Treatment will depend on several factors, including:
- the type and stage of the cancer
- the person’s sensitivity to hormones
- the age, overall health, and preferences of the individual
The main treatment options include:
- biological therapy, or targeted drug therapy
- hormone therapy
Factors affecting the type of treatment a person has will include the stage of the cancer, other medical conditions, and their individual preference.
If surgery is necessary, the type will depend on both the diagnosis and individual preference. Types of surgery include:
Lumpectomy: This involves removing the tumor and a small amount of healthy tissue around it.
A lumpectomy can help prevent the spread of the cancer. This may be an option if the tumor is small and easy to separate from its surrounding tissue.
Mastectomy: A simple mastectomy involves removing the lobules, ducts, fatty tissue, nipple, areola, and some skin. In some types, a surgeon will also remove the lymph nodes and muscle in the chest wall.
Sentinel node biopsy: If breast cancer reaches the sentinel lymph nodes, which are the first nodes to which a cancer can spread, it can spread into other parts of the body through the lymphatic system. If the doctor does not find cancer in the sentinel nodes, then it is usually not necessary to remove the remaining nodes.
Axillary lymph node dissection: If a doctor finds cancer cells in the sentinel nodes, they may recommend removing several lymph nodes in the armpit. This can prevent the cancer from spreading.
Reconstruction: Following mastectomy, a surgeon can reconstruct the breast to look more natural. This can help a person cope with the psychological effects of breast removal.
The surgeon can reconstruct the breast at the same time as performing a mastectomy or at a later date. They may use a breast implant or tissue from another part of the body.
A person may undergo radiation therapy around a month after surgery. Radiation involves targeting the tumor with controlled doses of radiation that kill any remaining cancer cells.
A doctor may prescribe cytotoxic chemotherapy drugs to kill cancer cells if there is a high risk of recurrence or spread. When a person has chemotherapy after surgery, doctors call it adjuvant chemotherapy.
Sometimes, a doctor may choose to administer chemotherapy before surgery to shrink the tumor and make its removal easier. Doctors call this neoadjuvant chemotherapy.
Hormone blocking therapy
Doctors use hormone blocking therapy to prevent hormone sensitive breast cancers from returning after treatment. Hormone therapy may be used to treat estrogen receptor (ER)-positive and progesterone receptor (PR)-positive cancers.
They usually administer hormone blocking therapy after surgery but might sometimes use it beforehand to shrink the tumor.
Hormone blocking therapy may be the only option for people who are not suitable candidates for surgery, chemotherapy, or radiotherapy.
Doctors may recommend a person has hormone therapy for 5–10 years after surgery. However, the treatment will not affect cancers that are not sensitive to hormones.
Examples of hormone blocking therapy medications may include:
- aromatase inhibitors
- ovarian ablation or suppression
- Goserelin, which is a luteinizing hormone-releasing agonist drug that suppresses the ovaries
Hormone treatment may affect fertility.
Targeted drugs can destroy specific types of breast cancer. Examples include:
- trastuzumab (Herceptin)
- lapatinib (Tykerb)
- bevacizumab (Avastin)
Treatments for breast and other cancers can have severe adverse effects. When deciding on a treatment, people should discuss the potential risks with a doctor and look at ways to minimize the side effects.