There are now more treatments for breast cancer than ever before, with new therapies being developed in clinical trials. Oncologists (cancer specialists) recommend treatments they think will be most effective based on the type of breast cancer and the stage. Oncologists also take into account your age, overall health, and any other conditions you have. Ultimately, the choice of your breast cancer treatment is up to you.
Breast cancer treatments fall into five main categories: surgery, radiation therapy, chemotherapy, targeted therapy, and hormone therapy. Most breast cancer is treated with a combination of treatments. Read about the side effects of breast cancer treatments or visit specific treatment pages.
For many women, surgery is the first step in treating breast cancer. Other women may undergo chemotherapy first to shrink the tumor before surgery — this is referred to as neoadjuvant therapy. There are many different types of surgery to diagnose and treat breast cancer.
Sentinel node biopsy is the surgical removal of one or more lymph nodes for testing. It is a diagnostic procedure performed in order to determine whether breast cancer has developed the ability to spread through the body. A negative sentinel node biopsy indicates that the cancer is still localized in the breast, whereas a positive sentinel node biopsy suggests that the cancer is metastasizing, or spreading. (Read more about stages of cancer.) Sentinel node biopsy helps doctors determine the stage of the cancer and decide what the best treatment options are.
Axillary lymph node dissection is the surgical removal of several lymph nodes, usually between five and 30, from the underarm area. It is both a diagnostic procedure performed in order to determine whether breast cancer has developed the ability to spread through the body, and a way of treating breast cancer that is spreading. Axillary lymph node dissection may be performed as an independent surgery, during a mastectomy in cases of invasive breast cancer, or before or after lumpectomy. Axillary lymph node dissection is a more extensive surgery than sentinel node biopsy.
Lumpectomy, also known as breast-conserving or breast-sparing surgery, wide local excision, or partial mastectomy, is surgery to remove a breast cancer tumor along with some of the normal breast tissue that surrounds it. The goal in removing the normal breast tissue is to create clear margins and help ensure that no cancer cells remain in your breast. One or more lymph nodes near the tumor or in the armpit may also be removed during a lumpectomy. Unlike mastectomy, lumpectomy removes only a portion of the breast. The amount and location of the breast tissue removed depend on the type, size and location of your tumors.
Lumpectomy may be performed to confirm or to rule out a diagnosis of breast cancer. It may also be a treatment option for women with early-stage breast cancer or locally advanced breast cancer. Lumpectomy is most frequently recommended as a treatment for breast cancer when there is only one tumor in the breast, and the tumor is less than five centimeters in diameter. When used as a treatment, lumpectomy is most frequently followed by radiation therapy in order to lower the risk that cancer might recur.
Mastectomy is surgery intended to remove all breast tissue. Mastectomy to remove one breast is referred to as unilateral mastectomy; if both breasts are removed, it is referred to as bilateral mastectomy. Bilateral mastectomy is a treatment option for women who have cancer in both breasts. Some women who have cancer in one breast choose to undergo bilateral mastectomy in order to reduce their risk of developing breast cancer in the healthy breast as well. Other women who have extremely high risk factors for developing breast cancer in the future, but who do not currently have breast cancer, opt to have a bilateral mastectomy to reduce their chances of developing the disease. In these cases, the procedure is also referred to as prophylactic mastectomy or preventative bilateral mastectomy. Some experts believe that bilateral mastectomy provides the most benefits to women who are premenopausal and whose cancer is hormone receptor-negative. (Read more about types of cancer.)
Many women choose reconstructive surgery after breast cancer removal surgery in order to restore the appearance and feel of their breasts. There are many different options for reconstruction, including timing, types of surgery, and materials. For instance, reconstructive surgery can be started or completed immediately after mastectomy during the same surgery, or be postponed until a later surgery. Depending on your breast cancer, the surgeon may or may not be able to use skin-sparing or nipple-sparing techniques during mastectomy that will allow for a more natural-looking reconstruction. Reconstruction material options include silicone, saline and using your own tissue from another part of your body. Each choice has its own benefits and risks. What type of reconstructive surgery you choose can depend on the specifics of your breast cancer, the size of your breasts and of your body in general, what type of insurance you have, and how important it is to you that your reconstructed breast and your healthy breast closely match.
Any type of surgery carries risks including blood clots, blood loss, infection, breathing problems, reactions to medication, and heart attack or stroke during the surgery. Breast cancer surgery causes scarring, changes to the way the breast looks and feels, and pain and numbness that may be long-term. Stiffness and loss of range of motion may occur in the arm on the affected side. After breast cancer surgery, many women develop lymphedema, swelling due to the buildup of lymph fluid in the arm on the side that was treated.
Radiation therapy helps prevent the return or spread of cancer. It is most frequently used after surgery, especially lumpectomy. In breast cancer where surgery is not an option, radiation therapy can help shrink tumor size, slow or prevent the spread of tumors, and may help treat pain.
Even if the surgeon has successfully removed all of the tumors, a few cancer cells may remain behind, too small to detect. Radiation therapy helps to eliminate these remaining cancer cells. It is believed that cancer cells are more vulnerable to radiation since they divide so rapidly. Radiation kills cancer cells more easily, but the normal, healthy cells of your body are better able to survive and heal.
Radiation therapy comes in two main forms, external beam radiation and internal radiation.
External beam radiation is the most common form used for breast cancer. In external beam radiation, beams of energy are projected from a machine into your body, carefully targeted onto locations such as the whole breast, lymph nodes, or other areas affected by cancer.
Internal radiation, also known as brachytherapy, is direct and localized. It involves implanting a small catheter (tube) or device into the body near the surgical site from which the tumors were removed. During the radiation therapy, small radioactive pellets will be introduced via the catheter or device. This type of radiation therapy is not as common.
Radiation therapy is usually delivered five days a week during the treatment period, which can last as long as seven weeks. In accelerated breast irradiation, treatment is given twice daily for only one to three weeks.
Chemotherapy is the treatment of cancer with drugs. Chemotherapy drugs may be taken intravenously or orally. Chemotherapy may be given after surgery (referred to as adjuvant chemotherapy), before surgery (neoadjuvant therapy), or in cases of advanced breast cancer. The goal of chemotherapy is to kill cancer cells, shrink tumors and prevent or slow the spread of cancer.
There are many classes of chemotherapy drugs. Most chemotherapy drugs are given in combinations of two or more drugs of different classes depending on what stage of cancer you have, how effective they are in your specific case, and how well your body tolerates any side effects. If one combination is not showing results, or if you experience intense side effects, your doctor may adjust your dosage or change the combination of drugs you receive.
Chemotherapy is administered in cycles of treatment and recovery. Cycles are usually two or four weeks long. Depending on which drugs you are receiving and how well you tolerate side effects, the drugs may be given only on the first day of the cycle, or as frequently as every day for 14 days. Each period of treatment will be followed by a recovery period to allow your body to rest. In some women with breast cancer, more frequent treatments and shorter recovery periods prove effective. This is called dose-dense chemotherapy. However, this type of chemotherapy may increase the intensity of side effects. For adjuvant and neoadjuvant chemotherapy, treatment usually lasts three to six months. Chemotherapy for advanced breast cancer may be given for longer.
During chemotherapy, some women use scalp cooling (cold caps) to reduce or avoid hair loss. Scalp cooling works by reducing blood flow to the scalp before, during, and after chemotherapy, limiting the amount of chemotherapy drug that reaches the hair follicles.
In about 25 percent of breast cancers, there is a genetic variation that causes tumor cells to produce extra receptors for a growth factor. This gene, known as human epidermal growth factor receptor 2 (HER2), causes the cancer to grow more aggressively. Herceptin is a member of a class of drugs called biologics. Herceptin (trastuzumab) and Perjeta (pertuzumab) are proteins designed to target the HER2 protein. They are believed to work by reducing the activity of growth factor receptors on cancer cells and assisting the body's immune system in attacking the cancer cells, thereby slowing the growth of tumors. Herceptin and Perjeta are administered as intravenous injections.
Kadcyla (ado-Trastuzumab Emtansine) is a similar drug believed to work by targeting and killing HER2-positive breast cancer cells. Kadcyla is given as an intravenous infusion during chemotherapy treatments.
Tykerb (lapatinib) and Nerlynx (neratinib) are members of a class of drugs called tyrosine kinase inhibitors. Tyrosine kinase inhibitors are designed to inhibit the growth of cancer cells with the HER2 gene. They are believed to work by interfering with the growth of HER2-positive cancer cells. Tykerb and Nerlynx are taken orally.
Ibrance (palbociclib), Kisqali (ribociclib), and Verzenio (abemaciclib) are members of a class of medications called cyclin-dependent kinase (CDK) inhibitors. CDK inhibitors are believed to inhibit the growth of cancer cells. These drugs may be used in combination with a hormone-blocking drug called an aromatase inhibitor. CDK inhibitors are prescribed in cases where tumors are estrogen receptor (ER)-positive and HER2-negative.
Afinitor (everolimus) is another type of kinase inhibitor sometimes prescribed in cases where women are postmenopausal and breast cancer is advanced, hormone receptor-positive, and HER2-negative.
Lynparza (olaparib) is a targeted therapy in a class of drugs called poly ADP-ribose polymerase (PARP) inhibitors. Lynparza is believed to work by preventing cancer cells from repairing themselves once damaged by chemotherapy. Lynparza may be prescribed in women who have a genetic mutation of the BRCA1 or BRCA2 gene. (Read more about risk factors for breast cancer.)
About two-thirds of breast cancers are estrogen receptor-positive, meaning that they require estrogen in order to grow. Tamoxifen and Fareston (toremifene) are members of a class of drugs called selective estrogen receptor modulators, or SERM, that provide hormone therapy for receptor-positive breast cancer. Tamoxifen is believed to work by reducing the effect of estrogen in estrogen receptor positive breast cancers. Tamoxifen is taken orally.
Faslodex (fulvestrant) is a member of a class of drugs called estrogen receptor downregulators. Faslodex works by blocking estrogen from acting on breast cancer cells, thereby slowing the growth of the cancer. Faslodex is administered as an injection.
Arimidex (anastrozole), Aromasin (exemestane), and Femara (letrozole) are members of a class of drugs called aromatase inhibitors, which block the enzyme that helps produce estrogen. Aromatase inhibitors work by reducing the production of estrogen in the body, thereby slowing the growth of breast cancer. Aromatase inhibitors are taken daily as pills.
Read more about hormone therapy for breast cancer.
The waiting period before breast cancer treatment begins is an anxious time, but you can take steps to help make sure you are as well-prepared as possible. Before you begin breast cancer treatment, it is a good idea to work on improving your overall health.
During and after treatment, keep eating a healthy diet, getting regular exercise, managing stress, and getting support wherever you can.
These steps can help you better recover from surgeries, cope with side effects, and avoid complications during breast cancer treatment.
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