Breast Cancer Treatment: An Overview

Once there is a diagnosis, the medical team will evaluate all diagnostic criteria and consider the best breast cancer treatment and management approach for a particular breast cancer patient.

Determining the best treatment for breast cancer will depend upon the:-

tumor stage
grade
age of the patient
health of the patient

The main or primary approach to breast cancer treatment is usually through surgery. Other treatments are usually, but not always, employed in addition to surgery, and these are adjuvant therapies.

I just want to let you know that this page is kind of getting a little old, but still has very good research material. However, the best part of it is that I have a new version of this page with more up-to-date information on different types of breast cancer treatment.

It’s true. Treatments have improved since I made these pages. Everything about surgery is easier and better, everything about radiation is done better, and the medicines are new and absolutely amazing.

Ask questions to your oncologist. They stay up-to-date.

Adjuvant Treatments

The most common and historically effective adjuvant breast cancer treatments include

radiation treatment
chemical therapy (or chemotherapy)
hormone therapy (sometimes called endocrine therapy)

The above are the main treatments for successfully treating breast cancer. There are additional supplemental treatments which might increase the effectiveness of the above, but essentially surgical intervention, along with chemical, radiation, and hormonal treatments, is the first line of treatment for breast cancer.

invasive breast cancer treatments cells-1

Your breast cancer team will plan the treatments and they are usually sequential. So, the choice of a given treatment modality will mostly depend on whether the cancer is being treated at a local or at a systemic level. And remember, that almost 90% of breast cancers are curable.

This microscope slide of breast cancer, shows too many cells, mostly inside the round duct, BUT, some are outside the duct too, which makes it invasive.

Localized vs. Systemic Treatments

If your breast cancer physicians discover and treat the breast cancer while still contained in the breast regions, the treatment is called a localized treatment. In addition to removing the existing cancer, the concern is that breast cancer can return to the same area.

So, to help prevent local recurrence, a surgeon will try to remove the tumor with wide margins and also possibly treat the area with radiation.

Doctors may apply chemotherapy or hormone therapy, even for localized breast cancer, depending on the nature of an individual tumor. But, if there is evidence that the breast cancer has spread or metastasized to the lymph nodes, (which would then be considered an advanced stage III or stage IV breast cancer), the treatment would be more systemic in nature. At that point surgery alone can not be curative and treating systemic breast cancer is really the area where therapy with medicines comes into its forte.

Adjuvant vs Neo-adjuvant breast cancer treatments

An adjuvant breast cancer therapy is one that doctors prescribe after the initial surgery, or at the same time. Most of the time, surgery is the main or primary treatment, while radiation, chemotherapy, and hormone therapy are given as systemic breast cancer therapies.

A neoadjuvant breast cancer treatment is one that doctors apply before the use of the surgical intervention. Sometimes the hope is that a neoadjuvant chemical or radiation treatment will actually stop cancer and no surgery will be necessary. In addition, in some cases, physicians may apply a neoadjuvant treatment in the hope of making the surgery more effective and lasting.

Breast cancer surgical interventions

Diagnosis and subsequent breast cancer treatments usually involve a certain amount of either major or minor surgery.

Sometimes, in order to learn more about a breast cancer tumor itself, a surgeon will excise (surgically remove) a small portion of it for histological evaluation.

If the tumor is small or early stage enough, (or not cancer or a cancer threat), that sample-biopsy excision can often remove the entire lesion in question and result in a cure. But, once the biopsy report comes back and confirms the lesion to be either malignant breast cancer or some other breast disease that suggests aggressive surgical intervention, then a decision is made to remove the lump and possibly the breast itself.

There are several types of breast surgery so let’s take a look:-

A Lumpectomy

If the surgeon can easily remove the tumor mass, because it is small and well defined, then surgeons will perform a simple ‘lumpectomy’ (sometimes called tumorectomy).

Full or Simple Mastectomy

When the surgeon needs to remove the entire breast.

A Partial Mastectomy

If the surgery removes only a part of the affected breast, it is a partial mastectomy.

Radical Mastectomy

If the surgeon removes the entire breast and also some of the underlying muscle tissue and some lymph nodes.

Breast cancer will eventually metastasize without treatment

Malignant breast cancer spreads or metastasizes to other areas of the body without treatment. So, the first place the spreading is likely to show up is in the lymph nodes, particularly the lymph nodes in the armpit or axilla region. Thus, breast cancer treatment may involve the surgical excision of a number of these axillary lymph nodes to evaluate whether or not the breast cancer has spread.

If breast cancer is found in the lymph nodes, they too may be surgically removed.

Unlike the first picture, this is a different cancer and many more of the cancer cells are outside of the ducts. This one is worse.

Radiation treatment for breast cancer

Radiation treatment for breast cancer is primarily aimed at preventing local recurrence of carcinoma at the site of surgery. These areas are irradiated, which essentially destroys any missed or hiding malignant cancer cells at a molecular level, so they cannot multiply.

Of course, radiation therapy kills healthy cells in the area as well. In effect, radiation damages all the cells in the path of the beam, but healthy cells are able to repair, while cancer cells have a harder time repairing, and so die off.

Statistically, the combination of radiation therapy following surgery has proven to be a very effective treatment for early to mid stage breast cancers (which have not yet metastasized). However, if the cancer has spread to the lymph nodes, these areas are still sometimes treated with radiation, either with or without surgery, and with or without chemotherapy.

Breast cancer chemotherapy with medicines

Treatment of breast cancer by chemical medications, taken either orally or intravenously, is a common method of treating breast cancer which has either metastasized, or is threatening to metastasize, to the lymph nodes or other body areas.

Medics sometimes use chemotherapy, to treat early-stage breast cancer. Also, physicians may prescribe chemotherapy prior to breast cancer surgery in hopes of lessening odds of recurrence.

Breast cancer chemotherapy is a very large and confusing topic, especially for the patient. Very often, doctors will use a combination of agents. Breast cancer chemical medications are a major thrust of the drug companies, with new medications and combinations being tested and coming out all the time.

But essentially chemical breast cancer therapy aims to weaken or destroy the cancer cells in the body, by interfering with their ability to grow and divide.

Breast cancer chemotherapy

Chemotherapy is, in some ways, an over-arching term, because anything taken in the form of a medication is really chemotherapy. For example, the taking of antibiotics, or medications which involve hormones, are really also types of chemotherapy.

But in general breast cancer chemotherapy refers to the use of specific agents which are toxic (cytotoxins) and kill the cells, essentially by poisoning them.

Hormone or ‘endocrine’ breast cancer therapy

Hormone therapy, also called endocrine therapy, is a very specific or targeted approach to treating breast cancer in a systemic way. In some breast cancer cases, hormones can fuel tumor growth.

No one exactly knows or can predict what brings about the production of certain hormones and the exact changes and interactions that hormones will cause. However, histology procedures test and analyze each breast cancer tumor to reveal particular hormones. Histology determines which hormones are either present or absent or possibly overexpressed in breast cancer.

Based on these hormonal profiles, which will be specific to each case, (and often different for various types of breast cancer), doctors will prescribe chemical-hormonal agents. So, these drugs either suppress the growth potential of hormones characteristic to a given breast cancer tumor, or, enhance the potential of hormones which tend to suppress or stop cell proliferation.

Multi-modal breast cancer treatments

Breast cancer diagnosis and treatment can be a complex and dynamic process. The medical team has to consider treatments before and after the primary treatment of breast cancer. And, they must also consider follow-up evaluations and follow-up treatments for monitoring and preventing local recurrence and distant metastasis.

So, the modern approach to breast cancer treatments tend to be multi-modal. This implies some combination or permutation of surgery, radiation and chemical or endocrine therapies. Furthermore, physicians apply the treatments at various stages in the management of the disease.

Statistically, breast cancers that specialists treat with an individualized, multi-modal approach, tend to have a stronger prognosis than a single treatment method. Of course, early-stage and in situ breast cancers may not require a multi-modal approach.

Likewise, for benign or likely-benign breast lesions, not yet or not necessarily a threat for breast cancer, the treatment will be a more simplistic approach. (usually simple excision).

Additional and future breast cancer treatment approaches

Other treatment methods for breast cancer at the present time include:-

biological therapy
gene therapy
immunotherapy
stem cell-bone marrow transplantation

References

Montgomery, AC, Greening, WP, Levene, AL. Clinical study of recurrence rate and survival time of patients with carcinoma of the breast treated by biopsy excision without any other therapy. J R Soc Med 1978; 71:339.
Fisher, B, Anderson, S, Bryant, J, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 2002; 347:1233.
Haffty, BG, Goldberg, NB, Rose, M, et al. Conservative surgery with radiation therapy in clinical stage I and II breast cancer. Results of a 20-year experience. Arch Surg 1989; 124:1266.
von Minckwitz, G (March 2007). “Docetaxel/anthracycline combinations for breast cancer treatment”. Expert Opinion on Pharmacotherapy 8 (4): 485–495.
Wilcken, N., Dear, R., Chemotherapy in metastatic breast cancer: A summary of all randomised trials reported 2000–2007. European Journal of Cancer October 2008 ) Volume 44, Issue 15 , Pages 2218-2225,
Epstein RJ. Adjuvant breast cancer chemotherapy during late-trimester pregnancy: not quite a standard of care. BMC Cancer. 2007 May 30;7:92.
Cole BF, Gelber RD, Gelber S, Coates AS, Goldhirsch A: Polychemotherapy for early breast cancer: an overview of the randomised clinical trials with quality-adjusted survival analysis. Lancet 2001 , 358(9278):277-286.
Regan MM, Gelber RD: Predicting response to systemic treatments: learning from the past to plan for the future.Breast 2005 , 14(6):582-593.
Pritchar, K. Endocrinology and hormone therapy in breast cancer: Endocrine therapy in premenopausal women. Breast Cancer Res. 2005; 7(2): 70–76.

Early Breast Cancer Trialists’ Collaborative Group Effects of adjuvant tamoxifen and of cytotoxic therapy on mortality in early breast cancer: an overview of 61 randomized trials among 28,896 women. N Engl J Med. 1988;319:1681–1692.
Beatson GT. On the treatment of inoperable cases of carcinoma of the mamma: suggestions for a new method of treatment with illustrative cases. Lancet. 1896;2:104–107.
Engelsman E, Klijn JC, Rubens RD, Wildiers J, Beex LV, Nooij MA, Rotmensz N, Sylvester R. Classical CMF versus a 3-weekly intravenous CMF schedule in postmenopausal patients with advanced breast cancer. Eur J Cancer. 1991;27:966–970.
Seymour, HL, Khan, FM., Boen, JR., Potish, RA., Bowers, BJ. Multimodal therapy in the treatment of breast cancer. American Journal of Clinical Oncology: August 1983 – Volume 6 – Issue 4 – ppg 387-392
Buzdar AU. Role of biologic therapy and chemotherapy in hormone receptor- and HER2-positive breast cancer.Ann Oncol. 2009 Jun;20(6):993-9
Roy, V., Perez, EA. Biologic therapy of breast cancer: focus on co-inhibition of endocrine and angiogenesis pathways. Breast Cancer Research and Treatment. Volume 116, Number 1, 31-38
Obermiller, PS., Tait, DL, Holt, JT., Gene therapy for carcinoma of the breast: Therapeutic genetic correction strategies. Breast Cancer Res 2000, 2:28-31
Soliman, HS. Developing an Effective Breast Cancer Vaccine. Cancer Control. 2010;17(3):183-190.
Beug, Hartmut., Breast Cancer Stem Cells: Eradication by Differentiation Therapy? Cell,(august 2009) Volume 138, Issue 4, 623-625, 21.