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Breast Cancer Treatment (PDQ®)
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General Information About Breast Cancer
Key Points:
Breast cancer is a disease in which malignant (cancer) cells
form in the tissues of the breast.
The breast is made up of lobes and ducts. Each breast has 15 to 20 sections called
lobes, which have many smaller sections called lobules. Lobules end in dozens of tiny bulbs that
can produce milk. The lobes, lobules, and bulbs are linked by thin tubes called
ducts.
Breast anatomy; shows lobes, lobules, ducts, areola, nipple, fat, lymph nodes, and lymph vessels
Each breast also has blood
vessels and lymph
vessels. The lymph vessels carry an almost colorless fluid called lymph. Lymph
vessels lead to organs called lymph
nodes. Lymph nodes are small bean-shaped structures that are
found throughout the body. They filter substances in a fluid called lymph and help fight
infection and disease. Clusters of lymph nodes are found near the breast in the
axilla (under the arm), above the
collarbone, and in the chest.
The most common type of breast cancer is ductal
carcinoma, which begins in the cells of the ducts. Cancer that begins in the
lobes or lobules is called lobular carcinoma and is more often found in both
breasts than are other types of breast cancer. Inflammatory breast cancer is an uncommon type of
breast cancer in which the breast is warm, red, and swollen.
Age and health history can affect the risk of developing breast
cancer.
Anything that increases your chance of getting a disease
is called a risk factor. Risk factors for breast cancer include the following:
- Older age.
-
Menstruating at an
early age.
- Older age at first birth or never having given birth.
- A personal history of breast cancer or benign (noncancer) breast disease.
- A mother or sister with breast cancer.
- Treatment with radiation therapy to the breast/chest.
- Breast tissue that is dense on a mammogram.
- Taking hormones such as estrogen and progesterone.
- Drinking alcoholic beverages.
- Being white.
Breast cancer is sometimes caused by inherited gene mutations
(changes).
The genes in cells carry
the hereditary information that is
received from a person’s parents. Hereditary breast cancer makes up
approximately 5% to 10% of all breast cancer. Some altered genes related to
breast cancer are more common in certain ethnic groups.
Women who have an altered gene related to breast cancer and who
have had breast cancer in one breast have an increased risk of developing
breast cancer in the other breast. These women also have an increased risk of
developing ovarian cancer, and may
have an increased risk of developing other cancers. Men who have an altered
gene related to breast cancer also have an increased risk of developing this
disease. (For more information, refer to the PDQ summary on
Male Breast Cancer Treatment.)
Tests have been developed that can detect altered genes. These
genetic tests are sometimes done for
members of families with a high risk of cancer. (Refer to the PDQ summaries on
Screening for Breast
Cancer, Prevention of
Breast Cancer, and Genetics of Breast and Ovarian Cancer for
more information.)
Tests that examine the breasts are used to detect (find) and
diagnose breast cancer.
A doctor should be seen if changes in the breast are noticed. The
following tests and procedures may be used:
Certain factors affect prognosis (chance of recovery) and treatment options.
The prognosis (chance of recovery) and treatment options depend on the following:
- The stage
of the cancer (whether it is in the breast only or has spread to lymph nodes or other places
in the body).
- The type of breast cancer.
- Estrogen-receptor and progesterone-receptor levels in the tumor tissue.
- A woman’s age,
general health, and menopausal status (whether a woman
is still having menstrual periods).
- Whether the cancer has just been diagnosed or has recurred (come back).
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Stages of Breast Cancer
Key Points:
After breast cancer has been diagnosed, tests are done to find
out if cancer cells have spread within the breast or to other parts of the
body.
The process used to find out whether the cancer has spread within the breast or to other
parts of the body is called staging.
The information gathered from the staging process determines the
stage of the disease. It is
important to know the stage in order to plan treatment.
The following stages are used for breast cancer:
Stage 0 (carcinoma in situ)
There are 2 types of breast carcinoma in situ:
Tumor size compared to everyday objects; shows various measurements of a tumor compared to a pea, peanut, walnut, and lime
Stage I
In stage I, the tumor
is 2 centimeters or smaller and has not spread outside the
breast.
Stage IIA
In stage IIA:
- no tumor is found in the breast, but cancer is found in the axillary lymph nodes (the
lymph nodes under the arm);
or
- the tumor is 2 centimeters or smaller and has spread
to the axillary lymph nodes;
or
- the tumor is larger than 2 centimeters but not larger than 5 centimeters and has not
spread to the axillary lymph nodes.
Stage IIB
In stage IIB, the tumor
is either:
- larger than 2 centimeters but not larger than 5 centimeters and has spread
to the axillary lymph nodes; or
- larger than 5 centimeters but has not
spread to the axillary lymph nodes.
Stage IIIA
In stage IIIA:
- no tumor is found in the breast, but cancer is found in axillary lymph nodes that are attached to each other or to other structures; or
- the tumor is 5 centimeters or smaller and has spread
to axillary lymph nodes that are attached to each other or to other structures; or
- the tumor is larger than 5 centimeters and has spread to axillary
lymph nodes that may be attached to each other or to other
structures.
Stage IIIB
In stage IIIB, the
cancer may be any size and:
- has spread to tissues near the breast (the skin or
chest wall, including the ribs and
muscles in the chest); and
- may have spread to lymph nodes within the breast or under the arm.
Stage IIIC
In stage IIIC, the
cancer:
- has spread to lymph nodes beneath the collarbone and near the neck; and
- may have spread to lymph nodes within the breast or under the arm and to tissues near the breast.
Stage IIIC breast cancer is divided into operable and inoperable stage IIIC.
In operable stage IIIC, the cancer:
- is found in 10 or more of the lymph nodes under the arm; or
- is found in the lymph nodes beneath the collarbone and near the neck on the same side of the body as the breast with cancer; or
- is found in lymph nodes within the breast itself and in lymph nodes under the arm.
In inoperable stage IIIC breast cancer, the cancer has spread to the lymph nodes above the collarbone and near the neck on the same side of the body as the breast with cancer.
Stage IV
In stage IV, the cancer
has spread to other organs of the body, most often the bones,
lungs, liver, or brain.
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Inflammatory Breast Cancer
In inflammatory breast
cancer, the breast looks red and swollen and feels warm. The
redness and warmth occur because the cancer cells block the lymph vessels in the skin. The skin of the breast
may also show the pitted appearance called peau
d’orange (like the skin of an orange). Inflammatory breast cancer may be stage IIIB, stage IIIC, or stage IV.
Inflammatory breast cancer of the left breast with redness, peau d'orange, and inverted nipple.
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Recurrent Breast Cancer
Recurrent breast
cancer is cancer that has recurred
(come back) after it has been treated. The cancer may come back in
the breast, in the chest wall, or
in other parts of the body.
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Treatment Option Overview
Key Points:
There are different types of treatment for patients with breast
cancer.
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 Web site. Choosing the most appropriate cancer treatment is a
decision that ideally involves the patient, family, and health care
team.
Four types of standard treatment are used:
Surgery
Most patients with breast cancer have surgery to remove the cancer from the breast. Some
of the lymph nodes under the arm
are usually taken out and looked at under a microscope to see if they contain
cancer cells.
Breast-conserving
surgery, an operation to remove the cancer but not the breast
itself, includes the following:
Breast-sparing surgery; shows removal of tumor and axillary lymph nodes
Patients who are treated with breast-conserving surgery may also have some of the lymph nodes under the arm removed for biopsy. This procedure is called lymph node dissection. It may be done at the same time as the breast-conserving surgery or after. Lymph node dissection is done through a separate incision.
Other types of surgery include the following:
-
Total mastectomy: Surgery to remove the whole breast that has cancer. This procedure is also called a simple mastectomy. Some of the lymph nodes under the arm may be removed for biopsy at the same time as the breast surgery or after. This is done through a separate incision.
Total (simple) mastectomy; shows removal of the breast and lymph nodes
-
Modified radical
mastectomy: Surgery to remove the whole breast that has cancer, many of the lymph nodes under
the arm, the lining over the chest muscles, and sometimes, part of the
chest wall muscles.
Modified radical mastectomy;shows removal of the breast, most or all of the lymph nodes under the arm, the lining over the chest muscles and sometimes part of the chest wall muscles
-
Radical
mastectomy: Surgery to remove the breast that has cancer, chest wall muscles under the breast, and all of the lymph nodes under the arm. This procedure is sometimes called a Halsted radical mastectomy.
Even if the doctor removes all the cancer that can be seen at
the time of the surgery, some patients may be given radiation therapy,
chemotherapy, or
hormone therapy after surgery to kill any cancer cells that are left. Treatment given after the 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. Before the decision to get an implant is
made, patients can call the Food and Drug Administration's (FDA) Center for Devices and Radiologic Health at
1-888-INFO-FDA (1-888-463-6332) or visit the FDA's Web site for more information on breast implants.
Radiation therapy
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.
Chemotherapy
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.
Hormone therapy
Hormone therapy is a cancer treatment that removes hormones or blocks their action and stops cancer cells from growing. Hormones are substances produced by glands in the body and circulated in the bloodstream. Some hormones can cause certain cancers to grow. If tests show that the cancer cells have places where hormones can attach (receptors), drugs, surgery, or radiation therapy are used to reduce the production of hormones or block them from working.
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 exam 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.
Hormone therapy with an aromatase inhibitor is given to some postmenopausal women who have hormone-dependent breast cancer. Hormone-dependent breast cancer needs the hormone estrogen to grow. Aromatase inhibitors decrease the body's estrogen by blocking an enzyme called aromatase from turning androgen into estrogen.
For the treatment of early stage breast cancer, certain aromatase inhibitors may be used as adjuvant therapy instead of tamoxifen or after 2 or more years of tamoxifen. For the treatment of metastatic breast cancer, aromatase inhibitors are being tested in clinical trials to compare them to hormone therapy with tamoxifen.
New types of treatment are being tested in clinical trials.
These include the following:
Sentinel lymph node biopsy followed by surgery
Sentinel lymph node biopsy is the removal of the sentinel lymph node during surgery. The sentinel lymph node is the first lymph node to receive lymphatic drainage from a tumor. It is the first lymph node the cancer is likely to spread to from the tumor. A radioactive substance and/or blue dye is injected near the tumor. The substance or dye flows through the lymph ducts to the lymph nodes. The first lymph node to receive the substance or dye is removed. A pathologist views the tissue under a microscope to look for cancer cells. If cancer cells are not found, it may not be necessary to remove more lymph nodes. After the sentinel lymph node biopsy, the
surgeon removes the tumor (breast-conserving surgery or mastectomy).
| | |
| Sentinel lymph node biopsy. Radioactive substance and/or blue dye is injected near the tumor (first panel), the injected material is followed visually or with a probe (middle panel), and the first lymph nodes to take up the material are removed and checked for cancer cells (last panel). |
High-dose chemotherapy with stem cell transplant
High-dose chemotherapy with stem cell transplant is a way of giving high doses of chemotherapy and replacing blood-forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the blood or bone marrow of the patient or a donor and are frozen and stored. After the chemotherapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into (and restore) the body’s blood cells.
Studies have shown that high-dose chemotherapy followed by stem cell transplant does not work better than standard chemotherapy in the treatment of breast
cancer. Doctors have decided that, for now, high-dose chemotherapy should be tested only 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.
Monoclonal antibodies as adjuvant therapy
Monoclonal antibody therapy is a cancer treatment that uses antibodies made in the laboratory, from a single type of immune system cell. These antibodies can identify substances on cancer cells or normal substances that may help cancer cells grow. The antibodies attach to the substances and kill the cancer cells, block their growth, or keep them from spreading. Monoclonal antibodies are given by infusion. They may be used alone or to carry drugs, toxins, or radioactive material directly to cancer cells. Monoclonal antibodies are also used in combination with chemotherapy as adjuvant therapy.
Trastuzumab (Herceptin) is a monoclonal antibody that blocks the effects of the growth factor protein HER2, which transmits growth signals to breast cancer cells. About one-fourth of patients with breast cancer have tumors that may be treated with trastuzumab combined with chemotherapy.
Tyrosine kinase inhibitors as adjuvant therapy
Tyrosine kinase inhibitors are targeted therapy drugs that block signals needed for tumors to grow. Tyrosine kinase inhibitors may be used in combination with other anticancer drugs as adjuvant therapy.
Lapatinib is a tyrosine kinase inhibitor that blocks the effects of the HER2 protein and other proteins inside tumor cells. It may be used to treat patients with HER2-positive breast cancer that has progressed following treatment with trastuzumab.
This summary section refers to specific treatments under study in
clinical trials, but it may not mention every new treatment being studied.
Information about ongoing clinical trials is available from the
NCI Web site.
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Treatment Options by Stage
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Ductal Carcinoma In Situ (DCIS)
Treatment of ductal carcinoma in situ (DCIS) may include the following:
This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Web site.
Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with ductal breast carcinoma in situ.
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Lobular Carcinoma In Situ (LCIS)
Treatment of lobular carcinoma in situ (LCIS) may include the following:
This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Web site.
Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with lobular breast carcinoma in situ.
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Stage I, Stage II, Stage IIIA, and Operable Stage IIIC Breast Cancer
Treatment of stage I,
stage II, stage IIIA , and operable stage IIIC breast cancer may include the following:
Adjuvant
therapy (treatment given after surgery to
increase the chances of a cure) may include the following:
This summary section refers to specific treatments under study in
clinical trials, but it may not mention every new treatment being studied.
Information about ongoing clinical trials is available from the
NCI Web site.
Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage I breast cancer, stage II breast cancer, stage IIIA breast cancer and stage IIIC breast cancer.
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Stage IIIB, Inoperable Stage IIIC, Stage IV, and Metastatic Breast Cancer
Stage IIIB and inoperable stage IIIC breast cancer
Treatment of stage IIIB and inoperable stage IIIC breast cancer may include the following:
This summary section refers to specific treatments under study in
clinical trials, but it may not mention every new treatment being studied.
Information about ongoing clinical trials is available from the
NCI Web site.
Stage IV and metastatic breast cancer
Treatment of stage IV or
metastatic breast cancer may include
the following:
This summary section refers to specific treatments under study in
clinical trials, but it may not mention every new treatment being studied.
Information about ongoing clinical trials is available from the
NCI Web site.
Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with stage IIIB breast cancer, stage IIIC breast cancer and stage IV breast cancer.
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Treatment Options for Inflammatory Breast Cancer
Treatment of inflammatory breast
cancer may include the following:
This summary section refers to specific treatments under study in
clinical trials, but it may not mention every new treatment being studied.
Information about ongoing clinical trials is available from the
NCI Web site.
Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with inflammatory breast cancer.
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Treatment Options for Recurrent Breast Cancer
Treatment of recurrent
breast cancer (cancer that has come
back after treatment) in the breast or chest
wall may include the following:
Check for clinical trials from NCI's PDQ Cancer Clinical Trials Registry that are now accepting patients with recurrent breast cancer.
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Changes to This Summary (07/19/2007)
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
Changes were made to this summary to match those made to the health professional version.
This information is provided from the PDQ® database in collaboration with the NCI.
