Breast cancer treatment varies depending on the type, location, and stage of cancer. Surgery, chemotherapy, and radiation therapy are common components of a comprehensive care plan.

Receiving a breast cancer diagnosis can feel overwhelming, but effective treatments are available. Your doctor may present you with several therapeutic options, each of which has its own benefits and drawbacks.

Understanding the available treatments can help you feel empowered about your decisions and in control of your diagnosis.

This guide goes over the common treatment options for breast cancer, what to expect, and questions to ask your doctor along the way.

Chemotherapy is a treatment involving drugs that kill cancer cells. Not all breast cancers need chemotherapy, but your oncologist (cancer specialist) may consider these drugs when:

  • cancer cells may be left behind after surgery
  • there’s a high likelihood that cancer cells have spread but aren’t yet detectable
  • chemotherapy can shrink a tumor that’s too large for surgery or can result in less invasive surgery
  • there is extensive lymph node involvement
  • it’s necessary to test how cancer will respond to specific drugs
  • you have an aggressive type of breast cancer
  • chemotherapy can extend the time before surgery to allow for genetic testing or other necessary planning
  • cancer has a high chance of recurrence or has metastasized (spread)

Chemotherapy is rarely used as a solo treatment for breast cancer. It’s generally used in combination with surgery, radiation, or targeted treatments as part of a multidisciplinary approach.

Inoperable breast cancer, widely metastasized breast cancer, and some rare types of cancer may be candidates for chemotherapy-only approaches.

What should you expect during chemotherapy?

Chemotherapy for breast cancer treatment is usually given by your oncology team in an outpatient setting. Your doctor or nursing staff will give you an intravenous (IV) injection or place a catheter so you can receive a slow infusion of the drug over several minutes rather than all at once.

Chemotherapy is given in cycles — typically cycles of 2 to 3 weeks for up to 6 months — so you can recover from its effects before your next dose. Your exact schedule may vary, depending on the specific drugs and their effectiveness.

Common chemotherapy medications used in breast cancer treatment include:

  • doxorubicin
  • epirubicin
  • paclitaxel
  • docetaxel
  • 5-fluorouracil
  • capecitabine
  • cyclophosphamide
  • carboplatin

Some people experience pain or discomfort at the injection site. Other possible side effects of chemotherapy include:

  • fatigue
  • nausea
  • vomiting
  • diarrhea
  • hair loss
  • mouth sores
  • nail changes
  • hot flashes
  • fertility challenges
  • easy bruising/bleeding
  • increased risk for infections

What should you ask your doctor?

Your oncologist is a cancer specialist who is there to help you at every step of the breast cancer treatment process, including by answering questions about chemotherapy.

To help build your understanding of chemotherapy and what to expect, questions that might help include:

  • What is the goal or purpose of chemotherapy for my diagnosis?
  • Which chemotherapy medications will be used? Why?
  • How will chemotherapy be administered, and how often?
  • How does chemotherapy align with other treatments in my care plan?
  • What lifestyle changes should I make to support chemotherapy treatment?
  • What are the side effects?
  • Are there any long-term effects?
  • What are the signs of serious complications?
  • What should I do if I feel that I’m having a serious side effect?
  • How will you know if chemotherapy is effective?
  • How should I prepare for chemotherapy sessions?
  • What happens if chemotherapy isn’t effective?
  • Can chemotherapy be done at the same time as other breast cancer treatments?
  • Are there any changes to my current medications?

Radiation therapy uses high energy radiation to destroy cancer cells. In breast cancer treatment, external beam radiation therapy (EBRT) is the most common way radiation is applied to your body. EBRT involves a machine that delivers a concentrated beam of radiation to a specific cancer site or area.

The type of radiation therapy your oncologist recommends will depend on your individual diagnosis.

Like chemotherapy, radiation treatments can be used to kill lingering or undetected cancer cells after surgery (adjuvant) or to shrink tumors to make them more operable (neoadjuvant).

Your doctor may recommend radiation if:

  • the type of breast cancer you have is known to be resistant to drug treatments
  • you have a coexisting medical condition that eliminates the option of chemotherapy
  • cancer is localized with a low chance of spread
  • breast-conserving surgery is a priority
  • radiation will improve outcomes when combined with other treatments, such as chemotherapy or surgery

Often, radiation is used alongside chemotherapy and surgery to ensure that breast cancer is treated as effectively as possible. Common side effects include:

  • tissue swelling
  • skin changes in the treated area
  • fatigue
  • sun sensitivity in the treated area
  • long-term complications related to breastfeeding, nerve damage, and breast appearance

In very rare cases, radiation therapy may increase your chance of developing another type of cancer called angiosarcoma by causing damage to the DNA in noncancerous cells.

What should you expect during radiation therapy?

Some people receive radiation to large areas of their body, such as the entire affected breast, the axillary lymph nodes, or the chest wall, depending on the cancer’s stage and spread. These treatments are typically given 5 days per week for up to 7 weeks in an outpatient setting.

Other people are candidates for accelerated partial breast irradiation (APBI), in which radiation is delivered only to the tumor site (also called the tumor bed) rather than to the entire surrounding area. APBI can range from a single dose of radiation during surgery to continual dosing through a treatment called brachytherapy.

Brachytherapy is a type of internal radiation given in the form of radiation-emitting seeds or pellets inserted near the breast cancer site. Your radiation oncologist places brachytherapy through a specialized applicator or catheter during surgery or as a separate anesthetic procedure.

The amount of time brachytherapy stays in your body will depend on your diagnosis and your overall health.

What should you ask your doctor?

To learn more about radiation therapy for breast cancer and what it means for your care plan, consider asking your radiation oncologist the following questions:

  • Why is radiation therapy recommended for my diagnosis?
  • How will radiation therapy be administered? Why?
  • Are there any newer or alternative techniques available? Would they be appropriate?
  • How many sessions will my radiation therapy take?
  • How long does each session take?
  • Are there any special preparations I need to make before a radiation session?
  • What are the possible side effects?
  • What are the signs of serious complications?
  • What should I do if I’m experiencing a severe reaction?
  • Are there long-term changes that occur from radiation therapy?
  • Are there any lifestyle changes I should make to support the therapy’s success?
  • Are there any activities to avoid while on a radiation therapy schedule?
  • How will I know if radiation is effective?
  • Can I have radiation therapy alongside other breast cancer treatments?
  • Do I need to change any of your current medications?

Surgery is a primary feature in most breast cancer treatment plans, and it can be used for more than just tumor removal.

Surgical procedures such as biopsies and dissections can help inform your doctor about cancer’s spread. Reconstructive surgery can help restore the appearance of your breast after the removal of cancer. Some surgeries can relieve cancer pain or reduce the chance that breast cancer will recur.

Your oncologist may recommend:

  • Surgical biopsy: A surgeon removes a small tissue sample from an area and sends it to be evaluated for cancer cells.
  • Breast-conserving surgery: A surgeon removes only the part of your breast with cancer and some surrounding tissue. Lumpectomies, quadrantectomies, and partial or segmental mastectomies are types of breast-conserving surgeries.
  • Mastectomy (single or double): A surgeon removes your entire breast (or both breasts) and any necessary nearby tissues. This procedure is used to remove cancer as well as to prevent cancer in people who are considered high risk.
  • Lymph node removal: A surgeon removes lymph nodes that are already affected by breast cancer or likely to become the first involved if cancer spreads. Common lymph node surgeries include sentinel lymph node biopsy and axillary lymph node dissection.
  • Breast reconstruction: A surgeon uses reconstructive surgery techniques, such as fat grafts, to help reshape your breast after cancer has been removed.

What should you expect during surgery?

Surgical techniques vary significantly depending on the type of surgery. Your surgeon may offer traditional “open” surgery performed with a scalpel or more advanced styles such as robotic or laser surgery.

Surgery can also involve assistive technologies such as MRI scans and the injection of medical dye to improve cancer’s visibility. Wire or needle localization, guided by ultrasound or mammogram, is another technique a surgeon can use to identify breast cancer nodules before operating.

Before your surgical procedure, your doctor will go over any special preparation requirements. For example, if you’ll be receiving general anesthesia, you may not be able to eat or drink after a certain time the day before.

On the day of your procedure, you’ll arrive a few hours ahead of time, and the surgical team will order any final laboratory tests and set up monitoring equipment and fluid therapy to support your care during the procedure.

Your recovery time and how soon you can return home will depend on your specific surgery.

What should you ask your doctor?

To learn more about surgery for breast cancer and what it means for your specific diagnosis, consider asking your oncologist or surgeon the following questions:

  • Why is surgery recommended for my diagnosis?
  • What type of surgery is being considered? Why is it the preferred method?
  • How effective is surgery expected to be?
  • How will I know if the surgery was successful?
  • What lifestyle changes should I make to support surgery and recovery success?
  • Are there any presurgical requirements?
  • What is required for aftercare at home?
  • Is one procedure enough, or are more necessary?
  • What are the potential complications?
  • Are there any long-term effects?
  • How long is the expected recovery?
  • What are the signs of serious complications?
  • What should I do if I notice signs of serious complications?
  • Can surgery be done at the same time as other breast cancer treatments?
  • Will there be changes to my current medications?
  • Are there any newer or more advanced surgical techniques available?

Breast cancer treatment almost always involves using multiple approaches to treat cancer. Combining surgery with chemotherapy, radiation therapy, or both can often improve your overall outcome by attacking cancer through different mechanisms.

In addition to these primary components of breast cancer treatment, your doctor may recommend targeted therapies, immunotherapy, or hormone therapy. If cancer is resistant to current treatments, a clinical trial for new and emerging therapies might also be an option.

Your care plan is designed to maximize the effectiveness of all your treatments, improve survival, and reduce the chance of cancer recurrence.

Discussing your overarching breast cancer treatment plan with your doctor can help you understand whether there are any overlapping effects or additional complications you should consider when receiving multiple treatments at the same time.

Overall, you can manage side effects and support your recovery from any breast cancer treatment by maintaining the following healthy lifestyle habits as best you can:

You can also stay ahead of side effect symptoms by staying in regular communication with your cancer team and sticking to your treatment schedule. If you notice any change in how you feel, talk with your doctor. They can help you address side effects before they become extremely distressing.

Your doctor can tell you about home remedies and over-the-counter options for common concerns such as nausea, fatigue, headaches, vaginal dryness, and skin irritation.

Your local pharmacist is also an excellent resource to discuss medication-specific interactions, side effects, and what you can do at home to relieve symptoms.

Breast cancer treatment typically involves a combination of chemotherapy, radiation therapy, and surgery. Depending on your diagnosis, your doctor may also recommend hormone therapy, immunotherapy, or targeted therapies.

Understanding breast cancer treatments and why they’re recommended can help you make the most informed decisions possible. It’s always OK to explore all your options or seek other medical opinions before settling on a care plan.