Methods of treating breast cancer

Breast cancer may be treated with local or systemic therapy. Some patients have both kinds of treatment.

Local therapy is used to remove or destroy breast cancer in a specific area. Surgery and radiation therapy are local treatments. They are used to treat the disease in the breast. When breast cancer has spread to other parts of the body, local therapy may be used to control cancer in those specific areas, such as in the lung or bone.

Systemic treatments are used to destroy or control cancer throughout the body. Chemotherapy, hormonal therapy, and biological therapy are systemic treatments. Some patients have systemic therapy to shrink the tumor before local therapy. Others have systemic therapy to prevent the cancer from coming back, or to treat cancer that has spread.

Surgery is the most common treatment for breast cancer, and there are several types of surgery. The doctor can explain each type, discuss and compare their benefits and risks, and describe how each will affect the patient’s appearance.

An operation to remove the cancer but not the breast is called breast-sparing surgery or breast-conserving surgery. Lumpectomy and segmental mastectomy (also called partial mastectomy) are types of breast-sparing surgery. After breast-sparing surgery, most women receive radiation therapy to destroy cancer cells that remain in the area.

An operation to remove the breast (or as much of the breast as possible) is a mastectomy. Breast reconstruction is often an option at the same time as the mastectomy, or later on.

In most cases, the surgeon also removes lymph nodes under the arm to help determine whether cancer cells have entered the lymphatic system. This is called an axillary lymph node dissection.

In lumpectomy, the surgeon removes the breast cancer and some normal tissue around it. (Sometimes an excisional biopsy serves as a lumpectomy.) Often, some of the lymph nodes under the arm are removed.

In segmental mastectomy, the surgeon removes the cancer and a larger area of normal breast tissue around it. Occasionally, some of the lining over the chest muscles below the tumor is removed as well. Some lymph nodes under the arm may also be removed.

In total (simple) mastectomy, the surgeon removes the whole breast. Some lymph nodes under the arm may also be removed.

In modified radical mastectomy, the surgeon removes the whole breast, most of the lymph nodes under the arm, and, often, the lining over the chest muscles. The smaller of the two chest muscles also may be taken out to help in removing the lymph nodes.

In radical mastectomy (also called Halsted radical mastectomy), the surgeon removes the breast, both chest muscles, all of the lymph nodes under the arm, and some additional fat and skin. For many years, this operation was considered the standard one for women with breast cancer, but it is almost never used today. In rare cases, radical mastectomy may be suggested if the cancer has spread to the chest muscles.

Here are some questions a woman may want to ask her doctor before having surgery:

  • What kinds of surgery can I consider? Is breast-sparing surgery an option for me? Which operation do you recommend for me? What are the risks of surgery?
  • Should I store some of my own blood in case I need a transfusion?
  • Do I need my lymph nodes removed? How many? Why? What special precautions will I need to take if lymph nodes are removed?
  • How will I feel after the operation?
  • Will I need to learn how to do special things to take care of myself or my incision when I get home?
  • Where will the scars be? What will they look like?
  • If I decide to have plastic surgery to rebuild my breast, how and when can that be done? Can you suggest a plastic surgeon for me to contact?
  • Will I have to do special exercises?
  • When can I get back to my normal activities?
  • Is there someone I can talk with who has had the same treatment I’ll be having?

Breast reconstruction (surgery to rebuild the shape of a breast) is often an option after mastectomy. Women considering reconstruction should discuss this with a plastic surgeon before having a mastectomy.

Radiation therapy (also called radiotherapy) is the use of high-energy rays to kill cancer cells. The radiation may be directed at the breast by a machine (external radiation). The radiation can also come from radioactive material placed in thin plastic tubes that are placed directly in the breast (implant radiation). Some women have both kinds of radiation therapy.

For external radiation therapy, the patient goes to the hospital or clinic, generally 5 days a week for several weeks. For implant radiation, a patient stays in the hospital. The implants remain in place for several days. They are removed before the woman goes home.

Sometimes, depending on the size of the tumor and other factors, radiation therapy is used after surgery, especially after breast-sparing surgery. The radiation destroys any breast cancer cells that may remain in the area.

Before surgery, radiation therapy, alone or with chemotherapy or hormonal therapy, is sometimes used to destroy cancer cells and shrink tumors. This approach is most often used in cases in which the breast tumor is large or not easily removed by surgery.

Before having radiation therapy, a patient may want to ask her doctor these questions:

  • Why do I need this treatment?
  • What are the risks and side effects of this treatment?
  • Are there any long-term effects?
  • When will the treatments begin? When will they end?
  • How will I feel during therapy?
  • What can I do to take care of myself during therapy?
  • Can I continue my normal activities?
  • How will my breast look afterward?
  • What are the chances that the tumor will come back in my breast?

Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy for breast cancer is usually a combination of drugs. The drugs may be given in a pill or by injection. Either way, the drugs enter the bloodstream and travel throughout the body.

Most patients have chemotherapy in an outpatient part of the hospital, at the doctor’s office, or at home. Depending on which drugs are given and her general health, however, a woman may need to stay in the hospital during her treatment.

Hormonal therapy keeps cancer cells from getting the hormones they need to grow. This treatment may include the use of drugs that change the way hormones work, or surgery to remove the ovaries, which make female hormones. Like chemotherapy, hormonal therapy can affect cancer cells throughout the body.

Biological therapy is a treatment designed to enhance the body’s natural defenses against cancer. For example, Herceptin (trastuzumab) is a monoclonal antibody that targets breast cancer cells that have too much of a protein known as human epidermal growth factor receptor-2 (HER-2). By blocking HER-2, Herceptin slows or stops the growth of these cells. Herceptin may be given by itself or along with chemotherapy.

Patients may want to ask these questions about systemic therapy (chemotherapy, hormonal therapy, or biological therapy):

  • Why do I need this treatment?
  • If I need hormonal treatment, which would be better for me, drugs or an operation?
  • What drugs will I be taking? What will they do?
  • Will I have side effects? What can I do about them?
  • How long will I be on this treatment?

National Cancer Institute (NCI)