Breast Cancer Treatment & Care
- What are the treatment options?
- What are the new types of treatments being tested in clinical trials?
- Should I consider a clinical trial?
- Will I need any follow up tests during or after treatment?
- What are the treatments for my stage?
What are the treatment options?
Five types of standard treatment are used:
Surgery
Most patients with breast cancer have surgery to remove the cancer from the breast. Some of the lymph nodes under the arm are usually taken out and looked at under a microscope to see if they contain cancer cells.
Breast-conserving surgery, an operation to remove the cancer but not the breast itself, includes the following:
- Lumpectomy: Surgery to remove a tumor (lump) and a small amount of normal tissue around it.
- Partial mastectomy: Surgery to remove the part of the breast that has cancer and some normal tissue around it. This procedure is also called a segmental mastectomy.
Patients who are treated with breast-conserving surgery may also have some of the lymph nodes under the arm removed for biopsy. This procedure is called lymph node dissection. It may be done at the same time as the breast-conserving surgery or after. Lymph node dissection is done through a separate incision.
Other types of surgery include the following:
- Total mastectomy: Surgery to remove the whole breast that has cancer. This procedure is also called a simple mastectomy. Some of the lymph nodes under the arm may be removed for biopsy at the same time as the breast surgery or after. This is done through a separate incision.
- Modified radical mastectomy: Surgery to remove the whole breast that has cancer, many of the lymph nodes under the arm, the lining over the chest muscles, and sometimes, part of the chest wall muscles.
- Radical mastectomy: Surgery to remove the breast that has cancer, chest wall muscles under the breast, and all of the lymph nodes under the arm. This procedure is sometimes called a Halsted radical mastectomy.
Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given radiation therapy, chemotherapy, or hormone therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to increase the chances of a cure, is called adjuvant therapy.
Radiation therapy
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.
Chemotherapy
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.
Hormone therapy
Hormone therapy is a cancer treatment that removes hormones or blocks their action and stops cancer cells from growing. Hormones are substances produced by glands in the body and circulated in the bloodstream. Some hormones can cause certain cancers to grow. If tests show that the cancer cells have places where hormones can attach (receptors), drugs, surgery, or radiation therapy are used to reduce the production of hormones or block them from working. The hormone estrogen, which makes some breast cancers grow, is made mainly by the ovaries. Treatment to stop the ovaries from making estrogen is called ovarian ablation.
Hormone therapy with tamoxifen is often given to patients with early stages of breast cancer and those with metastatic breast cancer (cancer that has spread to other parts of the body). Hormone therapy with tamoxifen or estrogens can act on cells all over the body and may increase the chance of developing endometrial cancer. Women taking tamoxifen should have a pelvic exam every year to look for any signs of cancer. Any vaginal bleeding, other than menstrual bleeding, should be reported to a doctor as soon as possible.
Hormone therapy with an aromatase inhibitor is given to some postmenopausal women who have hormone-dependent breast cancer. Hormone-dependent breast cancer needs the hormone estrogen to grow. Aromatase inhibitors decrease the body's estrogen by blocking an enzyme called aromatase from turning androgen into estrogen.
For the treatment of early stage breast cancer, certain aromatase inhibitors may be used as adjuvant therapy instead of tamoxifen or after 2 or more years of tamoxifen. For the treatment of metastatic breast cancer, aromatase inhibitors are being tested in clinical trials to compare them to hormone therapy with tamoxifen.
Targeted Therapy
Targeted therapy is a type of treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells. Monoclonal antibodies and tyrosine kinase inhibitors are two types of targeted therapies being studied in the treatment of breast cancer.
Monoclonal antibody therapy is a cancer treatment that uses antibodies made in the laboratory, from a single type of immune system cell. These antibodies can identify substances on cancer cells or normal substances that may help cancer cells grow. The antibodies attach to the substances and kill the cancer cells, block their growth, or keep them from spreading. Monoclonal antibodies are given by infusion. They may be used alone or to carry drugs, toxins, or radioactive material directly to cancer cells. Monoclonal antibodies may be used in combination with chemotherapy as adjuvant therapy.
Trastuzumab (Herceptin) is a monoclonal antibody that blocks the effects of the growth factor protein HER2, which sends growth signals to breast cancer cells. About one-fourth of patients with breast cancer have tumors that may be treated with trastuzumab combined with chemotherapy.
Tyrosine kinase inhibitors are targeted therapy drugs that block signals needed for tumors to grow. Tyrosine kinase inhibitors may be used in combination with other anticancer drugs as adjuvant therapy.
Lapatinib is a tyrosine kinase inhibitor that blocks the effects of the HER2 protein and other proteins inside tumor cells. It may be used to treat patients with HER2-positive breast cancer that has progressed following treatment with trastuzumab.
What are the new types of treatments being tested in clinical trials?
This summary describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied.
Sentinel lymph node biopsy followed by surgery
Sentinel lymph node biopsy is the removal of the sentinel lymph node during surgery. The sentinel lymph node is the first lymph node to receive lymphatic drainage from a tumor. It is the first lymph node the cancer is likely to spread to from the tumor. A radioactive substance and/or blue dye is injected near the tumor. The substance or dye flows through the lymph ducts to the lymph nodes. The first lymph node to receive the substance or dye is removed. A pathologist views the tissue under a microscope to look for cancer cells. If cancer cells are not found, it may not be necessary to remove more lymph nodes. After the sentinel lymph node biopsy, the surgeon removes the tumor (breast-conserving surgery or mastectomy).
High-dose chemotherapy with stem cell transplant
High-dose chemotherapy with stem cell transplant is a way of giving high doses of chemotherapy and replacing blood -forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the blood or bone marrow of the patient or a donor and are frozen and stored. After the chemotherapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into (and restore) the body's blood cells.
Studies have shown that high-dose chemotherapy followed by stem cell transplant does not work better than standard chemotherapy in the treatment of breast cancer. Doctors have decided that, for now, high-dose chemotherapy should be tested only in clinical trials. Before taking part in such a trial, women should talk with their doctors about the serious side effects, including death, that may be caused by high-dose chemotherapy.
Monoclonal antibodies as adjuvant therapy
Monoclonal antibody therapy is a cancer treatment that uses antibodies made in the laboratory, from a single type of immune system cell. These antibodies can identify substances on cancer cells or normal substances that may help cancer cells grow. The antibodies attach to the substances and kill the cancer cells, block their growth, or keep them from spreading. Monoclonal antibodies are given by infusion. They may be used alone or to carry drugs, toxins, or radioactive material directly to cancer cells. Monoclonal antibodies are also used in combination with chemotherapy as adjuvant therapy.
Trastuzumab (Herceptin) is a monoclonal antibody that blocks the effects of the growth factor protein HER2, which transmits growth signals to breast cancer cells. About one-fourth of patients with breast cancer have tumors that may be treated with trastuzumab combined with chemotherapy.
Tyrosine kinase inhibitors as adjuvant therapy
Tyrosine kinase inhibitors are targeted therapy drugs that block signals needed for tumors to grow. Tyrosine kinase inhibitors may be used in combination with other anticancer drugs as adjuvant therapy.
Lapatinib is a tyrosine kinase inhibitor that blocks the effects of the HER2 protein and other proteins inside tumor cells. It may be used to treat patients with HER2-positive breast cancer that has progressed following treatment with trastuzumab.
Should I consider a clinical trial?
For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.
Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.
Patients can enter clinical trials before, during, or after starting their cancer treatment.
Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.
Clinical trials are taking place in many parts of the country.
Will I need any follow up tests during or after treatment?
Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. This is sometimes called re-staging.
Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.
What are the treatments for my stage?
The following stages are used for breast cancer.
Stage 0, Carcinoma in Situ
Stage 0, carcinoma in situ is either ductal carcinoma in situ (DSIC) or lobular carcinoma in situ (LCIS)
Treatment of ductal carcinoma in situ (DCIS) may include the following:
- Breast-conserving surgery and radiation therapy with or without tamoxifen.
- Total mastectomy with or without tamoxifen.
- Breast-conserving surgery without radiation therapy.
- Clinical trials testing breast-conserving surgery and tamoxifen with or without radiation therapy.
Treatment of lobular carcinoma in situ (LCIS) may include the following:
- Biopsy to diagnose the LCIS followed by regular examinations and regular mammograms to find any changes as early as possible. This is referred to as observation.
- Tamoxifen to reduce the risk of developing breast cancer.
- Bilateral prophylactic mastectomy. This treatment choice is sometimes used in women who have a high risk of getting breast cancer. Most surgeons believe that this is a more aggressive treatment than is needed.
- Clinical trials testing cancer prevention drugs.
Stage I
Treatment of stage I may include the following:
- Breast-conserving surgery to remove only the cancer and some surrounding breast tissue, followed by lymph node dissection and radiation therapy.
- Modified radical mastectomy with or without breast reconstruction surgery.
- A clinical trial evaluating sentinel lymph node biopsy followed by surgery.
Adjuvant therapy (treatment given after surgery to increase the chances of a cure) may include the following:
- Radiation therapy to the lymph nodes near the breast and to the chest wall after a modified radical mastectomy.
- Systemic chemotherapy with or without hormone therapy.
- Hormone therapy.
- A clinical trial of trastuzumab (Herceptin) combined with systemic chemotherapy.
Stage II
Treatment of stage II may include the following:
- Breast-conserving surgery to remove only the cancer and some surrounding breast tissue, followed by lymph node dissection and radiation therapy.
- Modified radical mastectomy with or without breast reconstruction surgery.
- A clinical trial evaluating sentinel lymph node biopsy followed by surgery.
Adjuvant therapy (treatment given after surgery to increase the chances of a cure) may include the following:
- Radiation therapy to the lymph nodes near the breast and to the chest wall after a modified radical mastectomy.
- Systemic chemotherapy with or without hormone therapy.
- Hormone therapy.
- A clinical trial of trastuzumab (Herceptin) combined with systemic chemotherapy.
Stage IIIA
Treatment of stage IIIA may include the following:
- Breast-conserving surgery to remove only the cancer and some surrounding breast tissue, followed by lymph node dissection and radiation therapy.
- Modified radical mastectomy with or without breast reconstruction surgery.
- A clinical trial evaluating sentinel lymph node biopsy followed by surgery.
Adjuvant therapy (treatment given after surgery to increase the chances of a cure) may include the following:
- Radiation therapy to the lymph nodes near the breast and to the chest wall after a modified radical mastectomy.
- Systemic chemotherapy with or without hormone therapy.
- Hormone therapy.
- A clinical trial of trastuzumab (Herceptin) combined with systemic chemotherapy.
Stage IIIB
Treatment of stage IIIB breast cancer may include the following:
- Systemic chemotherapy.
- Systemic chemotherapy followed by surgery (breast-conserving surgery or total mastectomy), with lymph node dissection followed by radiation therapy. Additional systemic therapy (chemotherapy, hormone therapy, or both) may be given.
- Clinical trials testing new anticancer drugs, new drug combinations, and new ways of giving treatment.
Stage IIIC
Treatment of operable stage IIIC may include the following:
- Breast-conserving surgery to remove only the cancer and some surrounding breast tissue, followed by lymph node dissection and radiation therapy.
- Modified radical mastectomy with or without breast reconstruction surgery.
- A clinical trial evaluating sentinel lymph node biopsy followed by surgery.
Treatment of inoperable stage IIIC breast cancer may include the following:
- Systemic chemotherapy.
- Systemic chemotherapy followed by surgery (breast-conserving surgery or total mastectomy), with lymph node dissection followed by radiation therapy. Additional systemic therapy (chemotherapy, hormone therapy, or both) may be given.
- Clinical trials testing new anticancer drugs, new drug combinations, and new ways of giving treatment.
Adjuvant therapy (treatment given after surgery to increase the chances of a cure) may include the following:
- Radiation therapy to the lymph nodes near the breast and to the chest wall after a modified radical mastectomy.
- Systemic chemotherapy with or without hormone therapy.
- Hormone therapy.
- A clinical trial of trastuzumab (Herceptin) combined with systemic chemotherapy
Stage IV
Treatment of stage IV or metastatic breast cancer may include the following:
- Hormone therapy and/or systemic chemotherapy with or without trastuzumab (Herceptin).
- Tyrosine kinase inhibitor therapy with lapatinib combined with capecitabine.
- Radiation therapy and/or surgery for relief of pain and other symptoms.
- Clinical trials testing new systemic chemotherapy and/or hormone therapy.
- Clinical trials of new combinations of trastuzumab (Herceptin) with anticancer drugs.
- Clinical trials of new combinations of lapatinib with anticancer drugs.
- Clinical trials testing other approaches, including high-dose chemotherapy with stem cell transplant.
- Bisphosphonate drugs to reduce bone disease and pain when cancer has spread to the bone.
This information is not intended to replace the advice of a doctor. Navigating Cancer disclaims any liability for the decisions you make based on this information. This information was sourced and adapted from the National Cancer Institute's web site, www.cancer.gov.
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