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What are the treatment options for breast cancer?

Women with breast cancer have many treatment options. The treatment that's best for one woman may not be best for another.

The options are surgery, radiation therapy, hormone therapy, chemotherapy, and targeted therapy. You may receive more than one type of treatment. The treatment options are described below.

  • Surgery and radiation therapy are types of local therapy. They remove or destroy cancer in the breast.
  • Hormone therapy, chemotherapy, and targeted therapy are types of systemic therapy. The drug enters the bloodstream and destroys or controls cancer throughout the body.

The treatment that's right for you depends mainly on the stage of the cancer, the results of the hormone receptor tests, the result of the HER2/neu test, and your general health.

You may want to talk with your doctor about taking part in a clinical trial, a research study of new treatment methods. Clinical trials are an important option for women at any stage of breast cancer.

Your doctor can describe your treatment choices, the expected results, and the possible side effects. Because cancer therapy often damages healthy cells and tissues, side effects are common. Before treatment starts, ask your health care team about possible side effects, how to prevent or reduce these effects, and how treatment may change your normal activities.

You may want to know how you will look during and after treatment. You and your health care team can work together to develop a treatment plan that meets your medical and personal needs.

Your doctor may refer you to a specialist, or you may ask for a referral. Specialists who treat breast cancer include surgeons, medical oncologists, and radiation oncologists. You also may be referred to a plastic surgeon or reconstructive surgeon. Your health care team may also include an oncology nurse and a registered dietitian.

At any stage of disease, supportive care is available to control pain and other symptoms, to relieve the side effects of treatment, and to ease emotional concerns.

You may want to ask your doctor these questions before you begin treatment:

  • What did the hormone receptor tests show? What did other lab tests show? Would genetic testing be helpful to me or my family? 
  • Do any lymph nodes show signs of cancer? 
  • What is the stage of the disease? Has the cancer spread? 
  • What are my treatment choices? Which do you recommend for me? Why? 
  • What are the expected benefits of each kind of treatment? 
  • What can I do to prepare for treatment?
  • Will I need to stay in the hospital? If so, for how long? 
  • What are the risks and possible side effects of each treatment? How can side effects be managed? 
  • What is the treatment likely to cost? Will my insurance cover it? 
  • How will treatment affect my normal activities? 
  • Would a research study (clinical trial) be appropriate for me? 
  • Can you recommend other doctors who could give me a second opinion about my treatment options?
  • How often should I have checkups?

Surgery

Surgery is the most common treatment for breast cancer. Your doctor can explain each type, discuss and compare the benefits and risks, and describe how each will change the way you look:

    Breast-sparing surgery: This is an operation to remove the cancer but not the breast. It's also called breast-conserving surgery. It can be a lumpectomy or a segmental mastectomy (also called a partial mastectomy). Sometimes an excisional biopsy is the only surgery a woman needs because the surgeon removed the whole lump. In breast-sparing surgery, the surgeon removes the cancer in the breast and some normal tissue around it. The surgeon may also remove lymph nodes under the arm. The surgeon sometimes removes some of the lining over the chest muscles below the tumor.

    Mastectomy: This is an operation to remove the entire breast (or as much of the breast tissue as possible). In some cases, a skin-sparing mastectomy may be an option. For this approach, the surgeon removes as little skin as possible.

    The surgeon usually removes one or more lymph nodes from under the arm to check for cancer cells. If cancer cells are found in the lymph nodes, other cancer treatments will be needed.

    In total (simple) mastectomy, the surgeon removes the whole breast. Some lymph nodes under the arm may also be removed.

    Inmodified radical mastectomy, the surgeon removes the whole breast and most or all of the lymph nodes under the arm. Often, the lining over the chest muscles is removed. A small chest muscle also may be taken out to make it easier to remove the lymph nodes.

The time it takes to heal after surgery is different for each woman. Surgery causes pain and tenderness. Medicine can help control the pain. Before surgery, you should discuss the plan for pain relief with your doctor or nurse. After surgery, your doctor can adjust the plan if you need more relief.

Any kind of surgery also carries a risk of infection, bleeding, or other problems. You should tell your health care team right away if you develop any problems.

You may feel off balance if you've had one or both breasts removed. You may feel more off balance if you have large breasts. This imbalance can cause discomfort in your neck and back.

Also, the skin where your breast was removed may feel tight. Your arm and shoulder muscles may feel stiff and weak. These problems usually go away. The doctor, nurse, or physical therapist can suggest exercises to help you regain movement and strength in your arm and shoulder. Exercise can also reduce stiffness and pain. You may be able to begin gentle exercise within days of surgery.

Because nerves may be injured or cut during surgery, you may have numbness and tingling in your chest, underarm, shoulder, and upper arm. These feelings usually go away within a few weeks or months. But for some women, numbness does not go away.

Removing the lymph nodes under the arm slows the flow of lymph fluid. The fluid may build up in your arm and hand and cause swelling. This swelling is called lymphedema. It can develop soon after surgery or months or even years later. You'll always need to protect the arm and hand on the treated side of your body from cuts, burns, or other injuries.

You may choose to have breast reconstruction. This is plastic surgery to rebuild the shape of the breast. It may be done at the same time as the cancer surgery or later. If you're considering breast reconstruction, you may wish to talk with a plastic surgeon before having cancer surgery.

You may want to ask your doctor these questions before having surgery:

  • What kinds of surgery can I consider? Is breast-sparing surgery an option for me? Is a skin-sparing mastectomy an option? Which operation do you recommend for me? Why? 
  • Will any lymph nodes be removed? How many? Why? 
  • How will I feel after the operation? Will I have to stay in the hospital? 
  • Will I need to learn how to take care of myself or my incision when I get home? 
  • Where will the scars be? What will they look like? 
  • If I decide to have plastic surgery to rebuild my breast, how and when can that be done? Can you suggest a plastic surgeon for me to contact? 
  • Will I have to do special exercises to help regain motion and strength in my arm and shoulder? Will a physical therapist or nurse show me how to do the exercises? 
  • Is there someone I can talk with who has had the same surgery I'll be having? 
  • How often will I need checkups?

Radiation Therapy

Radiation therapy (also called radiotherapy) uses high-energy rays to kill cancer cells. It affects cells only in the part of the body that is treated. Radiation therapy may be used after surgery to destroy breast cancer cells that remain in the area.

Doctors use two types of radiation therapy to treat breast cancer. Some women receive both types:

  • External radiation therapy: The radiation comes from a large machine outside the body. You will go to a hospital or clinic for treatment. Treatments are usually 5 days a week for 4 to 6 weeks. External radiation is the most common type used for breast cancer.
  • Internal radiation therapy (implant radiation therapy or brachytherapy): The doctor places one or more thin tubes inside the breast through a tiny incision. A radioactive substance is loaded into the tube. The treatment session may last for a few minutes, and the substance is removed. When it's removed, no radioactivity remains in your body. Internal radiation therapy may be repeated every day for a week.

Side effects depend mainly on the dose and type of radiation. It's common for the skin in the treated area to become red, dry, tender, and itchy. Your breast may feel heavy and tight. Internal radiation therapy may make your breast look red or bruised. These problems usually go away over time.

Bras and tight clothes may rub your skin and cause soreness. You may want to wear loose-fitting cotton clothes during this time.

Gentle skin care also is important. You should check with your doctor before using any deodorants, lotions, or creams on the treated area. Toward the end of treatment, your skin may become moist and "weepy". Exposing this area to air as much as possible can help the skin heal. After treatment is over, the skin will slowly heal. However, there may be a lasting change in the color of your skin.

You're likely to become very tired during radiation therapy, especially in the later weeks of treatment. Resting is important, but doctors usually advise patients to try to stay active, unless it leads to pain or other problems.

You may wish to discuss with your doctor the possible long-term effects of radiation therapy. For example, radiation therapy to the chest may harm the lung or heart. It can also change the size of your breast and the way it looks. If any of these problems occur, your health care team can tell you how to manage them.

You may want to ask your doctor these questions before having radiation therapy:

  • Which type of radiation therapy can I consider? Are both types an option for me?
  • When will treatment start? When will it end? How often will I have treatments? 
  • How will I feel during treatment? Will I need to stay in the hospital? Will I be able to drive myself to and from treatment? 
  • What can I do to take care of myself before, during, and after treatment? 
  • How will we know the treatment is working? 
  • Will treatment harm my skin? 
  • How will my chest look afterward?
  • Are there any lasting effects? 
  • What is the chance that the cancer will come back in my breast? 
  • How often will I need checkups?

Hormone Therapy

Hormone therapy may also be called anti-hormone treatment. If lab tests show that the tumor in your breast has hormone receptors, then hormone therapy may be an option. Hormone therapy keeps cancer cells from getting or using the natural hormones (estrogen and progesterone) they need to grow.

Chemotherapy

Chemotherapy uses drugs to kill cancer cells. The drugs that treat breast cancer are usually given through a vein (intravenous) or as a pill. You'll probably receive a combination of drugs.

You may receive chemotherapy in an outpatient part of the hospital, at the doctor's office, or at home.  Rarely, some patients need to stay in the hospital during treatment.

The side effects depend mainly on which drugs are given and how much. Chemotherapy kills fast-growing cancer cells, but the drugs can also harm normal cells that divide rapidly:

  • Blood cells: When drugs lower the levels of healthy blood cells, you're more likely to get infections, bruise or bleed easily, and feel very weak and tired. Your health care team will check for low levels of blood cells. If your levels are low, your health care team may stop the chemotherapy for a while or reduce the dose of the drug. There are also medicines that can help your body make new blood cells. 
  • Hair roots: Chemotherapy may cause hair loss. If you lose your hair, it will grow back after treatment, but the color and texture may be changed.
  • Cells that line the digestive tract: Chemotherapy can cause a poor appetite, nausea and vomiting, diarrhea, or mouth and lip sores. Your health care team can give you medicines and suggest other ways to help with these problems.

Some drugs used for breast cancer can cause tingling or numbness in the hands or feet. This problem often goes away after treatment is over.

Other problems may not go away. For example, some of the drugs used for breast cancer may weaken the heart. Your doctor may check your heart before, during, and after treatment. A rare side effect of chemotherapy is that years after treatment, a few women have developed leukemia (cancer of the blood cells).

Some anticancer drugs can damage the ovaries. If you have not gone through menopause yet, you may have hot flashes and vaginal dryness. Your menstrual periods may no longer be regular or may stop. You may become infertile (unable to become pregnant). For women over the age of 35, this damage to the ovaries is likely to be permanent.

On the other hand, you may remain able to become pregnant during chemotherapy. Before treatment begins, you should talk with your doctor about birth control because many drugs given during the first trimester are known to cause birth defects.

Targeted Therapy

Some women with breast cancer may receive drugs called targeted therapy. Targeted therapy uses drugs that block the growth of breast cancer cells. For example, targeted therapy may block the action of an abnormal protein (such as HER2) that stimulates the growth of breast cancer cells.

You may want to ask your doctor these questions before having hormone therapy, chemotherapy, or targeted therapy:

  • What drugs will I be taking? What will they do? 
  • When will treatment start? When will it end? How often will I have treatments? 
  • Where will I have treatment? 
  • What can I do to take care of myself during treatment? 
  • How will we know the treatment is working? 
  • Which side effects should I tell you about? 
  • Will there be long-term effects? 
  • How often will I need checkups?

Nutrition and Physical Activity

  • It's important for you to take very good care of yourself before, during, and after cancer treatment. Taking care of yourself includes eating well and staying as active as you can.
  • You need the right amount of calories to maintain a good weight. You also need enough protein to keep up your strength. Eating well may help you feel better and have more energy.
  • Sometimes, especially during or soon after treatment, you may not feel like eating. You may be uncomfortable or tired. You may find that foods don't taste as good as they used to. In addition, the side effects of treatment (such as poor appetite, nausea, vomiting, or mouth blisters) can make it hard to eat well. On the other hand, some women treated for breast cancer may have a problem with weight gain.
  • Your doctor, a registered dietitian, or another health care provider can suggest ways to help you meet your nutrition needs.
  • Many women find that they feel better when they stay active. Walking, yoga, swimming, and other activities can keep you strong and increase your energy. Exercise may reduce nausea and pain and make treatment easier to handle. It also can help relieve stress. Whatever physical activity you choose, be sure to talk to your doctor before you start. Also, if your activity causes you pain or other problems, be sure to let your doctor or nurse know.

Date Updated: 29-APR-2013



Akron General Medical Center • 1 Akron General Avenue (Formerly 400 Wabash Avenue) • Akron, OH 44307 • 330-344-6000 • 1-800-221-4601    © 2014 Akron General Health System
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