Several Breast Cancer Treatment

There are several forms of treatment offered for breast cancer: surgery, radiation therapy, chemotherapy, hormonal therapy and biologic therapy. Often, more than one treatment is used.

Surgical procedures

• Lumpectomy: A surgeon removes a “lump” of tissue that contains the breast cancer with a small margin of normal-appearing tissue.

• Total (simple) mastectomy: The surgeon removes the breast. No lymph nodes or muscle tissue are removed.

• Modified radical mastectomy: The surgeon removes the breast and does a sentinel node procedure or removes some of the axillary (underarm) lymph nodes.

• Radical mastectomy: Once the standard operation, radical mastectomy is rarely performed because it causes disfigurement. In addition to removing the breast, the surgeon also removes the chest muscles and all the lymph nodes under the arm. Modified radical mastectomy is as effective as the radical mastectomy and leaves the chest wall muscles intact.

• Lymph node dissection: Often the cancer first spreads (metastasizes) to nearby lymph nodes. An axillary (underarm) lymph node dissection is the removal of lymph nodes on the same side as the breast cancer to determine if the breast cancer has spread to these lymph nodes and to prevent spread to other organs. Lymph node dissection is done:
  • If the surgeon sees that the breast tumor invades surrounding tissue.
  • If the pathologist finds cancer cells in normal-appearing tissue next to the tumor.

• Sentinel node biopsy: This is a procedure for removing only a small part of the axillary (underarm) lymph nodes in order to avoid doing an entire lymph node dissection. The surgeon injects either blue dye or a radioactive substance that drains down the lymph vessels taking the same path that cancer cells would take. If the cancer has spread to the sentinel node, a complete lymph node dissection is done. This procedure is only done in some cases, especially for small tumors but is becoming the standard of practice.

Radiation therapy

Radiation therapy uses high-dose x-rays to kill cancer cells or keep them from dividing and growing. It is used after surgery (adjuvant radiation) to try to decrease the chance of recurrence of the cancer in the breast or chest where the cancer was originally removed. It is also used in patients with breast cancer that has spread (metastasized) to distant sites (such as bone) to decrease symptoms (such as pain) caused by the cancer.

Chemotherapy

Using anti-cancer drugs to kill or stop the growth of cancer cells. Chemotherapy is given intravenously or orally, in pill form.

Hormonal therapy

A lab test can identify tumors with cells that grow and proliferate in response to the body’s hormones, estrogen and progesterone. These tumors are said to be “ER/PR (estrogen receptor/progesterone receptor) positive.” In such cases, drugs such as tamoxifen, aromatase inhibitors (such as anastrozole or letrozole) and similar agents are helpful.

Biological therapy

Biologic therapy is the use of special drugs that are designed to target proteins or molecules in a cancer cell that cause it to grow out of control. Biologic therapy has lesser and different side effects than chemotherapy. Biologic therapy includes monoclonal antibodies. Trastuzumab (Herceptin®), a monoclonal antibody, has been shown in clinical trials to be an effective drug in treating breast cancer. Monoclonal antibodies are often used in combination with chemotherapy.

Staging breast cancer

The tumor size and behavior (whether it is invasive or has spread) are features used to “stage” cancer. The treatment plan is based on the “stage” of breast cancer as well as the patient’s health status and age. Early stage breast cancer (stages 0, I, II) is first treated by surgically removing all visible tumors. Radiation therapy, and possibly chemotherapy, hormonal treatment and biologic therapy, may follow surgery to eliminate any remaining cancer cells and prevent recurrence. Sometimes, chemotherapy or hormonal therapy may be given before surgery to try to shrink the tumor. Advanced stage breast cancer has spread to other organs and is usually treated with a mastectomy (removal of breast tissue) followed by radiation, chemotherapy, hormonal therapy and/or biological therapy.

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