Breast cancer treatment

The majority of breast cancers are treated successfully. Most breast cancers require a combination of treatments. Almost all patients will undergo surgery of the breast and possibly the lymph nodes.

Systemic therapy refers to medications that treat the entire body. Even if there are no signs that the breast cancer has spread, systemic therapy is prescribed for the majority of patients with an invasive breast cancer in order to reduce the odds it will come back and to improve survival.

Radiation treatments are given after surgery to reduce the odds of cancer reappearing in the breast, surrounding tissue, or surrounding lymph nodes. There are many exciting new targeted therapies for breast cancer, including immunotherapies.

Breast cancer treatments personalized for you

Breast cancer treatments are personalized taking into account the stage of your cancer, the type of breast cancer you have, what the best sequence of treatment will be, and also considering your personal preferences.

Because there are so many factors to consider, treatment for breast cancer can vary greatly from person to person. Your multidisciplinary team of breast cancer specialists will discuss the best combination of surgery, chemotherapy, radiation, hormone therapy, or new immunotherapy approaches to treat or control your cancer.

Surgery, performed by a surgical oncologist who specializes in removal of breast cancer through an operation, is often, but not always, the initial treatment for breast cancer. Surgical options include:

Mastectomy. A mastectomy is a complete removal of the breast. There are different types of mastectomy including a simple or total mastectomy, skin-sparing mastectomy, and nipple-sparing mastectomy. The type of mastectomy is determined based on location and extent of the cancer in the breast, as well as your breast size and whether or not you choose to have breast reconstruction.

Partial mastectomy (also called a lumpectomy). A partial mastectomy or lumpectomy is a surgical procedure to remove the breast cancer along with a surrounding margin of healthy breast tissue while preserving the majority of your healthy breast tissue. A lumpectomy surgery is typically an outpatient procedure with a shorter recovery than a mastectomy. Importantly, likelihood of curing your cancer is the same, whether the surgery is a lumpectomy or a mastectomy. Most patients who have a lumpectomy will require radiation treatments to the breast after their surgery.

Sentinel node biopsy. The sentinel lymph nodes are the lymph nodes in the armpit where breast cancer is most likely to spread IF it travels out of the breast. Most patients have 1-3 sentinel nodes. At the time of the breast surgery, the surgeon will inject a low dose radiation called Tc-99 in addition to a blue dye into the affected breast. The lymph circulation transports the Tc-99 and the dye to the sentinel nodes. A small incision is made in the armpit and the surgeon can find the nodes that have been labeled. These nodes are removed and sent for testing to look for spread of cancer. If the sentinel nodes are negative, this confirms an early localized breast cancer. If the sentinel node(s) show signs of cancer, additional treatments after surgery will be considered. In most cases, no further surgery is needed to remove more lymph nodes.

Axillary lymph node dissection. This is a surgical procedure to remove the majority of lymph nodes in the armpit when cancer has been found to have spread from the breast to the armpit nodes. Typically, 15-20 nodes are removed but the total number will vary from patient to patient. This procedure can cause long-term side effects including numbness on the back of the arm and hand and/or arm swelling. Our specialists may recommend getting systemic therapy before surgery with the goal of clearing cancer out of the lymph nodes so that and axillary dissection can be avoided.

Reconstructive surgery. Rebuilds the shape of the breast after a mastectomy. This may be done during the mastectomy or later, depending on your needs and your doctor’s recommendation.

DIEP flap reconstructive surgery. Uses fat and skin from your lower abdomen to create a new breast mound after a mastectomy.

Chemotherapy uses drugs that slow down, damage, or kill cancer cells. It may involve single drugs or combinations of drugs taken intravenously or by mouth. Chemotherapy is often taken in cycles lasting three or four weeks each. Your team may also prescribe drugs to reduce or eliminate chemotherapy’s side effects.

Radiation therapy (radiotherapy) uses X-rays and other types of medical radiation aimed at specific parts of the body. The radiation kills cancer cells, prevents cancer cells from developing or recurring, and improves many of cancer’s symptoms. For certain cancers, radiation therapy is combined with chemotherapy and called chemo-radiotherapy. It’s a very focused outpatient treatment that takes about 15 minutes from start to finish. You are never radioactive and you don’t lose your hair.

Because the presence of some hormones can cause certain cancers to grow, hormone therapy as a cancer treatment removes hormones or blocks their action to stop cancer cells from growing. Medications prescribed to block production or binding of estrogen as a treatment for breast cancer include:

Tamoxifen™: Used to prevent breast cancer from returning in women who have had treatment and show no sign of remaining cancer (remission) and to help women at high risk avoid developing breast cancer.

Aromatase inhibitors: Used to interfere with the amount of estrogen produced after menopause; limits the amount of estrogen that can cause breast cancer tumor growth.

Targeted therapies are drug treatments that help the body’s immune system fight cancer. Herceptin® is a type of biologic therapy that targets cells that produce too much of a protein called HER2. This protein is present in some breast cancer patients. Herceptin binds to the cells, shutting off HER2 production.

Immunotherapy uses substances, either made by your body naturally or made artificially, to boost your immune system. Immunotherapy can stop or slow cancer cell growth, can stop cancer cells from spreading to other parts of the body, and can help your body be more efficient at killing cancer cells.