Treatment usually involves surgery, often followed by chemotherapy or radiation. Targeted or hormone therapies may also be used depending on cancer characteristics.

Being diagnosed with stage 2 breast cancer can feel overwhelming, but knowing what to expect can make a big difference.

In this stage, the cancer may have spread to nearby lymph nodes or grown larger, but it’s still considered localized. Treatment options typically include surgery, chemotherapy, radiation, and hormone therapy.

Let’s review your options and discuss what you can expect as you begin your treatment journey.

Surgery

Surgery is a common treatment for stage 2 breast cancer. It typically involves removing the tumor and some surrounding tissue.

For Stage 2 breast cancer, the following types of surgery are used:

  • Lumpectomy: This surgery removes the tumor and a small margin of surrounding tissue to minimize the chance of recurrence. It’s often used if the tumor is 5 centimeters (cm) or smaller and allows most of the breast to be preserved. Radiation therapy usually follows to prevent recurrence.
  • Mastectomy: This involves removing the entire breast and is considered when the tumor is larger than 5 cm, there are multiple cancerous areas, or breast-conserving surgery isn’t possible due to tumor location. Patient preference and specific risk factors may also influence this choice.
  • Sentinel lymph node biopsy: This procedure removes and examines the first few lymph nodes (sentinel nodes) most likely to be affected by cancer. It helps determine if cancer has spread to the lymph nodes, guiding further treatment.
  • Axillary lymph node dissection: If cancer is found in the sentinel nodes, additional lymph nodes may be removed to assess the extent of spread. This is typically done if multiple positive lymph nodes are found or specific criteria are met.

Postsurgery, you may also receive radiation therapy to kill any remaining cancer cells.

Chemotherapy

Chemotherapy uses drugs to kill cancer cells throughout the body.

For stage 2 breast cancer, it may be given before surgery (neoadjuvant) to shrink tumors, making breast-conserving surgery more practical. This approach is more common in cases where the tumor is large, or there are concerns about its potential to spread.

Studies show that neoadjuvant chemotherapy can improve the chances of completely removing a tumor, which might lessen the need for more intense treatments later.

Chemotherapy may also be administered after surgery (adjuvant) to eliminate any remaining cancer cells. This approach is often used when the cancer is smaller or has been effectively removed by surgery, but there’s still a risk of residual disease.

Chemotherapy is administered through intravenous (IV) infusions or oral medications and may cause side effects such as nausea, fatigue, and hair loss.

Radiation therapy

Radiation therapy uses high energy rays to target and kill cancer cells. After surgery, such as a lumpectomy, radiation, specifically external beam radiation, is often used to destroy any remaining cancer cells in the breast area.

This treatment typically involves daily sessions over several weeks and can cause skin irritation and fatigue.

Although external beam radiation therapy can help stop breast cancer from coming back and can even help women keep their breasts after surgery, it can also have side effects. Side effects may include problems with the heart and lungs, swelling, and a small chance of getting another cancer later on.

Newer technology in radiation therapy is making the treatment more accurate, safer, and easier for patients.

Hormone therapy

Hormone therapy is used if the cancer cells have hormone receptors, meaning they grow in response to hormones like estrogen or progesterone. This treatment helps block or lower these hormones to slow or stop cancer growth.

Types of hormone therapy include:

  • Tamoxifen: This is a selective estrogen receptor modulator (SERM) that binds to estrogen receptors on cancer cells, blocking estrogen from attaching to the receptors. It’s taken in pill form. It can be used in both premenopausal and postmenopausal women.
  • Aromatase inhibitors: These drugs (such as anastrozole, letrozole, and exemestane) are commonly used in postmenopausal women. They work by blocking the enzyme aromatase, which converts androgens into estrogen, thereby lowering estrogen levels in the body.
  • Ovarian suppression: In premenopausal women, medications like goserelin or leuprolide may be given as injections to temporarily stop the ovaries from producing estrogen. Surgical removal of the ovaries (oophorectomy) is another option to reduce estrogen levels.
  • Fulvestrant: This drug is an estrogen receptor down regulator (ERD) that blocks and damages estrogen receptors. It’s more commonly used in advanced stages of breast cancer but may be considered in specific cases.

Targeted therapy

Targeted therapies ‘target’ specific molecules involved in cancer growth. They work by blocking the growth and spread of HER2 cancer cells, often with fewer side effects than traditional chemotherapy.

These therapies may include:

  • Trastuzumab (Herceptin): This is a monoclonal antibody given by IV infusion that targets HER2-positive breast cancer cells, often used in combination with chemotherapy.
  • Pertuzumab (Perjeta): This is also a monoclonal antibody administered by IV infusion that targets HER2-positive cells, and is frequently used alongside trastuzumab and chemotherapy.
  • Ado-trastuzumab emtansine (T-DM1): This is an antibody-drug conjugate given by IV infusion and used primarily after other treatments if cancer persists or recurs, targeting HER2-positive cells.

For stage 2 breast cancer, these therapies might be used if the cancer has certain genetic markers, like HER2-positive. They’re usually given in combination with other treatments.

After a breast cancer diagnosis, you’ll undergo additional tests to confirm the stage and create a treatment plan with your care team. This plan typically includes surgery, possibly in combination with chemotherapy, radiation, or hormone therapy.

You’ll receive instructions on pre-treatment preparations and how to manage side effects. You’ll have regular follow-ups to monitor progress and adjust treatment as needed.

The entire treatment process for stage 2 breast cancer can span 6 to 12 months, depending on the treatment plan and individual response.

Side effects vary based on the specific treatments used but may include fatigue, nausea, changes in appearance or body image, and emotional stress.

Doctors monitor treatment effectiveness through regular imaging tests, blood work, and physical exams. They look for signs such as tumor shrinkage, reduced symptoms, and stable or improved lab results.

If treatment isn’t working, alternative options may be explored, including changing medications or trying different therapies. Your doctor will assess these factors to adjust your treatment plan accordingly and ensure the best possible outcomes.

Tests and monitoring

For Stage 2 breast cancer, doctors use the following tests and monitoring methods:

  • Mammograms: To check for changes in breast tissue.
  • Ultrasound: To examine the breast and nearby lymph nodes.
  • MRI (magnetic resonance imaging): For detailed images of breast tissues.
  • CT scans: To detect any spread of cancer to other areas.
  • Blood tests: To monitor overall health and look for cancer markers.
  • Biopsies: To analyze cells and determine if cancer has spread.
  • Physical exams: To assess any changes in the breast or lymph nodes.

For stage 2 breast cancer, treatment typically involves a combination of surgery, chemotherapy, radiation, and sometimes hormone therapy or targeted therapy. The goal is to remove the tumor, reduce the risk of recurrence, and address any remaining cancer cells.

The outlook for stage 2 breast cancer is generally positive, with many women achieving successful outcomes. The overall 5-year survival rate is high, around 90%, although individual results can vary based on factors like tumor characteristics, treatment response, and overall health.

Regular follow-ups and personalized treatment plans are essential for managing the disease and supporting long-term recovery. Survival rates continue to improve due to earlier detection and advances in more personalized treatment options.