Breast cancer treatments include surgery, radiation therapy and medicines. Medicines used to treat breast cancer include estrogen blocker therapy, chemotherapy, targeted therapy and immunotherapy.
For early-stage breast cancers, treatment often starts with surgery to remove the cancer. Many people have other treatments after surgery, such as radiation and medicines. Some people receive medicines before surgery.
When breast cancer is found early, it often can be cured. A cure is less likely when the cancer spreads to other parts of the body.
If the cancer spreads, treatment usually starts with medicines. Medicines can slow the growth of the cancer and help you live longer. If the first treatment stops working, the care team may adjust the medicines or try new medicines. Newer treatments and personalized treatment approaches are helping many people live longer with advanced breast cancer.
Your treatment plan depends on your particular breast cancer. Your healthcare team considers the stage of the cancer, how quickly it's growing, whether the cancer cells are sensitive to hormones and whether the cells make extra HER2. Your care team also considers your overall health and what you prefer.
Here's how aspects of your cancer may affect your treatment options:
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Ductal versus lobular. Invasive lobular carcinomas are more likely to be hormone receptor (HR) positive and HER2 negative, so these cancers usually are treated with estrogen blocker therapy. Invasive ductal carcinomas vary more in their HR status and HER2 status.
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Low grade versus high grade. Low-grade cancers are likely to be HR positive. They are more likely to be treated with estrogen blocker therapy. High-grade cancers are more likely to be treated with chemotherapy.
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HR positive versus HR negative. The HR status tells the healthcare team whether estrogen blocker therapy might work against the cancer. HR positive cancers, including estrogen receptor positive breast cancers, are treated with estrogen blocker therapy. HR negative cancers usually are not.
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HER2 positive versus HER2 negative. HER2 positive cancers often are treated with anti-HER2 targeted therapy. HER2 negative cancers usually aren't. Some cancers have a low level of HER2 but not enough to be called positive. These cancers are called HER2 low. They are sometimes treated with medicines used for HER2 positive cancer.
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Triple-negative cancer. Triple-negative breast cancer is HR negative and HER2 negative. Estrogen blocker therapy and anti-HER2 therapy generally aren't used for this cancer. It's more likely to be treated with chemotherapy and immunotherapy medicines.
There are many options for breast cancer treatment. You don't have to make these decisions on your own. Your healthcare team can help explain your options and work with you to choose a treatment plan that fits your needs and goals. Consider seeking a second opinion from a breast specialist in a breast center or clinic. Some people also find it helpful to talk with others who have faced similar breast cancer treatment decisions.
Breast cancer surgery
Breast cancer surgery typically involves a procedure to remove the breast cancer and, sometimes, a procedure to remove some nearby lymph nodes. The main surgical procedures used to treat breast cancer include:
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Lumpectomy. A lumpectomy is surgery to remove the breast cancer and some of the healthy tissue around it. It allows you to maintain most of your breast. Other names for this surgery are breast-conserving surgery and wide local excision. Most people have radiation therapy after lumpectomy.
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Mastectomy. A mastectomy is surgery to remove all breast tissue from a breast. Total mastectomy, also called simple mastectomy, removes all of the breast, including the lobules, ducts, fatty tissue and some skin, including the nipple and areola. Other procedures include skin-sparing mastectomy, which leaves the skin, and nipple-sparing mastectomy, which leaves the areola, nipple and skin.
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Lymph node surgery. Lymph node surgery removes nearby lymph nodes to check them for cancer. When breast cancer spreads, it most often goes to the lymph nodes under the arm. A sentinel node biopsy removes some of those lymph nodes for testing. An axillary lymph node dissection removes most of the underarm lymph nodes.
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Double mastectomy. Some people who have cancer in one breast may choose to have their other breast removed, even if it doesn't have cancer. Removing both breasts during the same surgery is called a double mastectomy. It might be an option if you have a high risk of getting cancer in the other breast. The risk might be high if you have a strong family history of cancer or have DNA changes that increase the risk of cancer.
Complications of breast cancer surgery depend on the procedures you choose. All operations have a risk of pain and infection. Removing lymph nodes in the armpit carries a risk of arm swelling, called lymphedema.
You may choose to have breast reconstruction after mastectomy surgery. Breast reconstruction is surgery to restore shape to the breast. Options might include reconstruction with a breast implant or reconstruction using your own tissue. Consider asking your healthcare team for a referral to a plastic surgeon before your breast cancer surgery.
Radiation therapy
Radiation therapy treats cancer with powerful energy beams. The energy can come from X-rays, protons or other sources.
Radiation therapy for breast cancer often uses external beam radiation. During this type of radiation therapy, you lie on a table while a machine moves around you. The machine directs radiation to precise points on your body.
Radiation therapy is often used after breast cancer surgery. It can kill any cancer cells that might be left after surgery. The radiation lowers the risk of the cancer coming back.
Side effects of radiation therapy include feeling very tired and having a sunburnlike rash where the radiation is aimed. The breast may be painful or feel more firm.
Chemotherapy
Chemotherapy treats cancer with strong medicines. Many chemotherapy medicines exist. Chemotherapy for breast cancer often involves a combination of chemotherapy medicines. Most are given through a vein. Some are available in pill form.
Chemotherapy for breast cancer is often used after surgery. It can kill any cancer cells that might remain and lower the risk of the cancer coming back.
Sometimes chemotherapy is given before breast cancer surgery. This may help shrink the cancer so that surgery is possible or so that you might consider a less invasive surgery. It also gives the care team a chance to see how well the medicines work.
When the cancer spreads to other parts of the body, chemotherapy may help control it.
Chemotherapy side effects depend on which medicines you receive. Common side effects include hair loss, nausea, feeling very tired and mouth sores.
Estrogen blocker therapy
Estrogen blocker therapy treats breast cancer that is sensitive to hormones. This means the cancer cells have proteins called receptors. The receptors bind to the hormones estrogen and progesterone. The cancer grows in response to these hormones. Healthcare professionals call these cancers hormone receptor positive. Most breast cancers are sensitive to hormones.
Estrogen blocker therapy also is called endocrine therapy and hormone therapy for breast cancer.
Estrogen blocker therapy treatments can include:
- Medicines that block or destroy hormone receptors. These medicines are called selective estrogen receptor modulators.
- Medicines that lower hormone production. These medicines are called aromatase inhibitors.
- Surgery or medicines to stop the ovaries from making hormones.
Estrogen blocker therapy often is used after surgery and other treatments. It can lower the risk that the cancer will come back.
If the cancer spreads to other parts of the body, estrogen blocker therapy can help control it.
Estrogen blocker therapy side effects depend on the treatment you receive. The side effects can include hot flashes and night sweats.
Targeted therapy
Targeted therapy uses medicines that attack specific chemicals in the cancer cells. By blocking these chemicals, targeted treatments can cause cancer cells to die.
Some treatments target cancer cells that make extra HER2. Breast cancer that makes extra HER2 is called HER2 positive breast cancer. Other targeted therapy medicines attack other proteins in the body that help cancer cells grow. Your cancer cells may be tested to see whether these medicines might help you.
Targeted therapy medicines may be used before surgery to shrink the cancer and make it easier to remove. Some are used after surgery to lower the risk that the cancer will come back. Others are used only when the cancer has spread to other parts of the body.
Side effects of targeted therapy differ greatly by the medicine. In general, this treatment can cause diarrhea, mouth sores and nail changes. There also can be changes in how well the liver works.
Immunotherapy
Immunotherapy is a treatment with medicine that helps the body's immune system kill cancer cells. The immune system fights off diseases by attacking germs and other cells that shouldn't be in the body. Cancer cells survive by hiding from the immune system. Immunotherapy helps the immune system cells find and kill the cancer cells.
Immunotherapy might be an option for treating cancer that's triple negative. Triple-negative breast cancer means that the cancer cells don't have hormone receptors and don't make extra HER2. This treatment may be used before and after surgery.
Immunotherapy side effects include diarrhea, feeling very tired and rash.
Palliative care
Palliative care is a special type of healthcare that helps you feel better when you have a serious illness. If you have cancer, palliative care can help relieve pain and other symptoms. A team of healthcare professionals gives palliative care. This team can include doctors, nurses and other specially trained health professionals. Their goal is to improve the quality of life for you and the people who care about you.
Palliative care specialists work with you, your family and your healthcare team to help you feel better. They provide added support while you have cancer treatment. You can have palliative care at the same time as treatment for cancer, such as surgery, chemotherapy or radiation therapy.
When palliative care is used with other appropriate treatments, people with cancer may feel better and live longer.