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How is breast cancer treated?

It really depends on how the cancer presents. You tailor it for each woman. If it looks like it's early, meaning it's just in the breast, maybe gone to the armpit a little bit, then usually surgery is the first step, and often surgery goes hand-in-hand with radiation. So, you might do a lumpectomy, followed by radiation. And then, once that's done, some women have chemotherapy, other women don't. Sometimes you do chemotherapy beforehand, and sometimes you can give a pill, an antiestrogen medication, for 5 to 10 years after all of the upfront treatment is done.

The information, opinions, and recommendations presented in this article have been compiled from a podcast and are for general information only.

Trinity Health is a Catholic health care organization that acts in accordance with the Catholic tradition and does not condone or support all practices covered in this site. In case of emergency call 911.This site is educational and not a substitute for professional medical advice, always seek the advice of a qualified healthcare provider.

Dr. Stuart A. Linder, MD
Plastic Surgeon

In general, breast cancer treatment will depend on the specific type of tumor, size of the cancer and metastatic involvement. Options can include surgical options: lumpectomy, axillary nodal dissection, radiation therapy or simple mastectomy, modifed radical mastectomy, chemotherapy, Tamoxifen and hormonal suppression drugs. 

Dr. Mehmet Oz, MD
Cardiologist (Heart Specialist)

The treatment for breast cancer depends on the stage the cancer is caught:

  • Stage 1: Lumpectomy, partial mastectomy, radiation
  • Stage 2: Similar to stage 1, though radiation likelier; chemotherapy an option
  • Stage 3: More extensive surgery, sometimes preceded by chemotherapy
  • Stage 4: Surgery; chemotherapy, hormones, other systemic therapies

This content originally appeared on doctoroz.com.

Local versus systemic therapy
Local therapy is intended to treat a tumor at the site without affecting the rest of the body. Surgery and radiation therapy are examples of local therapies.

Systemic therapy refers to drugs which can be given by mouth or directly into the bloodstream to reach cancer cells anywhere in the body. Chemotherapy, hormone therapy and targeted therapy are systemic therapies.

Adjuvant and neoadjuvant therapy
Patients who have no detectable cancer after surgery are often given adjuvant (additional) systemic therapy. Doctors believe that, in some cases, cancer cells may break away from the primary breast tumor and begin to spread through the body by way of the bloodstream even in the early stages of the disease. These cells can't be felt on a physical exam or seen on x-rays or other imaging tests, and they cause no symptoms. But they can go on to become new tumors in other organs or in bones. The goal of adjuvant therapy is to kill these hidden cells.

Not every patient needs adjuvant therapy. Generally speaking, if the tumor is larger or the cancer has spread to lymph nodes, it is more likely to have spread through the bloodstream. But there are other features, some of which have been previously discussed, that may determine if a patient should get adjuvant therapy. Recommendations about adjuvant therapy are discussed in the sections on these treatments and in the section on treatment by stage.

Some patients are given systemic therapy, usually chemotherapy, before surgery to shrink a tumor in the hope it will allow a less extensive operation to be done. This is called neoadjuvant therapy.

If your breast cancer is smaller than 4 centimeters, you would probably be a candidate for lumpectomy or mastectomy. Remember, there is no survival difference between lumpectomy and mastectomy. Radiation therapy treats the "local area," that is, the breast, and you would be treated in a radiation facility. Chemotherapy is administered through an intravenous (IV) line or sometimes by injections and treats the whole body.
Dr Camille
Oncologist

The treatment for breast cancer can be divided into 4 areas:

  1. Surgery to remove the tumor - This includes lumpectomy (removing only the area involved) and mastectomy (removing the entire breast), with the addition of lymph node evaluation by sentinel lymph nodes or axillary lymph node dissection. After the tumor is removed, it is evaluated by a pathologist (a doctor who looks at and evaluates cancer cells under microscope using special stains and other means) who will give crucial information that will determine additional treatment recommendations. This will be given in a "final pathology report."
  2. Radiation Therapy - Part of the treatment plan, if lumpectomy was the surgery performed. This can be done via external beam radiation to the entire breast or partial breast radiation therapy. Your radiation oncologist will discuss which is appropriate. After a mastectomy, radiation therapy to the chest wall "may" also be indicated, pending review of the final pathology report.
  3. Chemotherapy - Chemotherapy will be offered depending on the stage of the cancer (size of tumor, number of lymph nodes, spread from area of origin).
  4. Hormone therapy - Offered if hormone receptors (such as estrogen) is expressed (positive) on the cancer cells. Herceptin, a monoclonal antibody, used in treatment if Her-2 neu is over-expressed in the cancer. All the information required to make these determination for treatment will be within the pathology report. 

To understand the basic terms used above and learn more about breast cancer visit www.LegacyEducators.com.

Once a diagnosis has been made, there are a number of treatments available for breast cancer. About two in three breast cancer patients are diagnosed with a tumor limited to the breast; doctors usually recommend a lumpectomy (removal of the tumor) or mastectomy (removal of the entire breast), so as to eradicate the disease before it spreads. These surgeries are typically accompanied by a form of radiation therapy.

If one's breast cancer has spread to the lymph nodes, chemotherapy or hormonal therapy may also be necessary.

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The treatment techniques available for breast cancer include surgery, radiation, chemotherapy, hormone therapy, and targeted therapy. Most women with breast cancer have surgery to treat the main breast tumor. The primary purpose is to remove as much cancer as possible, determine whether the cancer has invaded local tissue, spread to the lymph nodes under the arm or relieve symptoms of advanced cancer. Because surgery may remove only a portion of the breast tissue and cancer can metastasize from the primary tumor and spread through the bloodstream. There are many different types of breast cancer surgery including the following:

  • Breast-conserving surgery or partial mastectomy, segmental mastectomy, lumpectomy, quandrantectomy
  • Total mastectomy without axillary lymph node dissection or sentinel lymph node biopsy
  • Modified radical mastectomy with axillary lymph node dissection or with sentinel lymph node biopsy
  • Radical mastectomy with chest wall excision with axillary lymph node dissection or sentinel lymph node biopsy

Many surgeries may need to be preceded (neoadjuvant therapy) or followed (adjuvant therapy) by radiation treatments, rounds of chemotherapy, hormonal suppression or targeted therapy. For instance, when chemotherapy is given after surgery to patients it is called adjuvant chemotherapy and it aims to lower the chance of recurrence at a later date. However, chemotherapy that is given before surgery is called neoadjuvant chemotherapy and it aims to treat, reduce or minimize the cancer. Radiation therapy for breast cancer consists of either “external beam radiation” with series of targeted exposures to high-energy rays or “brachytherapy” with placement of radioactive pellets strategically positioned to kill rapidly dividing cancer cells. Less often, radiation therapy may be used to debulk or shrink a tumor before surgery. Radiation to the breast is often needed after breast-conserving surgery. It is usually given after any chemotherapy.

Chemotherapy for breast cancer is the use of anti-cancer drugs via oral medications, intramuscular injection or intravenous infusions. Because they enter the bloodstream and reach distant parts of the body, chemotherapy is important treatment for cancers that have spread to distant organs or lymphatics. Hormone therapy for breast cancer targets hormone receptors, blocks the effects of estrogen and progesterone that promote cancer cell growth, and thereby reduces the risk of the cancer recurrence after surgery. 

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.