There are a variety of treatments for breast cancer, and most people need a combination of two or more types of treatment.
Therapy given before the primary treatment is called neoadjuvant therapy. An example of this is when chemotherapy is used to shrink a tumor before surgery. Therapy given after the primary treatment is called adjuvant therapy. The purpose of adjuvant therapy is to prevent recurrence.
You can also look into complementary therapies at any stage of breast cancer. These are therapies used with standard medical treatments. Many women benefit from therapies like massage, acupuncture, and yoga.
Although there are standard treatments for different types and stages of breast cancer, your treatment will be tailored to your individual needs. In addition to stage at diagnosis, your doctors will consider the type of breast cancer you have and other health factors. Your plan will be adjusted according to how well you respond to it.
If precancerous cells are found within the milk ducts, it’s called non-invasive breast cancer or ductal carcinoma in situ (DCIS). Stage 0 breast cancer can spread beyond the ducts. Treatment is designed to stop you from developing invasive breast cancer. Lumpectomy plus radiation therapy are sufficient in many cases.
In a lumpectomy, the surgeon removes the cancerous cells and spares the rest of the breast. It’s a viable option when DCIS has not spread, and it may even be performed as an outpatient procedure.
A “simple mastectomy” is the surgical removal of the breast. It’s used when DCIS is found throughout the ducts. Surgery to reconstruct the breast can begin at the time of the mastectomy or at a later date.
Radiation is a type of targeted therapy. It’s usually recommended following lumpectomy for stage 0 breast cancers. High-energy X-rays are used to destroy cancer cells, prevent them from spreading, and lower risk of recurrence. Radiation therapy is typically administered five days per week over the course of five to seven weeks.
Your doctor will probably recommend a hormone treatment if you’ve had a lumpectomy for estrogen receptor-positive (ER+) or progesterone receptor-positive (PR+) breast cancer. Oral hormone treatments, like tamoxifen, are generally prescribed to lower your risk of developing invasive breast cancer. Hormone treatment isn’t always prescribed for women who have had a mastectomy for stage 0 breast cancer.
You might receive trastuzumab (Herceptin) therapy if your breast cancer tests positive for the human growth factor HER-2.
Stage 1A breast cancer means the primary tumor is 2 centimeters or less and the lymph nodes are not affected. In stage 1B, there is no tumor in the breast, or it’s smaller than 2 centimeters and cancer is found in axillary lymph nodes. Both are considered early-stage invasive breast cancer. Surgery and one or more adjuvant therapies may be recommended.
Lumpectomy and mastectomy are both options for stage 1 breast cancer. The decision is based on the size and location of the primary tumor, and personal preference. Biopsy of the lymph nodes will probably be performed at the same time. For mastectomy, reconstruction of the breast can begin at the same time or after additional treatment is completed.
Radiation therapy is often recommended after surgery for stage 1 breast cancer. It may not be necessary for women over 70 years old, especially if hormone therapy is possible.
Hormone therapy may be recommended for hormone receptor-positive breast cancers, regardless of tumor size.
Chemo isn’t always needed for early-stage breast cancers, especially if they can be treated with hormone therapy. Breast cancer that is negative for ER, PR, and HER2 is called triple-negative breast cancer (TNBC). Chemotherapy is almost always needed since there is no targeted treatment for TNBC.
In stage 2A the tumor is smaller than 2 centimeters and has spread to 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 nearby lymph nodes. Or it’s larger than 5 centimeters and hasn’t spread beyond the breast. You’ll probably need a combination of surgery, radiation, chemotherapy, and/or hormone treatment.
Lumpectomy and mastectomy may both be options depending on the size and location of the tumor. A modified radical mastectomy is a removal of the breast including chest muscles. If you choose reconstruction, the process may begin at the same time or after cancer treatment is complete.
Radiation therapy targets any remaining cancer cells in the chest and/or lymph nodes.
Chemo is systemic therapy to kill cancer cells throughout the body. The powerful drugs are delivered intravenously over the course of many weeks or months. There are a variety of chemotherapy drugs used to treat breast cancer, including docetaxel (Taxotere), doxorubicin (Adriamycin), and cyclophosphamide (Cytoxan). You may receive a combination of several chemo drugs. Chemotherapy is particularly important for TNBC.
After all other treatment is complete, you may benefit from continued treatment for ER+, PR+, and HER2+ breast cancers. Oral medications are generally prescribed for five years.
Stage 3A breast cancer means that the cancer has spread to four to nine axillary (armpit) lymph nodes, or has enlarged the internal mammary lymph nodes. The primary tumor may be any size. It can also mean the tumor is bigger than 5 centimeters, and small groups of cancer cells are found in the lymph nodes. Finally, stage 3A can also include tumors greater than 5 centimeters in size with involvement of one to three axillary lymph nodes or any breastbone nodes.
Stage 3B means a breast tumor has invaded the chest wall or skin and may or may not have invaded up to nine lymph nodes. Stage 3C means cancer is found in 10 or more axillary lymph nodes, lymph nodes near the collarbone, or internal mammary nodes.
Symptoms of inflammatory breast cancer (IBC) are different from other types of breast cancer. Diagnosis may be delayed since there is usually no breast lump. By definition, IBC is diagnosed at stage 3B or above.
Treatment for stage 3 breast cancers is similar to that of stage 2. If you have a large primary tumor, your doctor may recommend chemotherapy to shrink it before surgery. Otherwise, chemotherapy will follow surgery. Hormone therapy will be prescribed if needed. Radiation therapy will probably be needed before reconstruction can begin.
Stage 4 indicates that breast cancer has spread to a distant part of the body. Breast cancer most often spreads to the lungs, brain, liver, or bones. Aggressive systemic therapy is the main treatment. Depending on your type of breast cancer, you’ll probably have chemotherapy and one or more targeted therapies. The number and location of tumors determine your surgical options.
Clinical trials are research studies that use people to test new treatments. Ask your oncologist for information about available trials.