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Treatment Option Overview
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There are different types of treatment for patients with breast
cancer.
Different types of treatment are available for patients with breast
cancer. Some treatments are standard
(the currently used treatment), and some are being tested in
clinical trials. Before starting
treatment, patients may want to think about taking part in a clinical trial. A
treatment clinical trial is a research study meant to help improve current
treatments or obtain information on new treatments for patients with cancer.
When clinical trials show that a new treatment is better than the
standard treatment, the new
treatment may become the standard treatment.
Clinical trials are taking place in many parts of the country.
Information about ongoing clinical trials is available from the
NCI Cancer.gov Web site. Choosing the most appropriate cancer treatment is a
decision that ideally involves the patient, family, and health care
team.
Four types of standard treatment are used:
Surgery
Most patients with breast cancer have surgery to remove the cancer from the breast. Some
of the lymph nodes under the arm
are usually taken out and looked at under a microscope to see if they contain
cancer cells.
Breast-conserving
surgery, an operation to remove the cancer but not the breast
itself, includes the following:
Patients who are treated with breast-conserving surgery may also have some of the lymph nodes under the arm removed for biopsy. This procedure is called lymph node dissection. It may be done at the same time as the breast-conserving surgery or after. Lymph node dissection is done through a separate incision. Other types of surgery include the following:
- Total mastectomy: A surgical procedure to remove the whole breast that contains cancer. This procedure is also called a simple mastectomy. Some of the lymph nodes under the arm may be removed for biopsy at the same time as the breast surgery or after. This is done through a separate incision.
- Modified radical
mastectomy: A surgical procedure to remove the whole breast that contains cancer, many of the lymph nodes under
the arm, the lining over the chest muscles, and sometimes, part of the
chest wall muscles.
- Radical
mastectomy: A surgical procedure to remove the breast that contains cancer, chest wall muscles under the breast, and all of the lymph nodes under the arm. This procedure is sometimes called a Halsted radical mastectomy.
Even if the doctor removes all of the cancer that can be seen at
the time of surgery, the patient may be given radiation therapy,
chemotherapy, or
hormone therapy after surgery to try
to kill any cancer cells that may be left. Treatment given after surgery to
increase the chances of a cure is called adjuvant
therapy.
If a patient is going to have a mastectomy,
breast reconstruction (surgery to
rebuild a breast’s shape after a mastectomy) may be considered. Breast
reconstruction may be done at the time of the mastectomy or at a future time.
The reconstructed breast may be made with the patient’s own (nonbreast) tissue
or by using implants filled with saline or silicone gel. The Food and Drug
Administration (FDA) has decided that breast implants filled with silicone gel
may be used only in clinical trials. Before the decision to get an implant is
made, patients can call the FDA’s Center for Devices and Radiologic Health at
1-888-INFO-FDA (1-888-463-6332) for more information.
Radiation therapy
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.
Chemotherapy
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.
Hormone therapy
Hormone therapy is a cancer treatment that removes hormones or blocks their action and stops cancer cells from growing. Hormones are substances produced by glands in the body and circulated in the bloodstream. The presence of some hormones can cause certain cancers to grow. If tests show that the cancer cells have places where hormones can attach (receptors), drugs, surgery, or radiation therapy are used to reduce the production of hormones or block them from working.
Hormone therapy with tamoxifen is often given to patients with early
stages of breast cancer and those
with metastatic breast cancer (cancer
that has spread to other parts of the body). Hormone therapy with tamoxifen or
estrogens can act on cells all over the body and may increase the chance of
developing endometrial cancer.
Women taking tamoxifen should have a pelvic examination every year to look for any
signs of cancer. Any vaginal
bleeding, other than menstrual
bleeding, should be reported to a doctor as soon as possible.
Other types of treatment are being tested in clinical trials.
These include the following:
Sentinel lymph node biopsy followed by surgery
Sentinel lymph node biopsy is the removal of the sentinel lymph node (the first lymph node the cancer is likely to spread to from the tumor) during surgery. A radioactive substance and/or blue dye is injected near the tumor. The substance or dye flows through the lymph ducts to the lymph nodes. The first lymph node to receive the substance or dye is removed for biopsy. A pathologist views the tissue under a microscope to look for cancer cells. If cancer cells are not found, it may not be necessary to remove more lymph nodes. After the sentinel lymph node biopsy, the
surgeon removes the tumor (breast-conserving surgery or mastectomy).
High-dose chemotherapy with bone marrow transplantation
or peripheral blood stem cell transplantation
High-dose chemotherapy with bone marrow transplantation
or peripheral blood stem cell transplantation is a method of giving high doses of chemotherapy and replacing blood-forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the blood or bone marrow of the patient or a donor and are frozen and stored. After the chemotherapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into (and restore) the body’s blood cells.
Studies have shown that high-dose chemotherapy followed by bone marrow
transplantation or peripheral blood stem cell transplantation does not work better than standard chemotherapy in the treatment of breast
cancer. Doctors have decided that, for now, high-dose chemotherapy should be tested only in clinical trials. Before taking part in such a trial, women should
talk with their doctors about the serious side
effects, including death, that may be caused by high-dose chemotherapy.
This summary section refers to specific treatments under study in
clinical trials, but it may not mention every new treatment being studied.
Information about ongoing clinical trials is available from the
NCI Cancer.gov Web site.
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