Treatment

How Is Breast Cancer Treated?

The treatment information in this document is not official policy of the Society and is not intended as medical advice to replace the expertise and judgment of your cancer care team. It is intended to help you and your family make informed decisions, together with your doctor. Your doctor may have reasons for suggesting a treatment plan different from these general treatment options. Don't hesitate to ask him or her questions about your treatment options.

Local vs. Systemic Treatment

The purpose of local treatment is to treat a tumor without affecting the rest of the body. Surgery and radiation are examples of local treatment.

Systemic treatment is given into the bloodstream or by mouth to go throughout the body and reach cancer cells that may have spread beyond the breast. Chemotherapy, hormone therapy, and immunotherapy are systemic treatments.

Adjuvant and Neoadjuvant Therapy

When people who seem to have no cancer left after surgery are given more treatment it is referred to as adjuvant therapy. Doctors now think that cancer cells can break away from the main tumor and begin to spread through the bloodstream in the early stages of the disease. It’s very hard to tell if this has happened. But if it has, the cancer cells can start new tumors in other organs or the bones. The goal of adjuvant therapy is to kill these hidden cells. But not every patient needs adjuvant therapy.

Some people are given systemic treatment (most likely chemotherapy) before surgery to shrink a tumor. This is called neoadjuvant therapy.

Surgery for Breast Cancer

Most women with breast cancer will have some type of surgery to treat the main breast tumor. The purpose of surgery is to remove as much of the cancer as possible. Surgery can also be done to find out whether the cancer has spread to the lymph nodes under the arm (axillary dissection), to restore the breast's appearance after a mastectomy (mas-tek-tuh-me), or to relieve symptoms of advanced cancer. The following is a summary of some of the most common types of breast cancer surgery.

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Radiation Therapy

Radiation therapy is treatment with high-energy rays (such as x-rays) to kill cancer cells and shrink tumors. This treatment may be used to kill any cancer cells that remain in the breast, chest wall, or underarm area after breast-conserving surgery. There are 2 main ways in which radiation therapy can be given.

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Chemotherapy

Chemotherapy (commonly called just "chemo") is the use of cancer-killing drugs injected into a vein, given as a shot, or taken as a pill or liquid. These drugs enter the bloodstream and go throughout the body, making the treatment useful for cancers that have spread to distant organs. While these drugs kill cancer cells, they also damage some normal cells, which can lead to side effects.

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Hormone Therapy

Hormone therapy is another form of systemic therapy. It is most often used to help reduce the risk of the cancer coming back after surgery, though it may also be used for more advanced breast cancers.
The female hormone estrogen promotes the growth of breast cancer cells in some women (those who have ER-positive cancers). For these women, several methods to block the effect of estrogen or to lower its levels are used to treat breast cancer.

There are several treatments and drugs that affect female hormones which are being used for breast cancer. Your doctor can give you more details about any recommended treatments.

Targeted Therapy

As we have learned more about the gene changes that cause cancer, researchers have been able develop newer drugs that are aimed directly at these changes. These targeted drugs work differently than standard chemo drugs. They often have different and less severe side effects. At this time, they are most often used along with chemo.

Bisphosophonates

Bisphosphonates are drugs that are used when breast cancer has spread to the bones. These drugs can strengthen bones that have been weakened by invading breast cancer cells and reduce the risk of fractures or breaks.

Bisphosphonates may also help prevent bone thinning (osteoporosis) that can result from treatment with aromatase inhibitors (see above) or from early menopause caused by chemo. These drugs are given into a vein (IV).

Bisphosphonates can have side effects, including flu-like symptoms and bone pain. A rare but serious side effect from bisphosphonates is damage in the jaw bone. Doctors don't know why this happens. Some cancer doctors recommend that patients have a dental check-up and have any tooth or jaw problems treated before they start taking bisphosphonates.

High-Dose Chemotherapy With Bone Marrow or Peripheral Blood Stem Cell Transplant

In the past, it was thought that very high doses of chemotherapy followed by a method called stem cell transplant might offer some women the best chance for a cure--especially for those women with a high risk of the cancer coming back or with advanced cancer. But doctors have found that the women who received high-dose therapy did not live any longer than women who had standard dose chemo. And high-dose chemo with stem cell support can cause serious side effects. Research in this area is still going on. For now, experts in the field suggest that women receive this treatment only as part of a clinical trial.

Complementary and Alternative Therapies

When you have cancer you are likely to hear about ways to treat your cancer or relieve symptoms that are different from mainstream (standard) medical treatment. These methods can include vitamins, herbs, and special diets, or methods such as acupuncture or massage—among many others. You may have a lot of questions about these treatments.

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Deciding what to do

It is easy to see why people with cancer may think about alternative methods. You want to do all you can to fight the cancer. Sometimes standard treatments such as chemotherapy can be hard to take, or they may no longer be working. Sometimes people suggest that their method can cure your cancer without having serious side effects, and it's normal to want to believe them. But the truth is that most of these treatments have not been tested and have not been proven to be effective for treating cancer...

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