Treatment

The most important thing to remember about your treatment is not to delay it. After you have done your homework about the tumor type, grade and other characteristics, you will have the information you need set-up a treatment plan with your doctor. Your treatment plan will likely be based on whether the cancer has traveled into the lymph nodes near your breast, the size of the primary tumor and details of pathology tests such as the tumor grade, which shows how quickly the cancer cells are dividing. Most treatment plans will include the following options:

SURGERY
Your doctor will likely recommend some type of surgery, with the goal of removing the cancer from your breast. The two types of surgery for breast cancer are lumpectomy and mastectomy. In some cases, your doctor will recommend that you receive chemotherapy, radiation or hormone therapy to reduce the tumor prior to undergoing surgery for tumor removal. This is called neoadjuvant therapy. In other cases, your doctor will recommend that you undergo surgical removal of the tumor prior to receiving chemotherapy or radiation. This is called adjuvant therapy.
Your doctor will likely recommend a complete mastectomy (the removal of the entire breast),[1] if:


• You have multiple tumors in the breast
• The cancer is in your skin
• The tumor is in the nipple area
• You had cancer before in the same breast
• You have a large tumor (5cm or larger)
• You have calcifications (calcium deposits) or other abnormal cells over a large area in your breast

Lumpectomy is one type of breast-conserving surgery which is also referred to as a partial mastectomy. During this outpatient procedure, the surgeon removes the tumor plus a small rim of normal tissue around the tumor, called a margin. As shown below, you will keep most of your breast, and you will have a scar at the incision site.lumpectomy


This type of removal is usually recommended when:

  • You have a single breast cancer tumor less than five centimeters in diameter
  • You have enough tissue so that removing surrounding tissue would not leave a misshapen breast
  • You are medically able to undergo surgery AND follow-up radiation therapy

A lumpectomy followed by radiation therapy is often considered the standard therapy for women with breast cancer who meet these criteria. Large studies have shown similar survival rates for both breast conservation with radiation and removal of the whole breast, but a lumpectomy gives a better cosmetic result.[2]

CHEMOTHERAPY
Chemotherapy works by killing cancer cells throughout the body. Sometimes it may be the only cancer treatment needed. Some chemotherapy drugs are given intravenously via tube in the vein. Others may be given by injection or taken by mouth as a pill or liquid. Some types are available as creams that you rub on your skin.


Depending on the type of chemotherapy your doctor suggests, you may need to go to the hospital or an outpatient clinic for chemotherapy. Or you may be able to take your medicine at home. How and when you receive chemotherapy depends on a number of factors, including the medicine, the type of cancer, and your health. Chemotherapy may be given every day, every week, or every month, depending on the situation. For example, you may receive one week of chemotherapy, followed by three weeks of rest. This four-week period is considered a "cycle" of chemotherapy. You may need several cycles of treatment, depending on your condition.

 RADIATION
Radiation therapy is usually given after lumpectomy and is sometimes needed after a mastectomy. If you have a BRCA mutation, you may discuss with your doctors the option of removing both breasts. Depending on where you are in your life and whether you want to have biological children, you also may consider removing your ovaries to reduce your risk of ovarian cancer. Your doctor can help you understand how these decisions impact your treatment and quality of life.

HORMONE THERAPY

There are certain hormones that can attach to breast cancer cells and affect their ability to multiply. The purpose of hormone therapy -- also called hormonal therapy or hormone treatment -- is to add, block, or remove hormones.

With breast cancer, the female hormones estrogen and progesterone can promote the growth of some breast cancer cells. So in these patients, hormone therapy is given to block the body's naturally occurring estrogen and fight the cancer's growth.

There are two types of hormone therapy for breast cancer. Drugs that inhibit estrogen and progesterone from promoting breast cancer cell growth.
Drugs or surgery to turn off the production of hormones from the ovaries.

Do not confuse the term hormone therapy that is used for treating breast cancer patients with hormone replacement therapy that is typically used by postmenopausal women. Hormone therapy for cancer treatment stops hormones from getting to breast cancer cells. Hormone therapy for postmenopausal women without cancer -- in the past called "hormone replacement therapy" -- adds more hormones to your body to counter the effects of menopause.

Please note that treatment options are constantly changing. For the most up-to-date information on treatment options, visit the American Cancer Society's website at www.cancer.org.

REFERENCES
[1] http://breastcancer.about.com/od/treatments/tp/lumpectomy_procedure.html
[2] http://www.webmd.com/breast-cancer/lumpectomyr/lumpectomy-partial-mastectomy
[3] http://www.webmd.com/breast-cancer/hormone-therapy-overview

Last Medical Review: August 2010