Breast cancer treatment may include surgery, radiation therapy, chemotherapy or hormone therapy – or any combination of these procedures. Your doctor will explain your options based on the type of cancer diagnosed and the degree to which it has spread.
The size of the tumor, along with the type and stage of the cancer, will determine the surgery your doctor recommends. The two most common surgical treatments for breast cancer are lumpectomy and mastectomy.
A lumpectomy is the simplest type of breast surgery. The part of the breast with the cancerous tissue plus a margin of normal tissue is removed. A sample of the lymph nodes may be taken to check for the possible spread of cancer. A lumpectomy is usually followed by radiation therapy.
A modified radical mastectomy removes the entire breast, nipple and all of the fatty glandular tissue, but the major chest muscles are left intact. Additionally, a sample of the lymph nodes under the arm may be taken to determine if the cancer has spread.
About two-thirds of all breast cancers depend on hormones produced by the body for continued growth. During an evaluation of the biopsy tissue, a section of the tumor is evaluated to determine how receptive it is to the hormones estrogen and progesterone. These tests, called assays, determine if the tumor is hormone-dependent (or estrogen and progesterone receptor positive).
If the tumor is hormone-dependent, your doctor may recommend hormone therapy, such as Tamoxifen.
Women with family members who have had breast cancer or women who have had atypical cells noted on a previous breast biopsy, are considered at increased risk for breast cancer. Some of these women may desire chemoprevention, or Tamoxifen. Your doctor can talk to you about this treatment option.
Radiation therapy is recommended for many patients with breast cancer. The extent of the disease will determine the type of radiation therapy required. For patients who undergo limited breast surgery (lumpectomy only), radiation treatments are typically recommended as part of a breast conservation treatment. Radiation can also be used before surgery and after a mastectomy. It also is effective for patients with locally advanced disease, positive lymph nodes, or metastatic disease.
In the past, chemotherapy involved the use of medication to treat breast cancer cells that could not be removed surgically or treated by radiation because they had entered the blood stream.
Today, chemotherapy can involve one or more medications given at different intervals, depending on the selected medication and the extent of the cancer’s spread. Chemotherapy may be used after a breast cancer diagnosis but before the woman undergoes definitive surgery. Chemotherapy is highly individualized. At times patients may need a tissue marker to identify the tumor. This is done with image guidance in radiology, which is commonly referred to as a clip placement.
Chemotherapy typically has been used when the cancer has spread to the lymph nodes. New uses of chemotherapy are emerging, thanks to continuing research.
Breast cancer can have profound physical and emotional impact on women and their families. Support groups and counseling services are widely available and many people draw great strength and comfort from them.