Breast Cancer Treatments

Different types of treatment are available for patients with breast cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials.

Before starting treatment, patients may want to think about taking part in a clinical trial. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the "standard" treatment, the new treatment may become the standard treatment.

Clinical trials are taking place in many parts of the country. Information about ongoing clinical trials is available from the NCI Cancer.gov Web site. Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team.

Other types of surgery include the following:

• Total or simple mastectomy: Removal of the whole breast. Sometimes lymph nodes under the arm are also taken out.
• Modified radical mastectomy: Removal of the breast, many of the lymph nodes under the arm, the lining over the chest muscles, and sometimes, part of the chest wall muscles.
• Radical mastectomy (sometimes called the Halsted radical mastectomy): Removal of the breast, chest muscles, and all of the lymph nodes under the arm. This surgery is used only when the tumor has spread to the chest muscles.

Even if the doctor removes all of the cancer that can be seen at the time of surgery, the patient may be given radiation therapy, chemotherapy, or hormone therapy after surgery to try to kill any cancer cells that may be left. Treatment given after surgery to increase the chances of a cure is called adjuvant therapy.

If a patient is going to have a mastectomy, breast reconstruction (surgery to rebuild a breast's shape after a mastectomy) may be considered. Breast reconstruction may be done at the time of the mastectomy or at a future time. The reconstructed breast may be made with the patient's own (nonbreast) tissue or by using implants filled with saline or silicone gel. The Food and Drug Administration (FDA) has decided that breast implants filled with silicone gel may be used only in clinical trials. Before the decision to get an implant is made, patients can call the FDA's Center for Devices and Radiologic Health at 1-888-INFO-FDA (1-888-463-6332) for more information.

If you or your partner are considering mastectomy as a breast cancer treatment option, you may want to read Higsinc.com's section on breast cancer and sexuality.

2. Radiation therapy

Radiation therapy is the use of x-rays or other types of radiation to kill cancer cells and shrink tumors. Radiation therapy may use external radiation (using a machine outside the body) or internal radiation. Internal radiation involves putting radioisotopes (materials that produce radiation) through thin plastic tubes into the area where cancer cells are found. Radiation may be used after surgery in addition to chemotherapy, and hormone therapy. Breast cancer is treated with external radiation.

3. Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells. Chemotherapy may be taken by mouth, or it may be put into the body by inserting a needle into a vein or muscle. Either type of chemotherapy is called systemic treatment because the drugs enter the bloodstream, travel through the body, and can kill cancer cells throughout the body.

If you or your partner are considering chemotherapy as a breast cancer treatment option, you may want to read Higsinc.com's section on breast cancer and sexuality to learn more about the potential sexual side effects of chemotherapy.

4. Hormone therapy

Hormones are chemicals produced by glands in the body and are circulated in the bloodstream. Estrogen and progesterone are hormones that affect the way some cancers grow. If tests show that the cancer cells have estrogen and progesterone receptors (molecules found in some cancer cells to which estrogen and progesterone will attach), hormone therapy is used to block the way these hormones help the cancer grow. This may be done by using drugs that block the way hormones work or by surgically removing organs that make hormones, such as the ovaries. Hormone therapy with tamoxifen is often given to patients with early stages of breast cancer and those with metastatic breast cancer (cancer that has spread to other parts of the body). Hormone therapy with tamoxifen or estrogens can act on cells all over the body and may increase the chance of developing endometrial cancer. Women taking tamoxifen should have a pelvic examination every year to look for any signs of cancer. Any vaginal bleeding, other than menstrual bleeding, should be reported to a doctor as soon as possible.

If you or your partner are considering hormone therapy as a breast cancer treatment option, you may want to read Higsinc.com's section on breast cancer and sexuality which discusses the sexual side effects of tamoxifen.

Other types of treatment are being tested in clinical trials, including:

• Sentinel lymph node biopsy followed by surgery. Sentinel lymph node biopsy is a procedure in which the doctor injects a radioactive substance and/or blue dye near the tumor. The substance or dye flows through lymph ducts to the sentinel node or nodes (the first lymph node or nodes where cancer cells are likely to have spread). The surgeon removes only nodes with the radioactive substance or dye. A pathologist then checks the sentinel lymph nodes for cancer cells. If no cancer cells are detected, it may not be necessary to remove additional nodes. After the sentinel lymph node biopsy, the surgeon removes the tumor (breast-conserving surgery or mastectomy).
• High-dose chemotherapy with bone marrow transplantation and peripheral blood stem cell transplantation Chemotherapy can reduce the ability of bone marrow to make blood cells. Bone marrow transplantation and peripheral blood stem cell transplantation have been tested as ways to help the blood recover so that higher than standard doses of chemotherapy can be given. Studies have shown that high-dose chemotherapy followed by bone marrow transplantation or peripheral blood stem cell transplantation does not work better than standard chemotherapy in the treatment of breast cancer. Doctors have decided that, for now, high-dose chemotherapy should only be tested in clinical trials. Before taking part in such a trial, women should talk with their doctors about the serious side effects, including death, that may be caused by high-dose chemotherapy.