A woman or man who is diagnosed with breast cancer with metastases in the lymph nodes can count on different treatment methods in different hospitals. In this article I explain how my treatment went and what the differences are from one hospital to another. The treatment in one or another hospital for breast cancer makes quite a difference. The treatment of Her2 neu negative hormone-sensitive breast cancer with metastases in the lymph nodes meant that I first received chemo at the Antoni van Leeuwenhoek and then other treatments.
A lump under my arm
My cancer manifested itself in a lump under my arm. Not a big bump, just a bump. I quickly took it to the doctor, who actually didn’t make much of it. But he did forward me. The surgeon at the local hospital immediately looked much more difficult and let me know that it could be cancer. When he ordered a mammography together with a puncture, I must admit that I had never thought about breast cancer. I felt nothing different in my chest than before. I suffered from mastopathy, but I had had that for years. I had a mammogram at least once a year and it showed time and time again that nothing was wrong. When I went for the puncture of the bump under my arm, a mammography was first done. When the radiologist came back, his face was concerned and he said he had also seen something in my chest. He wanted to make a biopsy of that. Only then was I shocked and I actually knew then that something was wrong.
Making the biopsy for breast cancer
I had to undergo the biopsy twice. First in the regional hospital where they wanted to find out whether the cells were malignant or not. Later in the Antoni van Leeuwenhoek where they removed the pieces of tissue to find out whether they were Her2/Neu positive or negative tumors. The last biopsy would not have been necessary if they had done their work properly in the first hospital. That is why my advice is: Choose the best hospital for breast cancer.Moreover, it would have saved me a lot of pain and a bruised chest for a very long time.The biopsy itself is made with a kind of needle. A long needle that is hollow. The breast is anesthetized and this happens very quickly. You actually don’t feel anything during the procedure itself. With the AVL they first made a small incision and the needle then passed through it. The needle is then pricked three times to ensure there is enough tissue to examine. The biopsies are used for four things:
- To determine whether it is cancer
- Where the cancer is located: in the milk duct (ductal carcinoma) or in the mammary gland (lobular carcinoma)
- To determine whether the tumors are Her2/Neu positive or negative
- To determine whether the tumors are hormone sensitive
Her2/Neu positive or negative
Her2/Neu is a protein that attaches to the tumor. Ten to twenty percent of breast cancers have an excess of this protein and tumors with this shape are therefore called Her2/Neu positive. This cancer is much more aggressive than Her2/Neu negative, but because Herceptin is now given for this variant, the chances for women and men with this variant have become much greater.
Types of treatments for breast cancer
In a regional hospital, I was advised to first undergo breast-conserving surgery for my breast cancer with metastases in the lymph nodes in the armpit. At that time it was not yet known whether I was Her2/Neu positive or negative and it had not been investigated whether the tumors were hormone sensitive. It later turned out that an affected lymph node that was attached to my sternum had not been discovered in the local hospital. Remarkably, the tumor in my breast was much smaller than the one in my armpit and research had also shown that it was in a preliminary stage. Apparently that is possible. A second opinion at the Antoni van Leeuwenhoek revealed a completely different treatment plan. There they first wanted to do the chemo, then the operation (still breast conserving) and then the radiation. Because the tumors also turned out to be 100 percent hormone sensitive, I immediately knew that I would have to take hormone tablets for years.
Chemotherapy for breast cancer before surgery
Once it was known which types of cancer I had, chemotherapy was started within 3 weeks. To determine where the tumors are located, a radioactive particle was first inserted into the chest and armpit. This indicates where the tumors are located and may they shrink significantly during treatment. This way you can still see where the tumors were originally located and where the surgeon should cut. An MRI was made to determine the starting position for chemo. At the Antoni van Leeuwenhoek they want to see whether the chemo works. If after 3 treatments and a new MRI it appears that this is not the case, another treatment is started.
Type of chemo for Her2/Neu negative tumors
In patients with Her2/Neu negative tumors, a schedule is used in which a cocktail is first given once every two weeks. This consists of:
- Adriamycin or Doxorubicin (injected through the IV needle but comes from two large syringes). This takes about 5 minutes
- Cyclophosphamide or Endoxan. This is administered through an IV bag. This takes about 20 minutes.
- After chemotherapy, a subcutaneous injection of Neulasta is given between 24 and 48 hours after treatment. This drug works to speed up bone marrow recovery and to prevent or reduce infections.
After 3 courses in 6 weeks, another MRI is made to see whether the chemo is working. If this is the case, the treatment will be continued in this way and there will be 3 more treatments every 2 weeks. In total, this means 12 weeks of chemotherapy once every two weeks. This is also called a ddAC treatment, because the treatment is given more often than normal (in most cases once every 3 weeks, now once every 2 weeks). This also has to do with the fact that it is done before the operation and the treatment must therefore ensure that many of the cells are broken down and the tumors are reduced as quickly as possible.
ddAC treatment does not work
If the ddAC treatment does not appear to have worked after 3 times, you will switch to another treatment. In that case, an infusion is administered once every 3 weeks with a cocktail of:
- Docetaxel. This takes about an hour.
- In addition, the patient must take Capecitabine or Xeloda tablets twice a day for 14 days.
- He or she does not have to take any medication on days 15 to 21.
Chemo in patients with Her2/neu positive tumors
Patients with Her2/neu positive tumors receive a completely different treatment plan if they receive chemo before surgery. This treatment also takes much longer and takes place weekly. Here too, the MRI is necessary to indicate the initial situation. In that case, the schedule for this PTC administration is as follows:First a cocktail for 6 weeks that is given weekly and consists of:
- Paclitaxel or Taxol via IV (takes about an hour)
- Trastuzumab or Herceptin (first administration via infusion takes about an hour and a half, later administrations can be given in a shorter time)
- Carboplatin through the IV in about half an hour
- During the first administration, there is a waiting period of 1 hour between giving the Trastuzumab and the Paclitaxel.
There is no administration in weeks 7 and 8. An MRI should then provide a definitive answer as to whether the treatment is working. If this is the case, the same cycle data of 6 times the above treatment will be repeated twice more. Weeks 13 and 14 are medication-free again. The treatment itself therefore lasts a total of 24 weeks (which includes 4 weeks of no treatment).
The PCT treatment does not work
If after the first MRI it appears that there is no good response to the treatment, then another cocktail called FE75C is used. It looks like this:
- 5-FU through an IV in 15 minutes
- Epirubicin through the IV in a few minutes
- Cyclosphosphamide or Endoxan via infusion in 15 minutes
- Trastuzumab or Herceptin via an infusion in about half an hour
- This treatment is given 4 times and then once every 3 weeks.
After neoadjuvant chemotherapy
Whether a patient is Her2/Neu positive or negative, once these chemotherapy treatments have been completed, surgery will follow, with the following options available:
- Mastectomy
- Breast conserving surgery
- Removal of lymph nodes in the armpit
Radiotherapy
Breast-conserving surgery always involves radiotherapy, commonly referred to as radiation. The same applies to affected lymph nodes. I also had a lymph node near my sternum affected. Because this cannot be operated on, that part is also irradiated.
Hormone therapy
Because some breast tumors are hormone sensitive (this can vary from slightly sensitive to 100 percent sensitive), women who are hormone sensitive also had to take hormone tablets for up to 5 years after their treatment. These rules have now been adjusted and most women now have to take the antihormones for ten years. In addition, it alternates. For example, tamoxifen for a number of years and then anastrazole.
What can you do yourself against breast cancer?
It’s just bad luck that you have breast cancer, but it’s better to prevent or stop being overweight, continuing to take the pill and drinking alcohol.
Personal blog about breast cancer
In my personal blog about breast cancer I describe all stages of research and treatment of my own breast cancer and provide tips and advice. The blog can be found at: I have breast cancer