The mainstay of breast cancer treatment is surgery when the tumor is localized, followed by chemotherapy (when indicated), radiotherapy and adjuvant hormonal therapy for ER positive tumours (with tamoxifen or an aromatase inhibitor). Management of breast cancer is undertaken by a multidisciplinary team based on national and international guidelines. Depending on clinical criteria (age, type of cancer, size, metastasis) patients are roughly divided to high risk and low risk cases, with each risk category following different rules for therapy. Treatment possibilities include radiation therapy, chemotherapy, hormone therapy, and immune therapy.
A patient must first go through the staging process to see if s/he can benefit local treatment. It makes use of Clinical, imaging and pathological assessment to make a best guess by the physician. If the cancer has spread beyond the Breast and the lymph nodes then it is classified as Stage 4 or metastaic cancer and requires mostly systemic treatment.
Live tissue samples for testing
Recently live tissue samples from surgery are tested with various chemotherapy agents to derive probabilities of which ones may work better and specially the ones which would not work (Cell-death assays). The companies need the sample within 24 hours of surgical excision. This is specially useful for early stage cancers were a response for the therapy cannot be determined once the wole cancer is taken out during the surgery and the chemotherepy is given in an adjuciant setting. However, the benefits of such tests have not yet been established in clinical trials and is not mainstream.
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