BREAST CANCER: Breast Cancer Treatment

Medically reviewed by Alana Biggers, M.D., MPH — By Ann Pietrangelo

Abstract

A variety of treatments for breast cancer exist, and treatment is available at every stage of cancer. Most people need a combination of two or more treatments.

After diagnosis, your doctor will determine the stage of your cancer. They will then decide on the best treatment options based on your stage and other factors, such as age, family history, genetic mutation status, and personal medical history.

Treatments for early stage breast cancer may not be effective for advanced stage breast cancer.

Surgery for breast cancer

Most people with breast cancer will undergo surgery to remove cancer cells or tumors from the breast and other affected areas.

Lumpectomy and mastectomy are two surgical options. Deciding which option to use is based on:

• the size and location of the primary tumor

• personal preference

• other factors such as genetic predisposition

• Biopsy of the lymph nodes will probably be performed at the same time.

• Mastectomy

A mastectomy is the surgical removal of the entire breast. It’s recommended when cancer is found throughout the breast. Some people will get a double or bilateral mastectomy, where both breasts are removed. Surgery to reconstruct the breast can begin at the time of the mastectomy or at a later date.

Lumpectomy

In a lumpectomy, also called a breast-conserving surgery, the surgeon removes the cancerous cells and spares the rest of the breast. It’s an option when cancer is confined to one area of the breast.

A lumpectomy may be performed as an outpatient procedure. This means you can go home shortly after the surgery and won’t need to stay in a hospital overnight.

Reconstructive

In breast reconstruction surgery, a plastic surgeon uses an artificial implant or a flap of tissue from elsewhere on your body to create a breast shape.

Breast reconstructive surgery typically takes place during or soon after a mastectomy or lumpectomy, but can also be done months or years later.

There are two types of reconstruction surgeries: prosthetic reconstruction and tissue flap reconstruction.

In prosthetic reconstruction, a plastic surgeon creates the shape of a breast using an artificial implant filled with either saline or silicone.

In tissue flap surgery, a plastic surgeon uses tissue from various parts of your body, like your stomach, back, thighs, or buttocks, to rebuild the shape of your breasts.


Radiation therapy

Radiation is a type of targeted therapy where high-energy X-rays are used to kill cancer cells and prevent them from spreading. It’s usually recommended in the early stages of breast cancer, after lumpectomy for stage 0 breast cancers, and can be used alongside other treatments.

This treatment can lower the risk of cancer recurrence. Radiation therapy is typically administered 5 days per week over the course of 5 to 7 weeks.

Chemotherapy

Chemotherapy is a cancer treatment that uses powerful drugs to kill cancer cells throughout your body. It’s typically given intravenously or orally through pills but is occasionally administered directly into the spinal fluid surrounding the spinal cord.

Not everyone who gets breast cancer will need chemotherapy. It’s typically recommended before surgery to shrink a tumor so it can be removed more easily, or after surgery to kill any remaining cancer cells.

Chemotherapy is also used as a central treatment in people with advanced, metastatic breast cancer that has spread throughout the body.

There are a variety of chemotherapy drugs used to treat breast cancer, including:

• docetaxel (Taxotere)

• doxorubicin (Adriamycin)

• cyclophosphamide (Cytoxan)

You may receive a combination of several chemotherapy drugs.

Chemotherapy drugs are typically administered at a doctor’s office, hospital, or infusion center using an IV or injection. It’s standard for chemotherapy treatments to be given in cycles of 2 to 3 weeks followed by a rest period to give your body time to recover.

The length of chemotherapy treatment depends on how well the treatment is working and how well your body tolerates it.

Hormone therapy for breast cancer

About 2 of every 3Trusted Source breast cancer cases are hormone-receptor positive. This means the breast cancer cells grow by attaching to hormones like estrogen and progesterone. Hormone therapy, also called endocrine therapy, stops these hormones from attaching to cancer cells, thus stopping their spread.

There are different types of hormone therapy but most work by altering levels of estrogen and preventing estrogen from connecting to cancer cells.

Hormone therapy is most often used after surgery to reduce the risk of cancer returning but is sometimes used before surgery. It’s a long-term treatment taken for at least 5 to 10 years.

Targeted therapy refers to a variety of drugs that enter the bloodstream and treat cancer throughout the body. Targeted therapy drugs aim to attack cancer cells without harming healthy cells, and tend to have fewer side effects than chemotherapy drugs.

Targeted therapies are often used to treat HER2-positive breast cancers. These are cancers that have an excess of a protein called HER2 that promotes the growth of cancer cells.

Common targeted therapy drugs for HER2-positive breast cancers include:

• Monoclonal antibodies like trastuzumab (Herceptin) are synthetic antibodies designed to attach to HER2 proteins and stop cells from growing.

• Antibody-drug conjugates like ado-trastuzumab emtansine (Kadcyla or TDM-1) attach to HER2 proteins on cancer cells and help chemotherapy reach them.

• Kinase inhibitors like Lapatinib (Tykerb) block HER2 proteins.

Targeted therapies are also used to treat hormone receptor-positive breast cancer along with hormone therapy

Common targeted therapy drugs for people with hormone receptor-positive cancers include:

• CDK4/6 inhibitors, which block CDK proteins in cancer cells to stop them from dividing and slow cancer growth.

• mTOR inhibitors, which block mTOR proteins in cancer cells to stop them from dividing and growing. This treatment is believed to help hormone therapy drugs work more efficiently.

• PI3K inhibitors, which block the PI3K proteins in cancer cells and helps prevent them from growing.

• Triple-negative breast cancer (TNBC) is a type of breast cancer that is neither HER2-positive nor hormone-receptor positive. Because of this, it doesn’t respond well to hormone therapy and other drugs must be used.

Common targeted therapy drugs for people with TNBC include:

Antibody-drug conjugates, which attach to proteins in the breast cancer cells and help chemotherapy reach them.

Breast cancer treatment by stage

Stage 0 (DCIS)

If precancerous or cancer cells are confined to the milk ducts, it’s called noninvasive breast cancer or ductal carcinoma in situ (DCIS).

Stage 0 breast cancer can become invasive and spread beyond the ducts. Early treatment can stop you from developing invasive breast cancer. Early treatment can include surgeries like lumpectomy and mastectomy followed by radiation.

Stage 1

Stage 1A breast cancer means the primary tumor is 2 centimeters or less and the axillary lymph nodes aren’t affected. In stage 1B, cancer is found in lymph nodes and there’s no tumor in the breast or the tumor is smaller than 2 centimeters.

Both 1A and 1B are considered early stage invasive breast cancers. Surgery and one or more other therapies, like radiation or hormone therapy, may be recommended.

Stage 2

In stage 2A, the tumor is smaller than 2 centimeters and has spread to between one and three nearby lymph nodes. Or, it’s between 2 and 5 centimeters and hasn’t spread to lymph nodes.

Stage 2B means the tumor is between 2 and 5 centimeters and has spread to between one and three nearby lymph nodes. Or it’s larger than 5 centimeters and hasn’t spread to any lymph nodes.

You’ll probably need a combination of surgery, chemotherapy, and one or more of the following: targeted therapy, radiation, and hormone treatment.

Stage 3

Treatment for stage 3 typically involves a combination of treatments including:

Systemic therapies. Systemic therapies include chemotherapy, targeted therapy for HER2-positive cancers, and hormone therapy for hormone receptor-positive cancers.

Surgery. If cancer improves with chemo, the next step is surgery. Because IBC is so aggressive and affects a large area of the breasts and skin, breast-conserving surgeries like lumpectomies and partial mastectomies are not an option. Instead, surgery typically involves the removal of the entire breast through a modified radical mastectomy. If cancer doesn’t respond to chemotherapy, surgery cannot be done and other chemotherapy drugs or radiation therapy will be used.

Radiation therapy. Radiation treatment given after surgery, called adjuvant radiation, can lower the chances that cancer will come back.

Stage 4

People with stage 4 are primarily treated with systemic therapy, although surgery and radiation may be options in certain situations. Systemic therapy may include:

• chemotherapy

• hormonal therapy (for hormone receptor-positive cancers)

• targeted therapy (for HER2-positive cancers)

Inflammatory breast cancer treatment

Inflammatory breast cancer (IBC) is an uncommon and aggressive type of breast cancer caused by cancer cells blocking lymph vessels in the skin.

All IBC cases are classified as at least stage 3 breast cancer. If the cancer is metastatic (has spread to other parts of the body), it’s considered stage 4.

Treatments for IBC depend on what stage the cancer is in.


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