Breast Cancer: Understanding Your Treatment Options
Cancer treatment is now highly customized—with no two women undergoing the same exact regimen. To determine the treatment plan best suited to your specific cancer, we will look at a number of variables, things like your age, general health and menopausal status; the stage and grade of your cancer; the number of receptors for the hormones estrogen and progesterone; and the amount of growth-promoting protein called HER2/neu (often shortened to HER2).
There are two types of cancer treatment, local and systemic. Local treatments are targeted to just the area with the cancer, in your case the breast and surrounding regions, such as lymph nodes. Systemic treatments target your entire body, and may be given after local treatment (adjuvant therapy) or before (neoadjuvant therapy). Adjuvant therapy is used to kill any undetected cancer cells that may have survived the original treatment. Here are your options for both:
There are two surgical options:
Lumpectomy: A surgeon removes the cancerous lump, plus a small border of surrounding tissue.
It might be right for you if: You have one tumor and it’s small enough that removing it will not affect the shape of your breast.
What you should know: Lumpectomy is nearly always followed by radiation to reduce the chance of a local recurrence. You may also undergo chemo before or after the surgery.
Mastectomy: The surgeon makes an incision and removes the glandular tissue of the breast, the nipple and some of the skin. When reconstruction is planned, the surgeon may make a smaller incision and preserve most of the skin. There are some specific situations in which the nipple and areola of the breast might also be able to be preserved.
It might be right for you if: Your tumor is large compared to the size of your breast, there is cancer in more than one area of your breast, you’re in the early stages of pregnancy, you have had breast cancer in the past or chest wall radiation for a childhood cancer, or you have an active medical issue that might make radiation risky.
What you should know: In a total (simple) mastectomy, only the breast is removed (possibly the sentinel lymph node). In a modified radical mastectomy, several underarm lymph nodes are also removed.
Radiation therapy is a common follow-up treatment for people with breast cancer. It uses high-energy radiation to shrink tumors and kill cancer cells. The choices include:
Standard external beam radiation therapy: This type of radiation is delivered in the form of high-powered energy beams, such as X-rays, to your entire breast from a machine outside your body.
It might be right for you if: You’ve had a lumpectomy as part of breast conservation, or a mastectomy for a large tumor with positive margins and more than four axillary nodes involved and you want to reduce your chances of recurrence; or to target sites if your cancer has metastasized.
What you should know: Treatments are commonly done each weekday for five to six weeks, although a three-week treatment period using larger doses of radiation is also possible. The area to be treated is “mapped,” then radiation beams are directed at it.