Stephen J. Schueler, M.D.

Cancer Breast Treatment

The treatment for breast cancer depends on a variety of factors, such as the cell type, the genetics of the cancer (HER2 positive or negative), and whether it has spread outside of the breast. Surgery is performed in most cases, followed by radiation therapy, chemotherapy, or hormone therapy. Surgical procedures may include a lumpectomy or mastectomy. A lumpectomy completely removes the tumor from the breast, while a mastectomy removes the entire breast. Additional surgery, called sentinel node biopsy, includes removing a lymph node from under the arm to look for the presence of cancer. If cancer is present in the lymph node, then all of the lymph nodes are removed from under the arm. After a mastectomy, breast reconstruction with a breast implant may be an option, in order to preserve the shape of the breast.

Breast cancer is often treated with a combination of surgery, radiation therapy, and hormone therapy. Chemotherapy may be added in the late stages of breast cancer that has spread to other tissues. Chemotherapy uses medications that either kill cancer cells directly, or interfere with their metabolism. Chemotherapy usually requires treatment with a combination of medications. Hormone therapy blocks natural hormones from stimulating the cancer cells to grow. Radiation therapy uses x-rays to directly kill cancer cells. Radiation therapy delivers a focused beam of radiation to the cancer so that any damage to surrounding tissue is minimized. A course of chemotherapy, hormone therapy, or radiation therapy may require weeks or months to administer.

Treatment for breast cancer may include:

Cancer Breast Chemotherapy

Cancer that has spread outside of the breast is usually treated with chemotherapy. Chemotherapy drugs are often used after breast cancer surgery.

Chemotherapy drugs kill cancer cells throughout the body. Chemotherapy is also used to slow this cancer once it has spread beyond the breast.

For many women, chemotherapy can help improve breast cancer survival and prevent its recurrence. In others it may slow the progression of the disease. Tumors that are not sensitive to estrogens may respond to other chemotherapy drugs. The decision regarding which agent or agents is most appropriate is complex and based on many factors.

Commonly used chemotherapy medications include:

Cancer Breast Hormone Therapy

Most breast cancers depend on the hormone, estrogen, in order to grow. Drugs that block or interfere with estrogen can help stop the growth of most breast cancers. Hormone therapy is not an option if the tumor does not have estrogen receptors.

Hormone therapy for breast cancer may include:

Cancer Breast Options DCIS

Any one of the following is an option for ductal carcinoma in situ (DCIS):

  • Lumpectomy and radiation therapy, with or without hormone therapy
  • Total mastectomy, with or without hormone therapy

Important factors that influence decision making:
  • A history of endometrial cancer makes hormone therapy risky.
  • A history of stroke, DVT or pulmonary embolism makes tamoxifen therapy more risky.
  • A history of vision problems or retinal disease makes tamoxifen therapy more risky.
  • Being pregnant limits drug and hormone therapy options.
  • Breast feeding limits drug and hormone therapy options.
  • Having had your ovaries removed makes hormone therapy unnecessary.
  • Having had your uterus removed makes hormone therapy less risky.
  • Hormone receptor status: hormone therapy is not an option if the tumor is estrogen receptor negative.
  • Hormone therapy can increase the risk of osteoporosis.
  • Hormone therapy recipients will need close follow-up to make sure they do not develop uterine cancer.
  • The desire to get pregnant makes tamoxifen therapy more risky, because it can cause birth defects.

Cancer Breast Options LCIS

Any one of the following is an option for lobular carcinoma in situ (LCIS):

  • Lumpectomy and radiation therapy with or without hormone therapy
  • Total mastectomy with or without hormone therapy

Important factors that influence decision making:
  • A history of endometrial cancer makes hormone therapy risky.
  • A history of stroke, DVT or pulmonary embolism makes tamoxifen therapy more risky.
  • A history of vision problems or retinal disease makes tamoxifen therapy more risky.
  • Being pregnant limits drug and hormone therapy options.
  • Breast feeding limits drug and hormone therapy options.
  • Having had your ovaries removed makes hormone therapy unnecessary.
  • Having had your uterus removed makes hormone therapy less risky.
  • Hormone receptor status: hormone therapy is not an option if the tumor is estrogen receptor negative.
  • Hormone therapy can increase the risk of osteoporosis.
  • Hormone therapy recipients will need close follow-up to make sure they do not develop uterine cancer.
  • The desire to get pregnant makes tamoxifen therapy more risky, because it can cause birth defects.

Cancer Breast Options Metastatic

Treatment for metastatic breast cancer:

Cancer Breast Options Recurrent

Treatment for recurrent breast cancer:

Cancer Breast Options Stage 1

Treatment for stage 1 breast cancer:

  • Lumpectomy to remove only the cancer and some surrounding breast tissue, followed by lymph node removal and radiation therapy
  • Modified radical mastectomy with or without breast reconstructive surgery

Any one of the following may also be added following surgery:
  • Radiation therapy to the lymph nodes and chest wall after a modified mastectomy
  • Systemic chemotherapy with or without hormone therapy
  • Hormone therapy
  • LHRH antagonist therapy instead of surgery to remove ovaries

Important factors that influence decision making:
  • A history of endometrial cancer makes hormone therapy risky.
  • A history of stroke, DVT or pulmonary embolism makes tamoxifen therapy more risky.
  • A history of vision problems or retinal disease makes tamoxifen therapy more risky.
  • Being pregnant limits drug and hormone therapy options.
  • Breast feeding limits drug and hormone therapy options.
  • Having had your ovaries removed makes hormone therapy unnecessary.
  • Having had your uterus removed makes hormone therapy less risky.
  • Hormone receptor status: hormone therapy is not an option if the tumor is estrogen receptor negative.
  • Hormone therapy can increase the risk of osteoporosis.
  • Hormone therapy recipients will need close follow-up to make sure they do not develop uterine cancer.
  • The desire to get pregnant makes tamoxifen therapy more risky, because it can cause birth defects.

Cancer Breast Options Stage 3a

Treatment for stage 3A breast cancer:

  • Lumpectomy to remove only the cancer and some surrounding breast tissue, followed by lymph node removal and radiation therapy
  • Modified radical mastectomy with or without breast reconstructive surgery

Any one of the following may also be added following surgery:
  • Radiation therapy to the lymph nodes and chest wall after a modified mastectomy
  • Systemic chemotherapy with or without hormone therapy
  • Hormone therapy
  • LHRH antagonist therapy instead of surgery to remove ovaries

Important factors that influence decision making:
  • A history of endometrial cancer makes hormone therapy risky.
  • A history of stroke, DVT or pulmonary embolism makes tamoxifen therapy more risky.
  • A history of vision problems or retinal disease makes tamoxifen therapy more risky.
  • Being pregnant limits drug and hormone therapy options.
  • Breast feeding limits drug and hormone therapy options.
  • Having had your ovaries removed makes hormone therapy unnecessary.
  • Having had your uterus removed makes hormone therapy less risky.
  • Hormone receptor status: hormone therapy is not an option if the tumor is estrogen receptor negative.
  • Hormone therapy can increase the risk of osteoporosis.
  • Hormone therapy recipients will need close follow-up to make sure they do not develop uterine cancer.
  • The desire to get pregnant makes tamoxifen therapy more risky, because it can cause birth defects.

Cancer Breast Options Stage 3b

Treatment for stage 3B breast cancer:

  • Chemotherapy
  • Hormone therapy if hormone receptor positive
  • Women who respond well to chemotherapy may be candidates for lumpectomy to remove only the cancer and some surrounding breast tissue, followed by lymph node removal and radiation therapy
  • Women who do not respond well to chemotherapy may be candidates for total mastectomy, followed by lymph node removal and radiation therapy.

Important factors that influence decision making:
  • A history of endometrial cancer makes hormone therapy risky.
  • A history of stroke, DVT or pulmonary embolism makes tamoxifen therapy more risky.
  • A history of vision problems or retinal disease makes tamoxifen therapy more risky.
  • Being pregnant limits drug and hormone therapy options.
  • Breast feeding limits drug and hormone therapy options.
  • Having had your ovaries removed makes hormone therapy unnecessary.
  • Having had your uterus removed makes hormone therapy less risky.
  • Hormone receptor status: hormone therapy is not an option if the tumor is estrogen receptor negative.
  • Hormone therapy can increase the risk of osteoporosis.
  • Hormone therapy recipients will need close follow-up to make sure they do not develop uterine cancer.
  • The desire to get pregnant makes tamoxifen therapy more risky, because it can cause birth defects.

Cancer Breast Options Stage 3c

Options for Stage 3C Operable
Any one of the following is an option:

  • Lumpectomy to remove only the cancer and some surrounding breast tissue, followed by lymph node removal and radiation therapy
  • Modified radical mastectomy with or without breast reconstructive surgery

Any one of the following may also be added following surgery:
  • Radiation therapy to the lymph nodes and chest wall after a modified mastectomy
  • Systemic chemotherapy with or without hormone therapy
  • Hormone therapy
  • LHRH antagonist therapy instead of surgery to remove ovaries

Important factors that influence decision making:
  • A history of endometrial cancer makes hormone therapy risky.
  • A history of stroke, DVT or pulmonary embolism makes tamoxifen therapy more risky.
  • A history of vision problems or retinal disease makes tamoxifen therapy more risky.
  • Being pregnant limits drug and hormone therapy options.
  • Breast feeding limits drug and hormone therapy options.
  • Having had your ovaries removed makes hormone therapy unnecessary.
  • Having had your uterus removed makes hormone therapy less risky.
  • Hormone receptor status: hormone therapy is not an option if the tumor is estrogen receptor negative.
  • Hormone therapy can increase the risk of osteoporosis.
  • Hormone therapy recipients will need close follow-up to make sure they do not develop uterine cancer.
  • The desire to get pregnant makes tamoxifen therapy more risky, because it can cause birth defects.

Options for Stage 3C Inoperable
Any one or more of the following may be an option:
  • Systemic chemotherapy (now considered to be the standard of care)
  • Hormone therapy if hormone receptor positive
  • Women who respond well to chemotherapy may be candidates for lumpectomy to remove only the cancer and some surrounding breast tissue, followed by lymph node removal and radiation therapy
  • Women who do not respond well to chemotherapy may be candidates for total mastectomy, followed by lymph node removal and radiation therapy.

Important factors that influence decision making:
  • A history of endometrial cancer makes hormone therapy risky.
  • A history of stroke, DVT or pulmonary embolism makes tamoxifen therapy more risky.
  • A history of vision problems or retinal disease makes tamoxifen therapy more risky.
  • Being pregnant limits drug and hormone therapy options.
  • Breast feeding limits drug and hormone therapy options.
  • Having had your ovaries removed makes hormone therapy unnecessary.
  • Having had your uterus removed makes hormone therapy less risky.
  • Hormone receptor status: hormone therapy is not an option if the tumor is estrogen receptor negative.
  • Hormone therapy can increase the risk of osteoporosis.
  • Hormone therapy recipients will need close follow-up to make sure they do not develop uterine cancer.
  • The desire to get pregnant makes tamoxifen therapy more risky, because it can cause birth defects.

Cancer Breast Options Stage 4

Treatment for stage 4 breast cancer:

  • Destruction of the ovaries with surgery, radiation or drugs
  • Herceptin and paclitaxel clinical trial if tumor is overexpressing HER2/neu gene
  • Hormone therapy if hormone receptor positive
  • Radiation therapy
  • Surgery usually only to control pain
  • Systemic chemotherapy (now considered to be the standard of care)

Cancer Breast Questions For Doctor

Questions to ask before treatment:

  • What are my treatment options?
    • Is surgery an option for me?
  • What are the risks associated with treatment?
  • Do I need to stay in the hospital?
    • How long will I be in the hospital?
  • What are the complications I should watch for?
  • How long will I be on medication?
  • What are the potential side effects of my medication?
  • Does my medication interact with nonprescription medicines or supplements?
  • Should I take my medication with food?

Questions to ask after treatment:
  • Do I need to change my diet?
  • Are there any medications or supplements I should avoid?
  • When can I resume my normal activities?
  • When can I return to work?
  • Do I need a special exercise program?
  • What else can I do to reduce my risk for having this problem again?
  • Are my children at risk for this condition?
  • How often will I need to see my doctor for checkups?
  • What local support and other resources are available?

Cancer Breast Radiation Therapy

Radiation can kill hidden cancer cells remaining after surgery. This treatment can be given by an external beam or by implanted seeds in the body.

Many studies show this treatment can help cure breast cancer or at least slow its growth. Many women will benefit from having this therapy after surgery. It is also used to help treat cancers that have spread beyond the breast.

Cancer Breast Specialist

Physicians from the following specialties evaluate and treat breast cancer:

Cancer Breast Surgery

Surgery for breast cancer:

  • Lumpectomy for breast cancer:
    • The most common surgery, where only the cancer is removed
  • Total mastectomy:
    • Removal of the entire breast and some lymph nodes under the arm
  • Radical mastectomy:
    • Removal of the entire breast, chest muscles, and some lymph nodes under the arm
  • Modified radical mastectomy:
    • Removal of the entire breast, the lining over the chest muscles, and some lymph nodes under the arm

Doctors need to know if the cancer has spread beyond the breast. During surgery, the lymph nodes undergo biopsy. These nodes can be located during surgery using colored or radioactive dyes.

Breast removal is often followed by reconstructive surgery. There are many methods to restore a breast that has been removed.

Continue to Cancer Breast Home Care

Last Updated: Jun 3, 2011 References
Authors: Stephen J. Schueler, MD; John H. Beckett, MD; D. Scott Gettings, MD
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PubMed Cancer Breast References
  1. Aiello EJ, Buist DS, White E, Seger D, Taplin SH. Rate of breast cancer diagnoses among postmenopausal women with self-reported breast symptoms. J Am Board Fam Pract. 2004 Nov-Dec;17(6):408-15. [15575032]
  2. Collaborative Group on Hormonal Factors in Breast Cancer: Breast cancer and hormone replacement therapy: collaborative reanalysis of data from 51 epidemiological studies of 52,705 women with breast cancer and 108,411 women without breast cancer. Collaborative Group on Hormonal Factors in Breast Cancer. Lancet 1997 Oct 11; 350(9084): 1047-59. [10213546]
  3. Giordano SH. A review of the diagnosis and management of male breast cancer. Oncologist. 2005 Aug;10(7):471-9. [16079314]
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