Your Breast Health Starts with You: What if I Need Chemotherapy or Other Medical Interventions?

Your Breast Health Starts with You: What if I Need Chemotherapy or Other Medical Interventions?

With earlier stages of breast cancer, surgery is usually the first stage of treatment. The cancer care team at Karmanos Cancer Institute at McLaren Flint analyzes the pathology report to understand the stage of diagnosis, the status of the lymph nodes and the types of receptors that may be contributing to cancer growth.

HER2 is one of those receptors. It affects around one in five women with breast cancer. HER2 is a protein that grows on the cancer cell and is known to grow aggressively. Along with checking for HER2, oncologists also check for estrogen and progesterone. Both receptors are linked to cancer growth but cause slower growth than HER2.

"If the patient is positive for hormone receptors, we usually prescribe five years of hormone blocking therapy," explained Sandeep Grewal, MD, medical oncologist at Karmanos. "If the patient is positive for the HER2 receptor, they take a targeted therapy drug or antibody called Herceptin."

There are possibilities that women could have triple negative breast cancer, meaning the presence for all three - estrogen, progesterone and HER2 - is negative. There are two approved treatments for triple negative breast cancer: chemotherapy and immunotherapy.

If a patient has a positive receptor for PD-L1 on immune cells, chemotherapy with immunotherapy treatments can help block this protein. Blocking PD-L1 helps the immune cells fight against cancer cells. Chemotherapy targets dividing cells but does not differentiate between cancer cells and healthy cells. Cancer cells are very active, so the treatment attacks those cells.

"The fact that chemotherapy attacks dividing cells, healthy or cancerous, is why there is hair loss with this treatment. Your hair cells are dividing, you may see changes in your nails, blood cells continue to divide so blood counts can drop," explained Dr. Grewal. "It's more like throwing bullets or arrows in the dark, hoping to hit the target. With immunotherapy, the medication is over activating your body's own defense mechanisms to get overactive and attack what does not belong, like cancer."

The size of the tumor is a large factor in if chemotherapy or medicinal treatments are needed. If the tumor is half a centimeter in size, or larger, and the surgeon identifies negative lymph nodes or very few positive lymph nodes, genomic profiling is normally conducted.

"The size of the tumor tells us to do a test called an oncotype score test," explained Dr. Grewal. "It's how we check the 21 gene panel. If the score is above 25, the patient gets chemotherapy."

Stage four breast cancer means the cancer has spread to other areas of the body. Often, cancer care teams decide surgery and radiation is not the best option to begin treatment for a stage four cancer patient. Though the cancer may not be curable at this stage, Dr. Grewal says the cancer is treatable.

"At stage four, it is more systemic treatment with chemotherapy, hormone blocking pills, antibodies or immunotherapy. Nowadays, the preference is to avoid chemotherapy when it comes to stage four and to prescribe more targeted therapies."

Targeted therapies target the mutation. After conducting a biopsy on the sites that contain cancer, medical oncologists can see what, if any, mutations exist. Once they identify those mutations, they can prescribe a medication that targets that mutation and blocks the growth.

"We also check for mutations in the BRCA and BRCA2 genes (breast cancer genes). There is a targeted therapy, called PARP (poly-ADP ribose polymerase) inhibitors, that we prescribe for this mutation. PARP inhibits the cell cycle of the tumor cells," added Dr. Grewal.

As part of the Karmanos mission, we are always seeking opportunities to provide our patients access to the most cutting-edge cancer treatments. Karmanos is a nationally recognized leader in both radiation and medical oncology clinical trials. Not only has this led to innovation of multiple new therapies, but it has also created a network that brings this research to all its cancer centers throughout Michigan. This has made the Karmanos Cancer Network the largest cancer research network in Michigan.

For more information about clinical trials and research at Karmanos, visit



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