Breast Cancer Treatment
At Banner MD Anderson Cancer Center, breast cancer is treated with a multidisciplinary approach in which a team of experts including medical, surgical and radiation oncologists work together to develop an individual treatment plan based on each patient’s unique needs. Clinical nurse navigators work closely with patients, guiding them through their first visit and then serving as a single point of contact throughout their care.
The specific treatment for breast cancer depends on multiple factors which include:
- The stage and type of your cancer
- Certain characteristics of the breast cancer cells (such as presence of estrogen and progesterone receptors and HER2 overexpression)
- Your menopausal status
- Your overall health including other medical conditions you may have
You may receive treatment for your breast cancer that is considered “standard” based on its demonstrated effectiveness in patients evaluated in previous trials or you may choose to go into a clinical trial. Clinical trials try to find better ways to treat breast cancer patients. If you are eligible for a clinical trial, your oncologist will discuss this option with you. In either case, treatment for breast cancer may include:
- Surgery to remove the cancer
- Breast reconstruction which can be performed immediately or a few months after a mastectomy
- Radiation therapy (using high energy x-rays to kill remaining cancer cells)
- Chemotherapy (using drugs to kill remaining cancer cells)
- Hormone therapy (drugs that either lower estrogen levels or block estrogen from stimulating remaining cancer cells)
- Targeted therapy (drugs that target specific molecules involved in breast cancer cell growth and progression)
Surgery is used to remove the cancer from the breast. During surgery, some lymph nodes under the arm are also removed. These lymph nodes are examined under a microscope to see if there are cancer cells present. This is very important to determine the stage of the cancer and guide further treatment decisions.
Multiple types of surgery can be used for breast cancer:
- Breast-conserving surgery
This can be called by multiple other names including lumpectomy, segmental mastectomy, partial mastectomy and wide excision. The cancer is removed from the breast with a small amount of surrounding normal tissue and the breast is left intact. This is usually followed by radiation therapy to the remaining breast or in some cases to just the portion of the breast surrounding the surgical site.
Simple or total mastectomy removes the entire breast
Modified radical mastectomy removes the entire breast and some lymph nodes under the arm.
Breast reconstruction after mastectomy may be done at the time of mastectomy or at a future time. Multiple options for reconstruction are available and are considered to be part of the overall cancer treatment plan and not cosmetic surgery. It is therefore usually covered by most insurance plans.
- Sentinel Lymph Node Biopsy (SLNB)
SLNB is a surgical procedure used to determine whether the cancer in your breast has spread to the lymph nodes under your arm. The sentinel node which is removed in this procedure is the first node to receive lymphatic drainage from the tumor. If the sentinel node has cancer cells an axillary dissection, a procedure in which more lymph nodes are removed from under the arm may be necessary.
- Radioactive Seed Localization (RSL)
What used to begin with the sometimes painful placement of a guide wire in a patient's breast to mark the location of a breast abnormality can now be done with a much more precise and less painful method. The process uses a thin needle to place one or two tiny radioactive seeds – about the size of a grain of rice – directly at the site of the abnormality. The procedure takes about 15 minutes from start to finish with minimal discomfort. The radiation in the seed is not dangerous. It gives off only enough radiation to act as a marker for the surgeon. The radioactive seed allows the surgeon to accurately remove the abnormal tissue, the seed and ideally, if cancer is found, additional tissue in the margins around the cancer. Radiation or chemotherapy may still be required after surgery. The previous and still most common approach to marking an abnormality that can only be seen through mammography is to place a guide wire in the patient’s breast in the morning, and then have surgery later in the day. By using RSL, discomfort with the wire is eliminated. Additionally, the seeds can be implanted up to five days prior to surgery, offering more scheduling flexibility for patients and surgeons. On the day of surgery, the surgeon uses a detection device that pinpoints the radioactive seeds, identifying the exact location of the abnormality so it can be removed.
In breast reconstruction surgery, a plastic surgeon recreates all or part of a breast that has been surgically removed. This is done using a breast implant, or tissue from another part of the body. The goal of reconstruction is to make breasts look natural and balanced when the patient is wearing clothing.
Candidates for breast reconstruction include women who have been:
- Diagnosed with breast cancer and had or will have a mastectomy (surgical removal of a breast)
- Diagnosed with breast cancer and had or will have breast conservation surgery, such as partial mastectomy or lumpectomy (surgical removal of the tumor and surrounding breast tissue)
- Found to have a genetic mutation and will have prophylactic mastectomy (removal of non-cancerous breast to prevent cancer)
With improved treatments, breast reconstruction techniques and new medical devices, there are many options. Surgeons can recreate a breast at the time of mastectomy or after you have had a mastectomy. They can also correct misshapen breasts that may result after breast conservation surgery.(back to top)
Radiation therapy may be used in many different situations for breast cancer patients.
- Following breast conserving surgery, radiation is given to the breast and sometimes the surrounding lymph node areas to kill any remaining cancer cells.
- Following a mastectomy, radiation may be used if there is a high risk of cancer recurring in the surrounding area. This decision of whether to give radiation therapy after a mastectomy is generally based on features of the tumor including the size of the tumor and extent of spread to the lymph nodes under the arm.
- In patients with metastatic breast cancer, radiation is sometimes given to specific areas of the body in conjunction with chemotherapy, hormone therapy and targeted agents.
Chemotherapy is the use of special drugs to kill cancer cells throughout the body. Most chemotherapy drugs are given by a needle in a vein. The specific drugs used will be determined by the stage of your cancer as well as features unique to you such as your overall health. Chemotherapy may be used alone without surgery or radiation therapy for metastatic breast cancer. In earlier stages of breast cancer, chemotherapy may be given before surgery (neoadjuvant chemotherapy) or after surgery (adjuvant therapy).
In some cases of early stage breast cancer, gene-expression profiling is used to predict who is likely to benefit from chemotherapy and who is not likely to benefit. This diagnostic test is performed on the tumor specimen that analyzes 21 genes in the cancer. In women with estrogen receptor-positive tumors that have not spread to the lymph nodes under the arm, the test helps to assess the likelihood that the breast cancer will return and helps to identify which women are most likely to benefit from chemotherapy.
Hormone (Endocrine) Therapy
If your breast cancer cells contain estrogen or progesterone receptors, hormone therapy will likely be part of your overall cancer treatment plan. Hormone therapy uses drugs that work by either lowering estrogen levels or by blocking estrogen from stimulating breast cancer cells. For premenopausal or perimenopausal women, tamoxifen is most commonly used. For women who are postmenopausal, an aromatase inhibitor may be used instead of tamoxifen.
Targeted therapy uses drugs that target specific molecules involved in breast cancer cell growth and progression. Monoclonal antibodies as well as tyrosine kinase inhibitors are types of targeted drugs commonly used for breast cancer. Based on the specific features of your breast cancer, your oncologist will determine whether these drugs are an option for you.