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.
Internal radiation therapy (brachytherapy): With this type, a radiation oncologist places one or more thin tubes inside the cancerous breast, then loads a radioactive substance into the tubes. After a few minutes, the radioactive substance is removed. After a lumpectomy, your doctor may place the radioactive substance in the pocket from which the lump was removed.
It might be right for you if: You are over age 50 and you’ve had a small tumor removed by lumpectomy, with no positive lymph nodes. It may be used alone or in addition to external radiation to the whole breast.
What you should know: Some women treated with lumpectomy/brachytherapy may later require a mastectomy if it’s discovered that the original tumor had already spread to other parts of the breast.
Chemotherapy (chemo) medication can be used to shrink (and possibly eliminate) a tumor before surgery and to kill cancerous cells that remain in the body after surgery.
It might be right for you if: You have invasive breast cancer that is hormone receptor-negative, your tumor is hormone receptor-positive and you choose to have chemo along with hormone therapy, your tumor is large and your doctor wants to shrink it prior to surgery (this is called neoadjuvant therapy), you’ve had surgery and want to kill unseen cancer cells, or your cancer has spread and is now growing in other locations, such as your bones, liver or lungs.
What you should know: In most cases, chemo is administered intravenously in a procedure known as an infusion. Sometimes chemo is taken as a pill, a liquid or by injection. It’s important to stay on the chemo schedule. If you skip a treatment, cancer cells could regrow. Also, strong chemo can reduce the number of infection-fighting white blood cells called neutrophils in your body, making you vulnerable to disease. Not only can infection interfere with your chemo schedule, it can also lead to life-threatening problems. Before you begin chemo, we will evaluate what steps you can take to boost your white blood cells. If necessary, we may prescribe a medication that increases levels of neutrophils.
Estrogen can fuel the growth of some cancers. The goal of hormone therapy is to either shut down your body’s production of this hormone or to stop your tissues from using it. Drugs like tamoxifen (also known as a SERM, or selective estrogen receptor modulator) temporarily block hormone receptors, preventing estrogen from binding to them. They are standard therapy for premenopausal women who have positive estrogen receptors. Aromatase inhibitors (AIs) are used to stop estrogen production in postmenopausal women. We can also halt estrogen production by removing your ovaries or using medication (which is temporary).
It might be right for you if: You have hormone-receptor-positive breast cancer.
What you should know: Hormone therapy can lead to early menopause in premenopausal women.
Biologic targeted therapy
Biologic therapies (also called targeted therapies) zero in on a molecular trait specific to a particular kind of cancer cell. They can, for example, block the proteins that cancer cells need in order to grow, while sparing healthy cells.
It might be right for you if: Your breast cancer has a special receptor on its surface, such as HER2, that responds to a protein that stimulates cancer growth.
What you should know: Biologic therapies are often used along with chemo medications. Your doctor may check tests of heart function while you are treated with certain biological therapies.
Immunotherapy works with the body’s immune system to fight cancer. Treatments can be in pill, injection or infusion form.
It might be right for you if: Your breast tumors produce too much HER2.
What you should know: Immunotherapy may cause side effects, such as fever, chills, pain, weakness, nausea, vomiting, diarrhea, headaches and rashes.