Therapy is based on the type of breast cancer, location, gene classification, and prognosis. It’s also critical to know the stages of breast cancer. Staging occurs during diagnosis, and ranges from early-stage disease to stage IV breast cancer, which means the cancer cells have already spread to distant sites in the body. The stage of disease impacts breast cancer survival rates.
Some patients' cases are discussed at a multidisciplinary tumor board — a conference attended by many doctors with different specialties that might be required for your care.
Five types of treatment are commonly used for breast cancer: surgery, radiation, chemotherapy, hormone therapy, targeted therapy.
Most patients have some type of surgery to remove the breast tumor. Surgical choices are often made based on the size and location of the tumor, the type of breast cancer that was diagnosed, and the patient's wishes.
Possible breast cancer surgeries include:
- Lumpectomy, or breast-conserving surgery, in which the surgeon removes the tumor and some of the surrounding normal tissue. Often some lymph nodes under the nearby arm are also removed to see if the cancer has spread.
- Mastectomy, which involves removing the whole breast and also removing and checking lymph nodes. There are three types of mastectomy, each with risks and benefits: total (simple) mastectomy, modified radical mastectomy, and radical mastectomy. The latter is rarely performed unless breast cancer has spread to the chest muscles.
- Breast reconstruction after a mastectomy, during which surgeons can build the new breast using the patient's own non-breast tissue or implants.
- A lymph node dissection or a lymph node biopsy, which is usually done by the surgeon to determine if the nodes have cancer cells in them, an indication of whether the disease has begun to spread. This procedure takes place at the same time as the breast surgery.
Radiation therapy uses energy from radiation beams, radio isotopes, or charged particles to target tumors and to eradicate cancer cells. External radiation is almost always used after a lumpectomy to ensure that the cancer does not return. Sometimes it's used after a mastectomy if the tumor is larger, or if it has spread to lymph nodes or other distant sites such as the bones or brain. Radiation can also be given internally (brachytherapy) to some breast cancer patients. Wilmot Cancer Institute also offers prone breast radiation, which allows the breast to hang away from the body and limits healthy tissue and organ exposure to radiation during treatment.
Chemotherapy uses drugs or combinations of drugs — given intravenously or as pills — to destroy cancer cells. Chemo can be given before or after surgery to breast cancer patients. When the cancer is in an advanced stage, chemotherapy may be the primary treatment.
If a breast cancer is found to be fueled by estrogen and/or progesterone, hormone therapy is offered after surgery to reduce the risk of cancer returning. This type of therapy either removes the hormone from the body or blocks its actions and stops cancer cells from growing.
Three common hormone therapies for breast cancer include:
- Tamoxifen, a pill, for premenopausal or postmenopausal women.
- Aromatase inhibitors, a pill, for postmenopausal women.
- Ovarian ablation for premenopausal women, to remove or shut down the ovaries, the source of estrogen.
These are newer drugs designed to target specific gene changes that result in breast cancer. They single out cancer cells without harming normal cells and usually have less severe side effects compared to chemotherapy. One common targeted therapy is Herceptin, which attacks the HER2/neu protein on breast cancer cells. About one in five women have a type of cancer that makes them eligible for Herceptin or other similar drugs in that category.
Other targeted therapies have been developed for women with advanced, hormone-receptor-positive breast cancer, and additional targeted therapies are being studied for women with triple-negative disease.
Bone-directed therapy is also used in women with metastatic breast cancer to strengthen bones that have been weakened by cancer, or to prevent a recurrence of breast cancer.
Many cancer treatments cause side effects such as hair loss or fatigue, but not everyone experiences them the same way.
Lymphedema is a common side effect of breast cancer surgery. It results in swelling of the arm due to excess fluid that collects after lymph nodes or vessels are removed, or after radiation treatment. UR Medicine offers special clinics for treatment and prevention of lymphedema at Strong Memorial Hospital and at Thompson Health in Canandaigua.
The American Cancer Society also offers a free online class to help patients manage the side effects of their illness.