Breast Cancer Treatment Options

As you might expect, the diagnosis and treatment of breast cancer is very complex. There are dozens of different types, grades, and stages of breast cancer and various forms of treatment options including various chemotherapy and radiation therapy protocols.

 

Perhaps the simplest way to describe the various treatment options is to group them according to the breast cancer type. Breast cancer can be divided into noninvasive and invasive groups. Noninvasive breast cancer includes lobular carcinoma in situ (LCIS) and ductal carcinoma in situ (DCIS). In general, lobular carcinoma in situ is treated with observation and/or tamoxifen (or similar drug). In ductal carcinoma in situ that has not invaded any other tissues, three main treatments are usually available. In the first two approaches, the cancerous area is surgically removed (lumpectomy) and the remaining area is either treated with radiation therapy or not. In the third, more aggressive approach, the entire affected breast is removed (mastectomy). In each of these cases the surrounding lymph nodes may or may not be sampled for cancer spread. Tamoxifen may be added to the therapeutic regimen.

 

 

For invasive breast cancer, the treatment options increase and the decisions involved become more complex. In order to understand the various treatment possibilities, it is important to understand the staging scheme for breast cancer. As with most cancer types, breast cancer is staged using a TNM system; T stands for tumor size, N stands for lymph node involvement and M stands for metastatic disease. The TNM system is shown. Also shown is how the TNM scale coincides with breast cancer staging. It is the stage that predicts treatment type.

 

For stages 1, 2A, or 2B, treatment follows a locoregional approach. This may include a lumpectomy or total mastectomy depending in large part on patient preferences. Radiation therapy is usually added and chemotherapy may also be added after surgery and radiation. Chemotherapy may precede surgery in some cases.

 

For stages 3A, 3B, and 3C, treatment usually begins with preoperative chemotherapy including an anthracycline drug with or without a taxane. Surgery involves lumpectomy or total mastectomy with lymph node dissection. In most cases, radiation therapy is performed. After surgery and radiation therapy, additional chemotherapy may be given as well. It is at this point that a targeted therapy such as Herceptin is given in conjunction with adjuvant chemotherapy. Breast and gynecologic exams along with mammograms are performed at standard intervals to watch for recurrent cancer.

Stage 4 breast cancer or cancer recurrence in any of the lower stages is treated with an individualized combination of chemotherapy, surgery, and radiation therapy.