Korean Breast Cancer Protocol: Surgery to Targeted Therapy Guide
Key Treatment Methods and Sequence
1. Basic Treatment Sequence (For Early-Stage Breast Cancer)
The most common sequence is as follows:
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Surgery: The cancerous area is excised (removed).
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Adjuvant Chemotherapy: Administered after surgery to eliminate residual microscopic metastatic cancer cells (may be omitted depending on the patient).
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Radiation Therapy: Performed to prevent local recurrence (essential when Breast-Conserving Surgery is performed).
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Endocrine Therapy & Targeted Therapy: Administered long-term if the cancer is hormone receptor-positive or expresses specific target factors.
2. Neoadjuvant Therapy
Recently, there is a growing trend to administer chemotherapy before surgery (Neoadjuvant Therapy) in cases where the tumor is large, the cancer is advanced, or for specific cancer types (Triple-Negative Cancer, HER2-Positive Cancer, etc.).
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Purpose: To shrink the tumor size, increasing the opportunity for Breast-Conserving Surgery, to treat systemic microscopic metastases from the outset, and to assess the cancer's response to the chemotherapy drugs beforehand.
Types of Breast Cancer Surgery
Breast cancer surgery is broadly divided into two main types, determined by the size and extent of the tumor, and the patient's breast size.
| | :--- | :--- | :--- | :--- | | Breast-Conserving Surgery (BCS) | Only the tumor mass and some surrounding normal tissue are removed to maintain the shape of the breast as much as possible. | Radiation therapy is mandatory after surgery to prevent local recurrence. | | Mastectomy | All breast tissue, including some skin and the nipple, is removed. | After mastectomy, patients can opt for Breast Reconstruction simultaneously (immediate reconstruction) or at a later time (delayed reconstruction). |
In addition, surgery on the axillary lymph nodes is also performed:
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Sentinel Lymph Node Biopsy (SLNB): If metastasis is not suspected, only the sentinel lymph nodes (the first nodes the cancer would spread to) are removed for examination.
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Axillary Lymph Node Dissection (ALND): Performed when lymph node metastasis is confirmed, involving the extensive removal of lymph nodes in the armpit.
Non-Surgical Treatments (Systemic and Local)
1. Chemotherapy
Traditional chemotherapy drugs are used to attack rapidly dividing cancer cells. It is administered before or after surgery, depending on the patient's stage and tumor characteristics, usually in 4 to 8 cycles at 3-week intervals.
2. Radiation Therapy
High-energy radiation is delivered to eliminate any remaining cancer cells or microscopic lesions.
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Main Candidates: Patients who underwent Breast-Conserving Surgery (mandatory), and patients who had a mastectomy but had a large tumor size or extensive lymph node metastasis.
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Duration: Typically begins after the surgical wound has healed, usually administered 5 times a week for about 4 to 6 weeks.
3. Endocrine Therapy (Anti-hormone Therapy)
If the cancer cells are Hormone Receptor-Positive (Estrogen, Progesterone), this therapy inhibits hormone action to block cancer cell growth. It begins after surgery and chemotherapy and is taken long-term for 5 to 10 years.
4. Targeted Therapy
This is a drug treatment that targets specific molecules on the cancer cells (e.g., HER2 protein). It is used for patients whose tumors express the corresponding target factor.
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