Breast Cancer

About Cancer Treatment

Your treatments will be either local or systemic. Local treatments target specific areas of the body and include surgery and radiation therapy. Systemic treatments include drug therapies (targeted therapy, chemotherapy, immunotherapy and hormone therapy) that travel throughout your body. Drug therapies can be given orally or intravenously (IV) through a vein in your arm or through a port. A port is surgically inserted under the skin in the upper chest area or arm to gain easy access to veins.

Whether delivered before or after surgery, an important goal of systemic therapy is to destroy breast cancer cells that may be hiding in other organs of the body, such as the liver, lungs, bones or brain. These hidden cancer cells, called micrometastatic disease, are usually too small to detect with laboratory testing or imaging studies. Delivering carefully selected systemic therapy to appropriate patients can often completely eliminate micrometastatic disease and is, therefore, extremely important as a partner with surgery for breast cancer in helping a patient become disease-free.

Your doctor will consider your age, general health and menopausal status for women, as well as the size of the tumor, its biomarker status ( ER , PR , HER2 ), the stage of the cancer and genetic markers, such as BRCA1 and BRCA2 mutations, if applicable, and the results of genomic testing. It is important to share your expectations for your quality of life. Then, together, you and your doctor will define your treatment goals.

Your doctor may adjust your treatment if the cancer becomes resistant (stops responding) to your current drug therapy or if the cancer recurs after previous treatment.

Following are common treatment options that may be used alone or in combination.

Surgery is the most common treatment for most breast cancers. It removes the tumor in the breast and it may be used to prevent or treat symptoms or complications of breast cancers that have metastasized to distant organs.

Lymph node surgery is usually necessary to stage the cancer (called a sentinel lymph node biopsy) or to control cancer that has spread to the nodes. The underarm (axilla) is the most common site of spread for breast cancer.

A lumpectomy, also called breast-sparing or breast-conserving surgery, removes the tumor along with a small margin of normal-appearing tissue around it. It is used for early-stage breast cancers detected as small tumors. A lumpectomy is usually followed by radiation treatments, which are designed to kill microscopic cancer cells hiding in other parts of the breast.

A mastectomy involves removal of the entire breast. Total mastectomy is the surgical removal of the entire breast without removing muscle. In a modified radical mastectomy, a total mastectomy is performed along with removal of a block of underarm (axillary) lymph node tissue (axillary dissection). Drains may be placed to collect fluid and assist in healing. Reconstructive surgery may be an option.

Survival rates for breast-conserving surgery plus radiation therapy compared to total mastectomy (with or without reconstruction) are essentially the same. Ongoing follow-ups after both types of surgery are important and recommended.

Radiation Therapy

Drug Therapy

Chemotherapy drugs may be used as neoadjuvant (preoperative) therapy to shrink a large, bulky tumor so it can be removed surgically or to reduce the tumor’s size to offer more surgical options. Neoadjuvant chemotherapy also offers the advantage of helping your doctor determine how well the chemotherapy drugs work against the tumor, and to identify whether additional therapy is needed post-operatively. Adjuvant (after surgery) chemotherapy is given to destroy cancer cells that may remain in the body.

Targeted therapy uses drugs or other substances to identify, attack and destroy specific types of cancer cells or to slow disease progression. Types include anti-HER2 drugs, kinase inhibitors and monoclonal antibodies. It can be given before or after surgery.

Hormone therapy is used to treat ER +/ PR + tumors. Several types may be used depending on the stage of the cancer and menopausal status of the female patient. Drugs that lower or block estrogen may be used, or the ovaries may be removed with surgery or suppressed with medication or radiation therapy.

Immunotherapy is designed to stimulate the body’s own immune system to treat certain breast cancers.

Clinical trials may be another option.

Clinical trials are medical research studies that may offer access to leading-edge treatments not yet widely available. Sometimes a clinical trial may be the best treatment option when an individual’s cancer has become resistant to the current treatment; when curative therapies are not yet available for that cancer type, subtype or stage; or the cancer is rare and has few, if any, approved treatments. Ask your doctor if you should consider this valuable option. Learn more about clinical trials here