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Once you’ve received the sobering news that you’ve been diagnosed with breast cancer, the next step is to discuss a personalized breast cancer treatment plan with your medical team. Your doctor’s recommendations will involve many factors, including your age, medical history, the type, location, and size of the cancer, and how aggressively it’s growing and/or spreading. He or she will also take into consideration your personal preferences.
These days, there are numerous breast cancer treatment options—each with their own benefits, risks, and side effects. Each option can be categorized into two types: local and systemic. Local treatments can possibly remove the tumor without affecting the rest of the body, while systemic treatments involve administering medications that can fight cancer cells throughout the entire body. First, let’s take a look at local treatments followed by systemic treatments.
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Local Breast Cancer Treatment Options
Doctors perform two main types of surgery to remove breast cancer from their patients: breast-conserving surgery and mastectomy.
The goal of breast-conserving surgery, which is also known as a lumpectomy, quadrantectomy, partial mastectomy or segmental mastectomy, is to remove the cancer and some of the surrounding normal tissue without removing the breast entirely. The amount of breast tissue to be removed depends on various factors, including the size and location of the tumor.
Depending on recommendations made by an oncologist, breast-conserving surgery may be a good option if you:
- Are concerned about losing your breasts
- Are a good candidate for radiation treatment
- Have not already had previous radiation or breast-conserving surgery
- Have a tumor that is 2 inches or smaller or a tumor that is small relative to your breast size
- Don’t have inflammatory breast cancer
- Don’t have genetic factors that might increase the chance of the cancer returning
- are not pregnant
- Have only one tumor in the breast or multiple tumors that are close together and can be removed simultaneously.
- Don’t have a connective tissue disease, such as scleroderma or lupus
Side effects following surgery can include pain, tenderness, temporary swelling, scar tissue, changes in the shape of the breast, and neuropathic pain.
Once surgery is complete, a pathologist will check to see if there are any cancer cells at the edges of the removed tissue. If a second surgery to remove additional tissue isn’t needed, most women will begin radiation therapy, hormone therapy, or chemotherapy. Some may also choose to have breast reconstruction surgery to address any significant differences in their appearance afterwards.
What’s Involved with a Mastectomy?
The goal of a mastectomy is to treat breast cancer by removing the entire breast. A mastectomy might be recommended if you:
- Prefer a more aggressive approach to your breast cancer treatment
- Are unable to have radiation treatment or have been treated with radiation in the past
- Are pregnant
- Have a tumor larger than 2 inches or a tumor that is large relative to your breast size
- Have had more than two breast-conserving surgeries that did not remove the cancer
- Have two or more tumors in the same breast that are not close enough to be removed simultaneously
- Have inflammatory breast cancer
- Have a genetic factor that might increase your chances of the cancer returning
- Have a connective tissue disease, such as scleroderma or lupus
There are several different types of mastectomies that your doctor will recommend depending on various factors, including how much tissue needs to be removed:
- Simple (or total): The entire breast, including nipple, areola, and skin is removed.
- Skin-sparing: Most of the skin over the breast is left intact.
- Nipple-sparing: The nipple and skin are left in place.
- Modified radical: A simple mastectomy is combined with the removal of lymph nodes under the arm.
- Radical: A “modified radical” procedure is combined with the removal of the pectoral muscles under the breast.
- Double: Both breasts are removed. Most of these performed as simple mastectomies, but some may be nipple-sparing.
BREAST CANCER TREATMENT PATTERN BY STAGE
According to the American Cancer Society, women in the U.S. with invasive breast cancer in 2013 underwent the following treatments depending on the stage of their cancer:
Stages I and II
- BCS and radiation: 34%
- BCS, radiation and chemotherapy: 17%
- Mastectomy alone: 17 %
- Mastectomy and chemotherapy: 12%
- Mastectomy, radiation, and chemotherapy: 48%
- BCS, radiation, and chemotherapy: 15%
- Mastectomy and chemotherapy: 13%
- Mastectomy alone: 7%
- Radiation and/or chemotherapy: 48%
- No surgery, radiation or chemotherapy: 21%
- Mastectomy and chemotherapy: 7 percent
- Mastectomy, radiation and chemotherapy: 7 percent
Side effects after surgery can include pain, tenderness, swelling, blood, and/or fluid build-up, limited arm or shoulder movement, numbness in the upper arm or chest, and neuropathic pain. Some women follow up surgery up with radiation therapy, hormone therapy, chemotherapy, or targeted therapy.
What Is Radiation Therapy?
Aside from surgery, radiation therapy is the other main type of local breast cancer treatment. The treatment involves the use of high-energy rays or particles to destroy cancer cells. Radiation therapy is administered in two ways:
- External beam radiation, where the radiation is administered from a machine outside of the body
- Internal radiation, where a radioactive source is placed inside of the body for a limited amount of time.
For external beam radiation, the length of the therapy depends on whether you’ve had BCS or a mastectomy and whether or not the cancer has spread to other parts of the body. The average length of treatment is five to six weeks. However, some women may qualify for less or more aggressive therapy. For internal radiation, treatments are typically given twice a day for five days during an outpatient procedure.
Possible side of effects of radiation therapy can include pain, swelling, fatigue, skin changes, infection, fatty tissue damage, and bruising.
Systemic Breast Cancer Treatment Options
The three main types of systemic breast cancer treatment options are chemotherapy, hormone therapy, and targeted therapy.
Chemotherapy involves administering anti-cancer drugs into the system intravenously or orally to reach and kill cancer cells in most parts of the body. Your doctor may recommend chemotherapy before surgery to shrink a tumor before removing it or after surgery to kill any cancer cells that may have been left behind. Chemotherapy is often most effective when multiple drugs are used, but advanced breast cancer is sometimes treated with single drugs.
Chemotherapy is often administered in cycles that last two to three weeks followed by a rest period over a period of three to six months. The length of treatment may be shorter or longer depending on how well it’s working and what side effects the patient experiences.
Possible side effects can include nausea and vomiting, loss of appetite, hair loss, mouth sores, and diarrhea. It can also increase your risk of infection, as well as fatigue and bleeding. Long-term side effects of chemotherapy can include menstrual changes, fertility issues, heart damage, nerve damage, hand-foot syndrome, cognitive issues, and increased risk of leukemia.
Hormone therapy is used on patients with breast cancers that are hormone receptor-positive, which means that they are affected by hormones in the blood. The goal of hormone therapy is to stop estrogen from attaching to the receptors in ER-positive and PR-positive breast cancer cells.
The following medications are commonly used to lower or stop estrogen levels in the body:
- Aromatase inhibitors
Some pre-menopausal women choose ovarian suppression instead of or in addition to hormone therapy by removing or shutting down the ovaries, which makes them post-menopausal.
Targeted therapy involves using medication to block the growth of cancer cells as opposed to using chemotherapy, which attacks all quick-growing cells. This therapy is often used to treat HER2-positive breast cancers, which tend to grow and spread aggressively.
The following drugs are designed to target the HER2 proteins that help cancer cells to grow:
Side effects of targeted therapy can include leg swelling, shortness of breath, fatigue, leg swelling, severe diarrhea, hand-foot syndrome, and heart damage.
Some women with hormone receptor-positive breast cancer may be advised to combine both hormone therapy and targeted therapy using CDK4/6 inhibiting drugs, such as palbociclib, ribociclib, and abemaciclib. There is also targeted therapy treatment options for women with BRCA gene mutations.
What About Triple-Negative Breast Cancer Treatment?
If you’re diagnosed with triple-negative breast cancer, this means that the cancer cells don’t have hormone receptors or the HER2 protein, which means that common hormone and targeted therapies would not be effective.
Triple-negative breast cancer, which often spreads faster than other breast cancer types, is often treated with chemotherapy, radiation and/or non-HER2 targeted therapy.
CHOOSING THE RIGHT TREATMENT PLAN
Once you’ve discussed your options with your medical team, you’ll want to ask yourself these important questions before making a final decision:
- Do I understand all of the information that was given to me?
- Do I have additional questions?
- Am I confident in my team’s ability to treat me?
- Do I have time to get a second opinion?
- Have I considered or asked about any alternative or complementary treatments?
- Should I consider joining a clinical trial?
- Do I have a solid support system?