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Treatment Options FAQs

Updated April 5, 2010

What types of treatments are used for breast cancer?

How are decisions made about what type of medical treatment I will need?

What is the difference between a lumpectomy and a mastectomy?

How are decisions made about what type of surgery I will have?

Where can I find information about breast reconstruction?

How are chemotherapy and hormonal therapy given?

What follow-up will I need after initial treatment ends?

Q: What types of treatments are used for breast cancer?

A: Breast cancer treatment involves local therapy and systemic therapy.

The goal of local therapy is to eliminate the cancer in your breast and lymph nodes under your arm, called the axillary lymph nodes. Local therapies are sometimes offered in combination with each other, and other times surgery is used alone. Each case is unique, and so is each treatment plan. Local therapies include:

  • Surgery. The goal of surgery is to remove the cancer from your breast. There are two types of breast surgery, breast conservation and mastectomy. In breast conservation, the surgeon performs a lumpectomy (also called a partial mastectomy or segmental excision), which is followed by radiation treatment to the remaining breast tissue. A mastectomy, or removal of the entire breast, is done for a variety of reasons, including personal preference, multiple tumors in different parts of the breast, tumors in the nipple area, previous breast cancer in the same breast or large tumors.
  • Radiation. The goal of radiation therapy is to treat any microscopic cancer cells that may be present in your breast or chest wall area after removal of the primary tumor. Radiation works by focusing the power of high-energy x-rays on the breast, chest wall or lymph nodes. It is very effective against cancer in the specific area it is directed to, but it will not treat breast cancer that has traveled to other parts of the body.

The goal of systemic therapy is to get rid of cancer cells from an invasive cancer that may have traveled away from the primary tumor and can form cancer in distant sites, such as the bones, liver, or lung. Systemic therapies include:

  • Chemotherapy. The goal of chemotherapy is to kill any microscopic cancer cells that may have spread from your breast before the tumor was discovered and removed. Chemotherapy works by killing rapidly dividing cells, including those found in some breast cancers. Chemotherapy medications may affect some normal cells as well as cancer cells and may cause side effects. There are many different types of chemotherapy medications. They may be administered alone (single-agent therapy), or together (combination therapy). Your doctor will help you determine the best chemotherapy treatment for your cancer based on the traits of your cancer and your treatment goals.
  • Targeted (Biologic) Therapy. Targeted therapies are adjuvant treatments that focus on a specific biological trait of cancer cells which differ from normal cells. In this way, the cancer cells are targeted by the treatment while normal cells are spared. For example, trastuzumab (Herceptin) targets breast cancer cells that have high levels of a protein called HER2. Other targeted therapies block the growth of blood vessels that some tumors need to grow. Many forms of targeted therapy are being tested in clinical trials. If you are interested in targeted treatments, ask your doctor whether you are eligible to receive trastuzumab or participate in a clinical trial.
  • Hormonal Therapy. Hormonal therapies are targeted treatments that seek to lessen the effects of estrogen. Your doctor may recommend a hormonal therapy if you have estrogen receptor-positive or progesterone receptor-positive breast cancer. Hormonal therapy works to prevent the growth of hormone-sensitive breast cancer cells and may protect you from your breast cancer coming back. Tamoxifen, for example, works by keeping the estrogen in your body from "communicating" with estrogen receptors on your tumor. Your cells will no longer "see" the estrogen and will stop growing. Researchers have also developed other hormonal therapies that work like tamoxifen but have fewer serious side effects. Aromatase inhibitors work in women who are post-menopausal or whose ovaries no longer produce hormones by blocking the activity of an enzyme called aromatase, which converts substances produced by the adrenal glands into estrogen.

For more information on types of treatments, download a copy of our Guide for the Newly Diagnosed. This guide includes a section on treatment basics that explains what local and systemic treatments may be offered.

Reviewed by Rick Michaelson, MD

Q: How are decisions made about what type of medical treatment I will need?

A: You and your doctor will make this decision together based on the biology of your breast cancer, your overall health and lifestyle factors. It is important for you to understand why your doctor recommends a particular treatment and to understand why one treatment might benefit you more than another.

For example, not everyone can have breast conservation surgery (lumpectomy followed by radiation). Generally, your tumor needs to be less than five centimeters in diameter and involve only one area of your breast. In addition, you must have enough volume in your breast for the surgery to have good cosmetic results. If you have locally advanced cancer (large tumors in the breast), you may be a candidate for breast conservation therapy after receiving chemotherapy or radiation treatment, or both.

In some cases, your surgeon may recommend mastectomy, or removal of the entire breast, for a variety of reasons, including personal preference, multiple tumors in different parts of the breast, tumors in the nipple area, previous breast cancer in the same breast or large tumors. If you have a mastectomy, you may or may not have radiation treatment depending on the recommendations of your doctor.

Your doctors may recommend systemic treatments such as chemotherapy, targeted (biologic) therapy and hormonal therapy based on the results of your pathology report. They will consider factors such as the size of the tumor, how many lymph nodes were affected by the cancer, whether the tumor is estrogen sensitive, whether it overproduces the HER2 protein, the grade of the tumor (how similar it looks to a normal breast cell) and whether there are tumor cells in the lymphatic channels or blood vessels within your breast. They will also consider whether the cancer has invaded nearby tissues, is present in lymph nodes, grows in response to hormones and has an increased number of HER2 receptors. The recommendations may also take into account your age, your overall health, your preferences and the likelihood that your breast cancer could recur (come back).

You may be given a single treatment option, or you may have a choice among several options. Sometimes your doctor may recommend a clinical trial. Ask why each treatment is recommended and why one treatment might be more appropriate than another. Find out whether your doctor has information about the effectiveness of each treatment, and how the side effects of each treatment could impact your quality of life.

Reviewed by Rick Michaelson, MD

Q: What is the difference between a lumpectomy and a mastectomy?

A: A lumpectomy, also called partial or segmental mastectomy or breast conservation surgery, involves removing only the cancer from the breast with a rim of healthy tissue surrounding it (called a margin). In most cases, lumpectomy is followed by radiation therapy to the remaining breast tissue. If you have a small breast cancer, or a cancer that is small when compared to the overall size of your breast, breast-conserving therapy (lumpectomy and radiation therapy) is as effective as mastectomy in its ability to treat cancer while preserving the breast.

Mastectomy is removal of your entire breast, which includes the nipple, the areola and all the underlying breast tissue. It can be done with or without an immediate reconstruction. Most of the time, if you choose mastectomy, radiation is not required. However, if the tumor is large, or there is tumor in more than four lymph nodes, post-mastectomy radiation is recommended.

Breast conservation treatment and mastectomy are equal to one another in their ability to treat cancer.

Reviewed by Jennifer Chalfin Simmons, MD, FACS

Q: How are decisions made about what type of surgery I will have?

A: Breast conservation is recommended only for those who have small tumors that occupy one quadrant (quarter) or area of the breast. In addition, you must be willing and able to have radiation afterward in order to have breast conservation. Tumors that are large, occupy more than one quadrant of the breast or that involve the skin, the nipple or the chest wall are not amenable to breast conservation. They require mastectomy for treatment.

If your doctor offers you a choice between lumpectomy and mastectomy, consider how you feel about removing your breast and whether you can devote the additional time and travel for radiation therapy. Be sure to get all the facts. Though you may think of mastectomy as a way to "take it all out as quickly as possible," doing so may not provide a better treatment outcome. Your doctor should be able to explain the advantages and disadvantages of each treatment and help you to decide which is best for you.

Reviewed by Jennifer Chalfin Simmons, MD, FACS

Q: Where can I find information about breast reconstruction?

A: Breast reconstruction can take place at the same time as the mastectomy surgery (immediate reconstruction) or months or even years later (delayed reconstruction). Surgeons may use silicone or saline-filled implants, or tissue from other parts of your body, or a combination of both, to recreate a breast.

If you are thinking about breast reconstruction, discuss your options with your doctor as you are planning your treatment. If you decide to have immediate reconstruction, you and your doctor should discuss your personal preferences and lifestyle, the size and shape of your breasts, the size and shape of your body, your level of physical exercise, details about your medical situation and whether reconstructive surgery could impact further treatment. You should state your expectations up front so that your final result is what you want it to be.

Here are some other resources to learn more about breast reconstruction:

  • Talk with other women who have gone through reconstruction. To find someone to talk to, call our  Breast Cancer Helpline at (888) 753-LBBC (5222). We can match you with a woman who is in a situation similar to yours.
  • Read the articles "Breast Reconstruction: Options, Expectations and Alternatives" and "Breast Reconstruction: Questions to Ask Surgeons You Interview" in the Summer 2008 Insight, LBBC's quarterly newsletter.
  • Listen to the podcast Breast Reconstruction: Understanding Your Options with Liza C. Wu, MD.

Reviewed by Jennifer Chalfin Simmons, MD, FACS

Q: How are chemotherapy and hormonal therapy given?

A: There are many different types of chemotherapy medicines, and they may be given alone (single-agent therapy) or together (combination therapy). Some chemotherapy medications do a better job of fighting the cancer when they are given together. Your doctor will determine the best chemotherapy treatment for your cancer based on the traits of your cancer and your treatment goals.

Chemotherapy is delivered directly into your bloodstream, usually intravenously but sometimes orally as pills or capsules. Your doctor will determine how often and how much chemotherapy you receive. Chemotherapy may be given weekly, every two weeks, every three weeks or monthly. Some treatments, mostly pills taken by mouth, are taken daily.

There are two categories of hormonal therapies. Selective estrogen receptor modulators, or SERMS, are used for DCIS and in premenopausal women. Aromatase inhibitors are used in postmenopausal women. Both tamoxifen, the most commonly used SERM, and aromatase inhibitors are taken orally, enter your bloodstream and travel throughout your body. In general, both tamoxifen and aromatase inhibitors are given for five years as a daily pill. Studies have indicated that taking tamoxifen for longer than five years does not increase its effectiveness. Clinical trials are helping researchers figure out when and how long you should take aromatase inhibitors.

Reviewed by Lillie Shockney, RN, BS, MAS

Q: What follow-up will I need after initial treatment ends?

Once you have been diagnosed with breast cancer, you have a higher risk for developing a new breast cancer than someone who has never had the disease before. It is very important to get the follow-up treatment and care your doctor recommends so your doctor can keep track of your side effects and how you are recovering. The American Society of Clinical Oncology has established the following guidelines:

  • Have a physical exam performed by a doctor every four to six months for five years.
  • Perform a breast self-exam every month.
  • Have a mammogram every 12 months. If you have been treated with breast conserving surgery and radiation therapy, have a mammogram six months after radiation therapy ends, then of both breasts every 12 months.
  • Understand which symptoms should be reported immediately, including new lumps, bone pain, chest pain, abdominal pain, dyspnea (difficult, painful breathing or shortness of breath) or persistent headaches. The American Cancer Society and People Living With Cancer are good resources for more information about symptoms of recurrence.
  • Have a pelvic exam every 12 months if you are taking tamoxifen and have not had your uterus removed.

Reviewed by Rick Michaelson, MD

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