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There are several treatment options. Often, more than one treatment is used.
- Surgery: taking out the cancer in an operation.
- Radiation therapy: using high-dose X-rays to kill cancer cells or keep them from dividing and growing.
- Chemotherapy: using anti-cancer drugs to kill or stop the growth of cancer cells.
- Hormonal therapy: using hormones to stop cancer cells from growing.
- Biological therapy (immunotherapy): using the immune system to fight cancer or to lessen the side effects that may be caused by some cancer treatments. Many biological therapies are being tested in clinical trials. See below for more information
Types of surgery
- Lumpectomy: A surgeon removes the breast cancer, a little normal breast tissue around the lump, and some lymph nodes under the arm. The surgeon is trying to totally remove the cancer, altering the breast as little as possible. Lumpectomy is usually accompanied by radiation therapy to destroy any remaining cancer cells.
- Total mastectomy: The surgeon removes the entire breast. Some lymph nodes under the arm may be removed also.
- Partial mastectomy: This surgery conserves as much as the breast as possible. Some breast tissue is removed, as well as the lining over the chest muscles below the tumor and usually some of the lymph nodes under the arm. Radiation therapy usually follows.
- Modified radical mastectomy: The surgeon removes the breast, some of the lymph nodes under the arm, the lining over the chest muscles and sometimes part of the chest wall muscles.
- Radical mastectomy: The surgeon removes the breast, chest muscles and all the lymph nodes under the arm. The standard operation for many years, it is used now only rarely when the cancer has spread to the chest muscles. There is no survival advantage if one has local therapy (lumpectomy or partial mastectomy plus radiation treatment versus modified radical mastectomy).
- A sentinel node biopsy: This is a technique that helps determine if a cancer has spread (metastasized), or is contained locally.
Radiation therapy
High-energy X-rays are used to destroy cancer cells that might still be present in the breast tissue. Doctors sometimes use radiation therapy following a lumpectomy or mastectomy, before or, rarely, instead of surgery and/or in conjunction with chemotherapy. Possible problems: feeling more tired than usual; skin reactions such as itching, redness, soreness, peeling, darkening, or shininess, and decreased sensation, and in some cases problems swallowing. Radiation does NOT cause hair loss, vomiting, or diarrhea. Depending on their risk analysis, women over 70 years of age may not require radiation therapy after surgery.
Chemotherapy
Even when a lump is small, cells may have broken off and spread outside the breast. Doctors can use chemotherapy to destroy them, using either a single drug or a combination of drugs.
The drugs often are injected into the bloodstream through an intravenous needle that is inserted into a vein, but sometimes they are administered as a pill. Adjuvant treatment to reduce the risk of cancer recurrence usually ranges from three to six months. Possible problems: hair loss, loss of appetite, nausea, vomiting, diarrhea, constipation, fatigue, infections, bleeding, weight change, mouth sores and throat soreness, infertility, early menopause, weakening of the heart, reduced ovarian function, damage to ovaries, secondary cancers such as leukemia.
These drugs are also used when the risk for recurrence is high such as having an aggressive (high risk) pathology of your cancer, if the cancer spread to your lymph nodes, and negative estrogen/progestin receptors.
You can learn more about chemotherapy by contacting NCI's 1-800-4-CANCER (1-800-422-6237) and requesting the following booklets: Helping Yourself During Chemotherapy, Chemotherapy and You, and Eating Hints for Cancer Patients.
Hormonal therapy
If lab tests show that your tumor relied on your natural hormones to grow, any remaining cancer cells may continue to be stimulated by your body's hormones. Hormonal therapy can prevent your body's hormones from reaching any remaining cancer cells.
Tamoxifen is one of the most common drugs used for hormonal therapy, taken daily as a pill. Estrogen stimulates the growth of tumors. Tamoxifen combats the resulting stimulation of estrogen receptor positive tumors. Although benefits are generally considered to far outweigh risks, you should be aware that tamoxifen use can increase risks for cancer of the uterus and, rarely, blood clots for patients also undergoing chemotherapy.
Possible problems: hot flashes, nausea, vaginal spotting, increased fertility. Less common side effects include depression, vaginal itching, bleeding or discharge, loss of appetite, eye problems, headache and weight gain.
Arimidex® (aromatase inhibitors) is a drug that may improve survival for women with breast cancer up to 50 percent. Unlike tamoxifen, it prevents estrogen production. It is only effective for postmenopausal women. In a clinical trial, women who were given Arimidex had a 17 percent reduction in the recurrence of the disease. In addition, women who took Arimidex experienced fewer side effects than women who were treated with tamoxifen. Armidex can be used for premenopausal women by giving them Lurpon or Zolodex to stop ovarian function. Femora® and Aromasin®, other aromatase inhibitors, appear to be equivalent to Arimidex and may be superior to tamoxifen for adjuvant and first line therapy.
Biological therapy
Antibodies are proteins made by the body's own natural immune system that are directed against foreign and infectious agents, called antigens. Monoclonal antibodies engineered through biotechnology are produced as therapeutic drugs to provide specific anti-tumor action within the human body. Herceptin® (trastuzumab) is a monoclonal antibody approved in 1998 by the Food and Drug Administration for the treatment of metastatic breast cancer. It inhibits cancer cell division and growth. Recently, it has been found to improve survival as an adjuvant treatment in patients with HER2-positive breast cancer after surgery.
New treatments designed to repair, stimulate or increase the body's natural ability to fight breast cancer currently are being investigated in clinical trials worldwide. Some of these experimental immunotherapies utilize, and, in others, boost substances produced naturally by the body's own cells. Cancer vaccines are being evaluated in clinical trials. Clinical trials adding Avastin® (bevacizumab) to chemotherapy and other VEGFs (vascular endothelial growth factor) have shown promise.
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External Sources
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Understanding Breast Cancer Treatment: A Guide for Patients, National Institutes of Health, National Cancer Institute.
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Understanding Breast Changes, National Institutes of Health, National Cancer Institute.
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A Woman's Guide to Breast Cancer Diagnosis and Treatment, California Department of Health Services.
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New Monoclonal Antibody Approved For Advanced Breast Cancer, US Department of Health and Human Services.
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Dollinger M, Rosenbaum, EH, Tempero M., et al. Everyone's Guide to Cancer Therapy, Fourth Edition, Kansas City, Missouri: Andrews McMeel Publishing, 2002.
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Rosenbaum, EH, Rosenbaum I. Everyone's Guide to Supportive Cancer Care: The Complete Guide for Patients and Their Families, Fourth Edition, Kansas City, Missouri: Andrews McMeel
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This article was reviewed and updated June 2007.
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