Women with breast cancer now have many treatment options. Many
women want to learn all they can about the disease and their
treatment choices so that they can take an active part in decisions
about their medical care. They are likely to have many questions and
concerns about their treatment options.
The doctor is the best person to answer questions about treatment
for a particular patient: what her treatment choices are and how
successful her treatment is expected to be. Most patients also want
to know how they will look after treatment and whether they will
have to change their normal activities. A woman should not feel that
she needs to ask all her questions or understand all the answers at
once. She will have many chances to ask the doctor to explain things
that are not clear and to ask for more information.
A woman's treatment options depend on a number of factors. These
factors include her age and menopausal status; her general health;
the size and location of the tumor and the stage of the cancer; the
results of lab tests; and the size of her breast. Certain features
of the tumor cells (such as whether they depend on hormones to grow)
are also considered. In most cases, the most important factor is the
stage of the disease. The stage is based on the size of the tumor
and whether the cancer has spread. The following are brief
descriptions of the stages of breast cancer and the treatments most
often used for each stage. (Other treatments may sometimes be
appropriate.)
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Stage 0 is sometimes called noninvasive carcinoma or
carcinoma in situ.
Lobular carcinoma in situ (LCIS) refers to
abnormal cells in the lining of a lobule. These abnormal cells
seldom become invasive cancer. However, their presence is a sign
that a woman has an increased risk of developing breast cancer.
This risk of cancer is increased for both breasts. Some women with
LCIS may take a drug called tamoxifen, which can reduce the risk
of developing breast cancer. Others may take part in studies of
other promising new preventive treatments. Some women may choose
not to have treatment, but to return to the doctor regularly for
checkups. And, occasionally, women with LCIS may decide to have
surgery to remove both breasts to try to prevent cancer from
developing. (In most cases, removal of underarm lymph nodes is not
necessary.)
Ductal carcinoma in situ (DCIS) refers to
abnormal cells in the lining of a duct. DCIS is also called
intraductal carcinoma. The abnormal cells have not spread beyond
the duct to invade the surrounding breast tissue. However, women
with DCIS are at an increased risk of getting invasive breast
cancer. Some women with DCIS have breast-sparing surgery followed
by radiation therapy. Or they may choose to have a mastectomy,
with or without breast reconstruction (plastic surgery) to rebuild
the breast. Underarm lymph nodes are not usually removed. Also,
women with DCIS may want to talk with their doctor about tamoxifen
to reduce the risk of developing invasive breast cancer.
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Stage I and stage II are early stages of breast
cancer in which the cancer has spread beyond the lobe or duct and
invaded nearby tissue. Stage I means that the tumor is no more
than about an inch across and cancer cells have not spread beyond
the breast. Stage II means one of the following: the tumor in the
breast is less than 1 inch across and the cancer has spread to the
lymph nodes under the arm; or the tumor is between 1 and 2 inches
(with or without spread to the lymph nodes under the arm); or the
tumor is larger than 2 inches but has not spread to the lymph
nodes under the arm.
Women with early stage breast cancer may have breast-sparing
surgery followed by radiation therapy to the breast, or they may
have a mastectomy, with or without breast reconstruction to
rebuild the breast. These approaches are equally effective in
treating early stage breast cancer. (Sometimes radiation therapy
is also given after mastectomy.)
The choice of breast-sparing surgery or mastectomy depends
mostly on the size and location of the tumor, the size of the
woman's breast, certain features of the cancer, and how the woman
feels about preserving her breast. With either approach, lymph
nodes under the arm usually are removed.
Many women with stage I and most with stage II breast cancer
have chemotherapy and/or hormonal therapy after primary treatment
with surgery or surgery and radiation therapy. This added
treatment is called adjuvant therapy. If the systemic therapy is
given to shrink the tumor before surgery, this is called
neoadjuvant therapy. Systemic treatment is given to try to destroy
any remaining cancer cells and prevent the cancer from recurring,
or coming back, in the breast or elsewhere.
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Stage III is also called locally advanced cancer. In
this stage, the tumor in the breast is large (more than 2 inches
across) and the cancer has spread to the underarm lymph nodes; or
the cancer is extensive in the underarm lymph nodes; or the cancer
has spread to lymph nodes near the breastbone or to other tissues
near the breast.
Inflammatory breast cancer is a type of locally
advanced breast cancer. In this type of cancer the breast looks
red and swollen (or inflamed) because cancer cells block the lymph
vessels in the skin of the breast.
Patients with stage III breast cancer usually have both local
treatment to remove or destroy the cancer in the breast and
systemic treatment to stop the disease from spreading. The local
treatment may be surgery and/or radiation therapy to the breast
and underarm. The systemic treatment may be chemotherapy, hormonal
therapy, or both. Systemic therapy may be given before local
therapy to shrink the tumor or afterward to prevent the disease
from recurring in the breast or elsewhere.
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Stage IV is metastatic cancer. The cancer has spread
beyond the breast and underarm lymph nodes to other parts of the
body.
Women who have stage IV breast cancer receive chemotherapy
and/or hormonal therapy to destroy cancer cells and control the
disease. They may have surgery or radiation therapy to control the
cancer in the breast. Radiation may also be useful to control
tumors in other parts of the body.
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Recurrent cancer means the disease has come back in
spite of the initial treatment. Even when a tumor in the breast
seems to have been completely removed or destroyed, the disease
sometimes returns because undetected cancer cells remained
somewhere in the body after treatment.
Most recurrences appear within the first 2 or 3 years after
treatment, but breast cancer can recur many years later.
Cancer that returns only
in the area of the surgery is called a
local recurrence. If the disease returns in another part of the body,
the distant recurrence is called metastatic breast cancer. The patient may have one type of
treatment or a combination of treatments for recurrent cancer.
