How is breast cancer treated?
There are several breast cancer treatment options, including surgery, chemotherapy, radiation therapy, hormone therapy, immunotherapy and targeted drug therapy. What’s right for you depends on many factors, including the location and size of the tumor, the results of your lab tests and whether the cancer has spread to other parts of your body. Your healthcare provider will tailor your treatment plan according to your unique needs. It’s not uncommon to receive a combination of different treatments, too.
Breast cancer surgery
Breast cancer surgery involves removing the cancerous portion of your breast and an area of normal tissue surrounding the tumor. There are different types of surgery depending on your situation, including:
- Lumpectomy. Also called a partial mastectomy, a lumpectomy removes the tumor and a small margin of healthy tissue around it. Typically, some of the lymph nodes — in your breast or under your arm — are also removed for evaluation. People who have a lumpectomy often have radiation therapy in the weeks following the procedure.
- Mastectomy. Removal of your entire breast is another option. In some cases, doctors can perform a nipple-sparing mastectomy to preserve your nipple and areola (the dark skin around your nipple). Many women choose to undergo either immediate or delayed breast reconstruction following their mastectomy.
- Sentinel node biopsy. Because early detection of breast cancer has resulted in the lymph nodes being negative (for cancer) in most cases, the sentinel node biopsy was developed to prevent the unnecessary removal of large numbers of lymph nodes that aren’t involved by the cancer. To identify the sentinel lymph node, doctors inject a dye that tracks to the first lymph node that cancer would spread to. If that lymph node is cancer-free, then other lymph nodes don’t need to be removed. If that lymph node has cancer in it, it may be necessary to remove additional lymph nodes. Often, there’s more than one sentinel node identified, but the fewer lymph nodes removed the lower the chance of developing swelling in your arm (lymphedema). A sentinel lymph node biopsy can be done with either a lumpectomy or a mastectomy.
- Axillary lymph node dissection. If multiple lymph nodes are involved by the cancer, an axillary lymph node dissection may be done to remove them. This means removing many of the lymph nodes under your arm (your axilla).
- Modified radical mastectomy. During this procedure, your entire breast is removed in addition to your nipple. Nearby lymph nodes in your underarm area are also removed, but your chest muscles are left intact. Breast reconstruction can often be an option if desired.
- Radical mastectomy. This procedure is rarely performed today unless the breast cancer has spread to your chest wall muscles. During a radical mastectomy, your surgeon removes your entire breast, your nipple, underarm lymph nodes and chest wall muscles. People who undergo this procedure may choose to have breast reconstruction as well.
Chemotherapy for breast cancer
Your healthcare provider may recommend chemotherapy for breast cancer before a lumpectomy in an effort to shrink the tumor. Sometimes, it’s given after surgery to kill any remaining cancer cells and reduce the risk of recurrence (coming back). If the cancer has spread beyond your breast to other parts of your body, then your healthcare provider may recommend chemotherapy as a primary treatment.
Radiation therapy for breast cancer
Radiation therapy for breast cancer is typically given after a lumpectomy or mastectomy to kill remaining cancer cells. It can also be used to treat individual metastatic tumors that are causing pain or other problems.
Hormone therapy for breast cancer
Some types of breast cancer use hormones — such as estrogen and progesterone — to grow. In these cases, hormone therapy can either lower estrogen levels or stop estrogen from attaching to breast cancer cells. Most often, healthcare providers use hormone therapy after surgery to reduce the risk of breast cancer recurrence. However, they may also use it before surgery to shrink the tumor or to treat cancer that has spread to other parts of your body.
Immunotherapy for breast cancer
Immunotherapy uses the power of your own immune system to target and attack breast cancer cells. Treatment is given intravenously (through a vein in your arm or hand). Your healthcare provider might use immunotherapy for breast cancer in combination with chemotherapy.
Targeted drug therapy for breast cancer
Some drugs can target specific cell characteristics that cause cancer. Your healthcare provider might recommend targeted drug therapy in cases where breast cancer has spread to other areas of your body. Some of the most common drugs used in breast cancer treatment include monoclonal antibodies (like trastuzumab, pertuzumab and margetuximab), antibody-drug conjugates (like ado-trastuzumab emtansine and fam-trastuzumab deruxtecan) and kinase inhibitors (such as lapatinib, neratinib and tucatinib).
How is breast cancer diagnosed?
Your healthcare provider will perform a breast examination and ask about your family history, medical history and any existing symptoms. Your healthcare provider will also recommend tests to check for breast abnormalities. These tests may include:
- Mammogram. These special X-ray images can detect changes or abnormal growths in your breast. A mammogram is commonly used in breast cancer prevention.
- Ultrasonography. This test uses sound waves to take pictures of the tissues inside of your breast. It’s used to help diagnose breast lumps or abnormalities.
- Positron emission tomography (PET) scanning: A PET scan uses special dyes to highlight suspicious areas. During this test, your healthcare provider injects a special dye into your veins and takes images with the scanner.
- Magnetic resonance imaging (MRI): This test uses magnets and radio waves to produce clear, detailed images of the structures inside of your breast.
If your healthcare provider sees anything suspicious on the imaging tests, they may take a biopsy of your breast tissue. They’ll send the sample to a pathology lab for analysis.
What are the breast cancer stages?
Staging helps describe how much cancer is in your body. It’s determined by several factors, including the size and location of the tumor and whether the cancer has spread to other areas of your body. The basic breast cancer stages are:
- Stage 0. The disease is non-invasive. This means it hasn’t broken out of your breast ducts.
- Stage I. The cancer cells have spread to the nearby breast tissue.
- Stage II. The tumor is either smaller than 2 centimeters across and has spread to underarm lymph nodes or larger than 5 centimeters across but hasn’t spread to underarm lymph nodes. Tumors at this stage can measure anywhere between 2 to 5 centimeters across, and may or may not affect the nearby lymph nodes.
- Stage III. At this stage, the cancer has spread beyond the point of origin. It may have invaded nearby tissue and lymph nodes, but it hasn’t spread to distant organs. Stage III is usually referred to as locally advanced breast cancer.
- Stage IV. The cancer has spread to areas away from your breast, such as your bones, liver, lungs or brain. Stage IV breast cancer is also called metastatic breast cancer.
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