Treatment plans for breast cancer are developed based on several
factors. The type and stage of the cancer, the sensitivity of the cancer to
certain hormones, and the medical history of the patient are all taken into consideration.
Whether or not the cancer overexpresses the HER2/neu gene can also determine appropriate
Treatment plans usually include surgery to remove the cancer. Some
type of chemotherapy (drug therapy) or radiation therapy to aid the success of
the surgery often follows. This is known as adjuvant or neoadjuvant therapy.
The ultimate aim of all therapies is to increase long-term survival rates and
to hopefully lead to recovery.
If possible, the primary treatment for breast cancer is surgery,
either a lumpectomy or mastectomy.
During a lumpectomy, the surgeon removes the tumor and a small
margin of normal tissue around it. A lumpectomy is usually effective on small
tumors. This way they can be removed without involving too much surrounding
A mastectomy can be either simple or radical. A simple mastectomy
(also called "partial mastectomy”) involves removing all of the breast
tissue. The breast tissue includes skin, fatty tissue, lobules, and ducts. A
radical mastectomy (also called "total mastectomy") also removes the
chest wall muscles and the surrounding lymph nodes in the armpit.
In addition to surgery, breast cancer treatments usually include
drug or radiation therapies. These are called adjuvant therapies. Neoadjuvant
therapy treatments are used before surgery to shrink large tumors and
make the surgery easier or even possible in some cases. Adjuvant therapy treatments
are applied after the surgery to try to ensure that all
malignant cells in the body are killed. Both are intended to increase
long-term, disease-free survival rates. These therapies may include:
- biological or
- hormone therapy
In some cases, these therapies may be combined. The decision of
which therapy to use will depend on many factors. The patient's age, the size
and type of the tumor and its cells, and whether it has spread to the lymph
nodes are all weighed. How the cancer reacts to certain hormones is another
factor. The human epidermal growth factor receptor 2 (HER2/neu) status must
also be considered. Below are summaries of the four major adjuvant therapies.
Biological or Targeted Therapies
If the breast cancer cells make an excess of HER2/neu (a genetic
change that can trigger cancer cell growth), a biologic therapy called
trastuzumab (Herceptin) may be necessary.
Herceptin can stop the growth of the cancer by inhibiting the actions
of the HER2 proteins on cancer cells. Herceptin is often used along with
chemotherapy or hormone therapy. It’s known as a "targeted therapy"
because it kills only the cancer cells and does not damage any other cells.
Other therapies, such as lapatinib (Tykerb), also target specific parts of
There are now hundreds of chemotherapy drugs that have been
approved by the FDA for use in breast cancer treatments. These compounds may be
taken by injection or in pill form.
Chemotherapy offers several benefits. It not only destroys cancer
cells in the breast, but it also kills any cancer cells that are in the blood
or have spread to other parts of the body. When used before surgery,
chemotherapy can shrink the size of large tumors. This makes the surgery
simpler for the surgeon and sometimes can make it possible to surgically remove
a previously inoperable tumor. Finally, when it comes to earlier stages of
breast cancer, chemotherapy is known to reduce the risk of recurrence and to
There are many drawbacks to chemotherapy. There can be short-term,
possibly severe side
effects. There is also
a slight chance of some long-term complications and secondary diseases due to
the chemotherapy. However, most breast cancer patients and their doctors decide
the potential, long-term benefits of chemotherapy usually outweigh the
If tests show that the cancer cells have receptors on their
surface for the hormones estrogen and/or progestin, that patient is considered
"receptor-positive" and likely to benefit from hormone therapy. For
receptor-positive women, hormone therapy will most likely be part of their
Using high-powered, targeted X-rays to kill cancer cells can
reduce the risk of cancer recurrence. Radiation is commonly used to destroy any
cells that escaped the surgery. Radiation is regularly used for high-risk women
after a mastectomy. Radiation is also used:
- when a tumor is 2 or more inches across
- if multiple lymph nodes were involved
- if the tumor had invaded the chest muscles
Radiation therapy can be delivered in two forms. External
beam radiation is
delivered by an X-ray machine. Internal seed radiation is implanted next to the
tumor site with a needle or catheter.
When about a month has passed after surgery, radiation treatments
can begin. These may continue as often as daily for up to two months. If
chemotherapy is also part of the patient's treatment, radiation will frequently
come after the chemotherapy is finished to allow the patient to recover from
any chemo-related side effects. If hormone therapy will be used instead of
chemotherapy, radiation therapy need not be delayed.