourists and go to explore other parts of the body via the lymph system. They may not be visible on early scans or blood tests and are quite good at hiding in other parts of the body like the liver, lungs, and bones. If they like it there and nobody notices them, they may decide one day to build a new headquarters – and develop into a tumor elsewhere in the body.

That is what happens when breast cancer spreads (metastasize) and become very difficult to deal with. This is where chemotherapy and endocrine therapy (hormone blockers for hormone-sensitive cancers) play a crucial role. These drugs can travel throughout the whole body and destroy any of these cells that may have traveled away from the breast. This way, the chances of them surviving and forming a new cancer elsewhere are greatly limited.

It is this discovery that has made breast cancer survival so excellent. This is also why treating cancer with chemotherapy before surgery is so important with certain types of breast cancers – for those with the more aggressive personalities we don’t want those tourists to stand a chance anywhere else in the body and we want to try and make the headquarters in the breast as small and weak as possible.

Try to think of your treatment as two separate attacks:

1. Take out the mothership (surgery and radiation)
2. Kill the tourists and weaken the mothership (chemotherapy and hormone blockers)