Breast Cancer Treatment Options by Stage

Overview

A variety of treatments for breast cancer exist,

and treatment is available at every stage of
cancer. Most people need a combination of
two or more treatments.

After diagnosis, your doctor will determine the

stage of your cancer. They will then decide on
the best treatment options based on your
stage and other factors, such as age, family
history, genetic mutation status, and personal
medical history.

Treatments for early stage breast cancer may

not be effective for advanced stage breast
cancer. Breast cancer stages range from 0 to
4. Different factors determine your stage,
including:

 the size of the tumor

 the number of lymph nodes affected
 whether the cancer has spread to other
parts of your body
Doctors use different tests to stage breast
cancer. Imaging tests include CT
scan, MRI, ultrasound, X-ray, and PET scan.

These can help the doctor narrow down the

location of the cancer, calculate tumor size,
and determine whether the cancer has spread
to other parts of the body.

If an imaging test shows a mass in another

part of the body, your doctor can perform
a biopsy to see whether the mass is malignant
or benign. A physical exam and blood test can
also help with staging.

Stage 0 (DCIS)
If precancerous or cancer cells are confined to
the milk ducts, it’s called noninvasive breast
cancer or ductal carcinoma in situ (DCIS).

Stage 0 breast cancer can become invasive

and spread beyond the ducts. Early treatment
can stop you from developing invasive breast
cancer.

Surgery
In a lumpectomy, the surgeon removes the
cancerous cells and spares the rest of the
breast. It’s a viable option when DCIS is
confined to one area of the breast.

A lumpectomy may be performed as an

outpatient procedure. This means you can go
home shortly after the surgery and won’t need
to stay in a hospital overnight.

A mastectomy is the surgical removal of the

breast. It’s recommended when DCIS is found
throughout the breast. Surgery to reconstruct
the breast can begin at the time of the
mastectomy or at a later date.

Radiation therapy

Radiation is a type of targeted therapy. It’s

usually recommended after lumpectomy for
stage 0 breast cancers. High-energy X-rays
are used to destroy cancer cells and prevent
them from spreading.

This treatment can lower the risk of

recurrence. Radiation therapy is typically
administered five days per week over the
course of five to seven weeks.
Hormone treatment or targeted therapy

Your doctor may recommend a hormone

treatment if you’ve had a lumpectomy or
single mastectomy for estrogen receptor-
positive or progesterone receptor-positive
breast cancer.

Oral hormone treatments, such as tamoxifen,

are generally prescribed to lower your risk of
developing invasive breast cancer. Hormone
treatment may not be prescribed for women
who have had a double mastectomy for stage
0 breast cancer.

Your doctor may also recommend

trastuzumab (Herceptin), a targeted therapy, if
your breast cancer tests positive for excessive
HER2 proteins.

Stage 1

Stage 1A breast cancer means the primary

tumor is 2 centimeters or less and the axillary
lymph nodes aren’t affected. In stage 1B,
cancer is found in lymph nodes and there’s no
tumor in the breast or the tumor is smaller
than 2 centimeters.
Both 1A and 1B are considered early stage
invasive breast cancers. Surgery and one or
more other therapies may be recommended.

Surgery

Lumpectomy and mastectomy are both

options for stage 1 breast cancer. The
decision is based on:

 the size and location of the primary tumor

 personal preference
 other factors such as genetic
predisposition

Biopsy of the lymph nodes will probably be

performed at the same time.

For mastectomy, reconstruction of the

breast can begin at the same time if wanted,
or after additional treatment is completed.

Radiation therapy

Radiation therapy is often recommended after

surgery for stage 1 breast cancer. It may not
be necessary for women older than 70 years,
especially if hormone therapy is possible.
Chemotherapy and targeted therapy

Breast cancer that’s negative for estrogen,

progesterone, and HER2 is called triple
negative breast cancer
(TNBC). Chemotherapy is almost always
needed for these cases because there’s no
targeted treatment for TNBC.

Chemotherapy be also be given for hormone-

positive breast cancers. Herceptin, a targeted
therapy, is given along with chemotherapy
for HER2-positive breast cancers. Your doctor
may also recommend other HER2-targeted
therapies, such as Perjeta or Nerlynx.

However, chemotherapy isn’t always needed

for early stage breast cancer, especially if it
can be treated with hormone therapy.

Hormone therapy

Doctors may recommend hormone therapy

for hormone receptor-positive breast cancers,
regardless of tumor size.

Stage 2
In stage 2A, the tumor is smaller than 2
centimeters and has spread to between one
and three nearby lymph nodes. Or, it’s
between 2 and 5 centimeters and hasn’t
spread to lymph nodes.

Stage 2B means the tumor is between 2 and

5 centimeters and has spread to between one
and three nearby lymph nodes. Or it’s larger
than 5 centimeters and hasn’t spread to any
lymph nodes.

You’ll probably need a combination of

surgery, chemotherapy, and one or more of
the following: targeted therapy, radiation, and
hormone treatment.

Surgery

Lumpectomy and mastectomy may both be

options depending on the size and location of
the tumor.

A modified radical mastectomy is a removal of

the breast, including chest muscles. If you
choose reconstruction, the process may begin
at the same time or after cancer treatment is
complete.
Radiation therapy

Radiation therapy targets any remaining

cancer cells in the chest and lymph nodes. It’s
often recommended after surgery.

Chemotherapy

Chemotherapy is a systemic therapy to kill

cancer cells throughout the body. These
powerful drugs are delivered intravenously
(into a vein) over the course of many weeks or
months.

There are a variety of chemotherapy drugs

used to treat breast cancer, including:

 docetaxel (Taxotere)
 doxorubicin (Adriamycin)
 cyclophosphamide (Cytoxan)

You may receive a combination of several

chemotherapy drugs. Chemotherapy is
particularly important for TNBC. Herceptin is
given along with chemotherapy for HER2-
positive breast cancers.
Your doctor may also recommend other
HER2-targeted therapies, such as Perjeta or
Nerlynx.

Hormone treatment

After all other treatment is complete, you may

benefit from continued treatment for hormone-
positive breast cancers.

Oral medications such as tamoxifen or

aromatase inhibitors may be prescribed for
five or more years.

Stage 3

Stage 3A breast cancer means that the

cancer has spread to four to nine axillary
(armpit) lymph nodes or has enlarged the
internal mammary lymph nodes. The primary
tumor may be any size.

It can also mean the tumor is bigger than 5

centimeters and small groups of cancer cells
are found in the lymph nodes. Finally, stage
3A can also include tumors greater than 5
centimeters with involvement of one to three
axillary lymph nodes or any breastbone
nodes.

Stage 3B means a breast tumor has invaded

the chest wall or skin and may or may not
have invaded up to nine lymph nodes.

Stage 3C means cancer is found in 10 or

more axillary lymph nodes, lymph nodes near
the collarbone, or internal mammary nodes.

Symptoms of inflammatory breast cancer

(IBC) are different from other types of breast
cancer. Diagnosis may be delayed since
there’s usually no breast lump. By definition,
IBC is diagnosed at stage 3B or above.

Treatment

Treatments for stage 3 breast cancers are

similar to those for stage 2.

Stage 4

Stage 4 indicates that breast cancer has

metastasized (spread to a distant part of the
body).
Breast cancer most often spreads to the
lungs, brain, liver, or bones. Metastatic breast
cancer can’t be cured, but it can be treated
with aggressive systemic therapy.

Because the cancer involves different parts of

the body, you may need multiple therapies to
stop tumor growth and ease symptoms.

Treatment

Depending on how advanced your breast

cancer is, you’ll probably have chemotherapy,
radiation therapy, and hormone therapy (if you
have a hormone receptor-positive cancer).

Another option is targeted therapy, which

targets the protein that allows cancer cells to
grow. For HER2-positive cancers, HER2-
targeted therapies may include Herceptin,
Perjeta, Nerlynx, Tykerb, or Kadcyla.

If the cancer spreads to the lymph nodes, you

may notice swelling or enlargement of your
nodes. Surgery, chemotherapy, and radiation
can be used to treat cancer that spreads to
the lymph nodes.
The number and location of tumors
determines your surgical options.

Surgery isn’t the first line of defense with

advanced breast cancer, but your doctor may
recommend surgery to treat spinal cord
compression, broken bones, and single
masses caused by metastasis. This helps
relieve pain and other symptoms.

Other drugs used to treat advanced stage

breast cancer include:

 antidepressants
 anticonvulsants
 steroids
 local anesthetics