Breast Cancer Treatments By Stage

Systemic Treatments For Stage 1 Breast Cancer

Systemic treatments, often termed add-on or adjuvant treatments, treat breast cancer throughout your body and not just at the site of the tumor.

These treatments help destroy cancer cells that have spread beyond your breast but are still too small to be spotted. They include the therapies outlined below.

Chemotherapy

Doctors may recommend chemotherapy, also called chemo, after surgery to help destroy any undetected cancer cells. Chemotherapy may also lower your risk of the cancer coming back at a later stage.

Chemotherapy may be recommended for a smaller tumor if:

• Any cancer cells were found in the lymph nodes.
• You score high on a gene test such as Oncotype DX, which shows whether chemotherapy could help treat your breast cancer and if its likely to come back after surgery.
• The cancer cells are progesterone receptor- and estrogen receptor-negative.
• The breast cancer cells are positive for human epidermal growth factor receptor 2 various therapies can target these receptors.

Hormone therapy

Hormone therapy can be used to help slow down the growth of cancer cells in people with estrogen receptor-positive or progesterone receptor-positive cancer cells. Hormone therapy works by blocking hormone receptors on the cancer cells or by lowering the amount of estrogen produced in your body.

Its important to ask your doctor about the potential side effects of hormone therapy before you begin this treatment, so can you know what to expect.

Targeted therapy

Treatment Of Ductal Carcinoma In Situ

For information about the treatments listed below, see the Treatment Option Overview section.

• Breast-conserving surgery and radiation therapy, with or without tamoxifen.
• Total mastectomy with or without tamoxifen. Radiation therapy may also be given.

Use our clinical trial search to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based on the type of cancer, the age of the patient, and where the trials are being done. General information about clinical trials is also available.

Radiation Therapy And Mastectomy

Most people who have mastectomy dont need radiation therapy if theres no cancer in the lymph nodes.

In some cases, radiation therapy is used after mastectomy to treat the chest wall, the axillary lymph nodes and/or the lymph nodes around the collarbone.

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What Types Of Breast Cancer Should Be Treated With Chemotherapy

Almost all women with HER2-positive cancers still need some amount of chemotherapy. And women with triple-negative tumors still need a relatively intensive course of chemotherapy, Dr. Lustberg says.

Chemotherapy may also be used to treat certain larger HR-positive cancers that have spread to lymph nodes, even if the tumor is estrogen-positive. “Specialized testing can determine which of these breast cancers will benefit from chemotherapy,” Dr. Lustberg says. Because of the personalized therapy made possible by these predictive biomarkers, the use of chemotherapy in lymph node-negative and positive HR-positive cancers has decreased in recent years, with excellent clinical outcomes.

Treatment For Stage 4 Breast Cancer

Treatment for may include the following, either alone or in combination:

• targeted therapy, which targets the protein that allows cancer cells to grow
• immunotherapy, which boosts the bodys ability to fight cancer

In rare cases, a surgeon will operate to try and remove tumors. This is not usually the first option.

However, a doctor may recommend surgery to help relieve pain or other issues that may develop as a result of stage 4 breast cancer. These include spinal cord compression, removing single masses caused by metastasis, and fixing any broken bones.

A doctor may also prescribe medication to treat related symptoms, such as pain.

New treatments and therapies are emerging all the time, and anyone who has breast cancer at any stage can volunteer to try out these new treatments. People considering this should talk with their doctor to see whether any trials are available in their area.

As well as numbers, a zero or an X often follow the letters T, N, and M. According to the AJCC, the meanings are as follows:

The stages of breast cancer help doctors and individuals understand how far cancer affects the body and which treatment options may be effective. However, other factors can also play a role in making treatment decisions.

They include:

The outlook for breast cancer will depend on the stage at diagnosis, the type of cancer the person has, and other factors.

The average survival rates according to the stage at diagnosis, says SEER, were:

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Signs Of Breast Cancer Include A Lump Or Change In The Breast

These and other signs may be caused by breast cancer or by other conditions. Check with your doctor if you have any of the following:

• A lump or thickening in or near the breast or in the underarm area.
• A change in the size or shape of the breast.
• A dimple or puckering in the skin of the breast.
• A nipple turned inward into the breast.
• Fluid, other than breast milk, from the nipple, especially if it’s bloody.
• Scaly, red, or swollen skin on the breast, nipple, or areola .
• Dimples in the breast that look like the skin of an orange, called peaudorange.

How Has A Better Understanding Of Breast Cancer Changed Treatment

Years ago, people thought about breast cancer as a single, monolithic, often life-threatening disease. The disease was subdivided into four stages: In Stage I, the tumor is small and has not spread beyond the original site with Stage II and III cancers, the tumor is larger than in Stage I and may have spread to the lymph nodes and in Stage IV, the cancer has spread, or metastasized, to other parts of the body.

Outside of their stages, these cancers were thought to be the same disease, and every patient was given the same treatment.

But stage is really just the amount of cancer, Dr. Winer says. And while the stage is still part of determining treatment, its more important to take into account the type of cancer, he adds.

To that end, the types of breast cancers are categorized by their hormone receptors and whats called HER2 status.

Breast cancer cells that contain receptors for hormones like estrogen and/or progesterone are said to be hormone receptor -positive. And cancer cells that have high levels of receptors are called human epidermal growth factor receptor 2 -positive.

Cancer cells that do not contain hormones or HER2 receptors are called hormone receptor -negative or HER2-negative, respectively.

And breast cancers that do not have receptors for estrogen, progesterone, and HER2 are known as triple-negative.

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Progression During Hormone Therapy

For hormone receptor-positive cancers that were being treated with hormone therapy, switching to another type of hormone therapy sometimes helps. For example, if either letrozole or anastrozole were given, using exemestane, possibly with everolimus , may be an option. Another option might be using fulvestrant or a different aromatase inhibitor, along with a CDK inhibitor. If the cancer has a PIK3CA mutation and has grown while being treated with an aromatase inhibitor, fulvestrant with alpelisib might be considered. If the cancer is no longer responding to any hormone drugs, chemotherapy immunotherapy, or PARP inhibitors might be options depending on specific features of the cancer or any gene changes that might be present.

Breast Cancer Is Sometimes Caused By Inherited Gene Mutations

The genes in cells carry the hereditary information that is received from a persons parents. Hereditary breast cancer makes up about 5% to 10% of all breast cancer. Some mutated genes related to breast cancer are more common in certain ethnic groups.

Women who have certain gene mutations, such as a BRCA1 or BRCA2 mutation, have an increased risk of breast cancer. These women also have an increased risk of ovarian cancer, and may have an increased risk of other cancers. Men who have a mutated gene related to breast cancer also have an increased risk of breast cancer. For more information, seeMale Breast Cancer Treatment.

There are tests that can detect mutated genes. Thesegenetic tests are sometimes done for members of families with a high risk of cancer. For more information, see Genetics of Breast and Gynecologic Cancers.

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Patients Can Enter Clinical Trials Before During Or After Starting Their Cancer Treatment

Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring or reduce the side effects of cancer treatment.

Clinical trials are taking place in many parts of the country. Information about clinical trials supported by NCI can be found on NCIs clinical trials search webpage. Clinical trials supported by other organizations can be found on the ClinicalTrials.gov website.

Is Breast Cancer Curable

When caught early, breast cancer is extremely treatable. Currently, the average five-year relative survival rate for invasive breast cancer is 90%. But when the cancer is localized, meaning theres no sign the cancer has spread outside of the breast, that rate is 99%.

Relative survival rate compares people with the same type and stage of cancer to the overall population. This is what the American Cancer Society uses to talk about survival rates.

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Variable Definitions And Descriptions

We defined DFTI as the interval between the date of breast cancer diagnosis based on biopsy and the date on which the first treatment was initiated. Four DFTI groups were used to divide the included patients:30, 3160, 6190, and91 days. Next, we defined age as the age at which a patient received a confirmed breast cancer diagnosis based on pathological findings. We categorized marital status as single, married, divorced, widowed, and missing and grouped the education levels into six categories. The income of the patients was based on their monthly salary. The environmental factors were based on the urbanization level of the patients areas of residence before cancer diagnosis a total of seven levelsfrom highly developed urban cities to remote districts were employed.

How Breast Cancer Is Treated

In cancer care, doctors specializing in different areas of cancer treatmentsuch as surgery, radiation oncology, and medical oncologywork together with radiologists and pathologists to create a patients overall treatment plan that combines different types of treatments. This is called a multidisciplinary team. Cancer care teams include a variety of other health care professionals, such as physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counselors, nutritionists, and others. For people older than 65, a geriatric oncologist or geriatrician may also be involved in their care. Ask the members of your treatment team who is the primary contact for questions about scheduling and treatment, who is in charge during different parts of treatment, how they communicate across teams, and whether there is 1 contact who can help with communication across specialties, such as a nurse navigator. This can change over time as your health care needs change.

A treatment plan is a summary of your cancer and the planned cancer treatment. It is meant to give basic information about your medical history to any doctors who will care for you during your lifetime. Before treatment begins, ask your doctor for a copy of your treatment plan. You can also provide your doctor with a copy of the ASCO Treatment Plan form to fill out.

Learn more about making treatment decisions.

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Determining The True Stage Of Breast Cancer

All the diagnostic tests and scans up to this point have been critical for helping your doctors understand your disease. But the exact stage of cancer cant be determined until surgery happens which is sometimes referred to surgical staging or pathological staging.

Breast surgery is usually the first step in Stages 0-2, and sometimes Stage 3 breast cancer. Surgery allows your surgeon to see whats happening inside your body. It also allows them to remove cancerous tissues which is an important step in preventing the cancer from spreading and determining next steps for your treatment.

If surgery cant be done right away or at all, a clinical stage is given instead based on diagnostic imaging test results, biopsy pathology results, and a physical exam.

What Is Staging For Cancer

Staging is the process of learning how much cancer is in your body and where it is. Tests like biopsies, CTs and MRIs are done to help stage your cancer. Your providers need to know about your cancer and your health so that they can plan the best treatment for you.

Staging looks at the size of the tumor and where it is, and if it has spread to other organs. The staging system for breast cancer is called the TNM system, as described by the American Joint Committee on Cancer. It has three parts:

• T-describes the size/location/extent of the “primary” tumor in the breast.
• N-describes if the cancer has spread to the lymph nodes.
• M-describes if the cancer has spread to other organs .

Your healthcare provider will use the results of the tests you had to determine your TNM result and combine these to get a stage from 0 to IV.

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Hormone Receptorpositive Breast Cancer

Endocrine therapy and cyclin-dependent kinase inhibitor therapy

CDK4 and CDK6 have been implicated in the continued proliferation of hormone receptorpositive breast cancer resistant to endocrine therapy. CDK inhibitors have been approved by the U.S. Food and Drug Administration in combination with endocrine therapy in both first-line and later-line treatment of advanced hormone receptorpositive HER2-negative breast cancer. Three oral CDK4/6 inhibitors are currently available: palbociclib, ribociclib, and abemaciclib.

Overall, the addition of CDK4/6 inhibitors to endocrine therapy is associated with improved breast cancer outcomes and, in general, either maintained or improved quality of life. This benefit was observed across multiple clinicopathological subgroups of breast cancer.

First-line palbociclib and endocrine therapy

Evidence :

First-line ribociclib and endocrine therapy

Evidence :

Evidence :

Treatment For Stage 1 Breast Cancer

Doctors can offer a variety of for stage 1 breast cancer, although surgery is the primary treatment.

Surgery

A lumpectomy or mastectomy are both viable surgical options for people with stage 1 breast cancer. A doctor will decide what surgery is most appropriate depending on the location of the primary tumor, how large it is, the size of the breast, family history, genetics, and the persons preference.

The doctor may also carry out a biopsy on one or more lymph nodes.

After removing the tissue, they will send it to a laboratory for further tests. The results will help inform decisions on the next stage of treatment.

Radiation therapy

Radiation therapy is a standard treatment for stage 1 breast cancer. However, the decision will depend on factors such the age of the person, the type of cancer, the size of the tumor, and whether there are cancer cells in the lymph nodes.

Hormone therapy

If the breast cancer is ER+ or PR+, hormone therapy may be effective. Hormone therapy works by preventing the growth of estrogen, which helps cancer grow, by blocking estrogen from attaching to tissue and fuelling cancer growth, or both.

Hormone therapy can reach cancer cells in the breast, as well as other areas of the body, and it can reduce the risk of cancer returning.

Chemotherapy

However, the

Stage 2 breast cancer also has subcategories known as 2A and 2B.

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When Is Radiation Usually Used To Treat Stage 2 Breast Cancer

According to the American Cancer Society, radiation therapy may be used after lumpectomy to mitigate the risk of cancer cells recurring in the same breast or nearby lymph nodes. After a mastectomy, an oncologist may determine that radiation is necessary if the tumor was larger than 5 cm, if there was lymph node involvement, or if cancer was found outside of surgical margins.

How Is Breast Cancer Stage Determined

The breast cancer staging process helps doctors determine how much cancer there is and where its located. The higher the breast cancer stage number, the more advanced the disease.

Breast cancer staging is so important because it provides cancer care teams which include breast surgeons, oncologists, pathologists, radiologists and many others an agreed upon way to talk about the disease. This makes it easier for them to understand diagnoses and collaborate on treatment plans.

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Purpose Of This Summary

This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about the treatment of adult breast cancer. It is intended as a resource to inform and assist clinicians in the care of their patients. It does not provide formal guidelines or recommendations for making health care decisions.