Tumor Profiling And Chemotherapy
Some women who have hormone receptor-positive breast cancer should consider getting a tumor profiling test, such as Oncotype DX®, to see if chemotherapy is needed in addition to hormone therapy .
Tumor profiling can be used to help guide chemotherapy for early breast cancers that are all of the following :
- Estrogen receptor-positive
- Tumor size smaller than 5 cm
- Lymph node-negative or 1-3 positive lymph nodes
Tumor profiling may also be called genomic testing or molecular profiling.
For a summary of studies on trastuzumab and early breast cancer, visit the Breast Cancer Research Studies section.
What Are The Stages Of Breast Cancer And Their Treatment Options
Compared to most other cancers, staging breast cancer is more complex and that has to do with the number of breast cancer stages and differences in how breast cancer can develop.
How many stages of breast cancer are there? There are five stages, beginning at Stage 0 and going up to Stage 4. Within some stages there are additional categories based on the location and formation of the cancer.
So when it comes to treating breast cancer, there isnt a one-size-fits-all approach. Your treatment plan should be created especially for you and be coordinated across specialists and thats where your cancer care team comes in.
At HealthPartners, we believe cancer treatment and care is best managed by a group of doctors and specialists in whats known as multidisciplinary conferences. This is where breast surgeons, oncologists, radiologists, pathologists and other members of your care team gather to discuss the best treatment sequence for you.
Below we dive into the treatment options your care team might recommend at various breast cancer stages.
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.
For a summary of research studies on mastectomy versus lumpectomy plus radiation therapy and overall survival in early breast cancer, visit the Breast Cancer Research Studies section.
For a summary of research studies on radiation therapy following mastectomy for invasive breast cancer, visit the Breast Cancer Research Studies section.
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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 thestage of the disease. It is important to know the stage in order to plan treatment. The results of some of the tests used to diagnosebreast cancer are also used to stage the disease.
The following tests and procedures also may be used in the staging process:
Does Chemo Always Deliver Desired Outcomes
While we have discovered that chemotherapy does not always deliver desired outcomes, it should be pointed out that most chemotherapeutic drugs are not customized or matched to patient-specific cancer/tumor or biopsy. Instead, pharmaceutical drugs are developed to fit a model that promotes certain drug regimens for certain cancer types. Sadly, these Chemo-regimens are constructed through pharmaceutical sponsorship in partnership with prestigious cancer doctors and hospitals working together to politically position protocols as standards of care. The end result means such protocols are moved through the FDA with quantities of sales pre-approved and guaranteed by Medicare.
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Is There A Difference Between Standard And High Dose Chemotherapy
This study suggested that there were no differences in survival between the standard-dose and high-dose chemotherapy regimens in women with metastatic breast cancer who had a complete or partial response to initial standard-dose therapy. However, the number of women treated in this trial does not allow the identification of any subsets of women that might benefit more than the overall group from the high-dose regimen.
Why Do Breast Cancer Patients Fail
Relapse of breast cancer occurs because the high-dose chemotherapy is either unable to kill all the cancer cells in the patient and/or because cancer cells contamina ting the stem cells are infused back into the patient. The majority of relapses occur because all the cancer cells were not destroyed by the high-dose chemotherapy treatment. However, some relapses may be due to infusion of breast cancer contaminated stem cells. Doctors are performing clinical trials designed to improve the treatment of breast cancer with high-dose chemotherapy that include the following approaches alone or in combination:
If Breast Cancer Has Spread To My Lymph Nodes Do They All Have To Be Removed
Not always, says Tran. We are performing fewer axillary lymph node removal surgeries now. Just a few years ago, if you came to me with breast cancer that had spread to the lymph nodes, those nodes would all have to come out, which raises the risk of lymphedema.
Recent studies have found that for some patients with cancer in their lymph nodes, radiation to the remaining lymph nodes may control local cancer as well as axillary lymph node dissection removing all of your lymph nodes.
Another way to avoid axillary dissection is to shrink the cancer with a course of chemotherapy first. If there is a good response, we can remove fewer lymph nodes.
Will I Have To Have Chemo If I Have Breast Cancer
Tran says chemotherapy can be an effective way to reduce the size of a tumor, but admits the regimen can be tough. Depending on your individual situation, chemo is not always necessary.
For postmenopausal patients with invasive cancer where the tumor is greater than 1 centimeter and hormone receptor positive, the information we get from the oncotype genetic profile of cancer can help predict if chemotherapy will be beneficial, she says.
If tests come back with a low score for certain factors, even if theres cancer in lymph nodes, the patient may be able to skip chemotherapy and instead receive hormone-blocking treatment, which is easier to take and involves fewer side effects. Tran says hormone therapy is given over five years, and can be administered in pill form.
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Stage 2 Breast Cancer
What is Stage 2 breast cancer?
Stage 2 breast cancer cells or tumors are larger than Stage 1 cancers, and may have spread to nearby lymph nodes. There are two types of Stage 2 breast cancer:
- Stage 2A breast cancer Generally speaking, Stage 2A breast cancer can indicate one of the following:
- No tumor can be found in your breast, but cancer larger than 2 millimeters can be found in one to three underarm lymph nodes or near the breastbone.
- The tumor measures 2 centimeters or smaller, and has spread the nearby axillary lymph nodes.
- The breast cancer has not spread to area lymph nodes, however, the tumor measures between 2 and 5 centimeters.
What are the options for Stage 2 breast cancer treatment?
What is the Stage 2 breast cancer treatment timeline?
Again, it depends on what treatments or follow-up therapies are needed. Generally, the treatment timeline for Stage 2 breast cancer can last three to six months. Again, certain treatments like hormone therapies designed to stop the cancer from coming back can last for one to 10 years.
Will I Need Surgery And What Kind Should I Have
This is an important question but the answer may be less than definitive. It will vary from patient to patient and you may have more than one choice.
According to the American Cancer Society, most women with breast cancer have some type of surgery. But some breast cancers cant initially be surgically removed. In other cases, whether to operate and the type of surgery may depend on the cancers stage, the tumors size and location, the size of your breast and your personal preference.
In women whose breast cancers are operable, the choices are breast-conserving surgery or mastectomy. Mastectomy is the removal of most or all breast tissue and possibly nearby lymph nodes. Within each of those two broad categories are further options. Talk with your oncologist and breast surgeon. If you have any doubts, you may choose to seek a second opinion.
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Types Of Stage 1 And 2 Breast Cancer
The most common types of invasive breast cancers are named after the area of the breast where they begin. Types of early breast cancers include:
- Invasive ductal carcinoma IDC means that the cancer originated in the milk ducts of the breast, and has spread into the surrounding breast tissue. IDC is the most common type of breast cancer, accounting for 80% of all breast cancers.
- Invasive lobular carcinoma ILC means that the cancer originated in the milk-producing lobules of the breast, and has spread into the surrounding breast tissue. ILC is the second most common type of breast cancer, and accounts for 10% of breast cancers.
- There are also other less common forms of invasive breast cancer, such as inflammatory breast cancer and Pagets disease of the nipple. For more information on the various types of invasive breast cancer, including the less common forms, please visit Types of Breast Cancer page.
What Happens After Chemotherapy For Breast Cancer
Immediately after chemotherapy, you may feel sleepy or nauseated. Typically, the side effects of chemotherapy go away after you complete all prescribed cycles.
A Team Approach To Breast Cancer Treatment
Tran says older patients or anyone diagnosed with breast cancer can benefit from getting care at a comprehensive center, such as the one where she performs surgery: the Sullivan Breast Center at Sibley Memorial Hospital in Washington, D.C.
Our team meets weekly to discuss individual patients cases, and that helps us bring the best thinking to each persons treatment plan, Tran says. Our combined experience supports every patient.
Breast Health Services
There Are Different Types Of Treatment For Patients With Breastcancer
Different types of treatment are available for patients with . Some treatments are , and some are being tested in. Atreatment clinical trial is a meant to help improve currenttreatments or obtain information on new treatments for patients with .When clinical trials show that a new treatment is better than thestandard treatment, the newtreatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
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Want To Learn More About Your Breast Cancer Treatment Options Were Here For You
Whether you just received your diagnosis or youre looking for new treatment options, were here to help.
If youve just been diagnosed with breast cancer, your next stop will be to meet with a nurse navigator or breast surgeon, depending on your initial diagnosis, and start building your treatment plan. We offer cancer care clinic locations across the Twin Cities and western Wisconsin, so get started by selecting a location to make an appointment at.
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Does Stage 1 Breast Cancer Require Chemotherapy
In addition to surgery and radiation therapy, stage 1 breast cancer treatment may require chemotherapy, powerful drugs that attack all fast-growing cells in the body. In the past, almost all patients had chemotherapy. Today, the doctor may perform gene tests to help determine whether chemotherapy is likely to benefit you, or if its not necessary because your cancer isnt likely to recur after surgery and other treatment.
Chemotherapy may or may not be used along with other drugs such as hormone therapy, targeted therapy and/or immunotherapy. Your care team will determine which options may be most appropriate by examining your cancers specific characteristics. Patients typically take these drugs after surgery to kill the primary cancer.
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How Can I Prevent Breast Cancer Recurrence
Healthcare providers dont know why some people experience breast cancer recurrence. A recurrence isnt your fault. You didnt do anything wrong to cause it or fail to do something more to prevent it.
Certain medications may reduce the risk of breast cancer recurrence in people who have early stage breast cancer. For estrogen-receptive breast cancer, hormonal therapies including tamoxifen or aromatase inhibitors block either the activity of estrogen or the bodys production of estrogen. Chemotherapy may also be recommended to reduce risk of breast cancer recurrence.
Early diagnosis may make it easier to treat a recurrence. Follow your healthcare providers recommendations for mammograms and other screenings. You should also perform regular breast self-exams. Get familiar with how your breasts look and feel so you can see your provider quickly if you notice changes. And remember that most breast changes occur for reasons other than cancer.
For Metastatic Breast Cancer
Chemo can be used as the main treatment for women whose cancer has spread outside the breast and underarm area to distant organs like the liver or lungs. Chemo can be given either when breast cancer is diagnosed or after initial treatments. The length of treatment depends on how well the chemo is working and how well you tolerate it.
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Treatment For Breast Cancer May Cause Side Effects
Some treatments for breast cancer may cause side effects that continue or appear months or years after treatment has ended. These are called late effects.
Late effects of radiation therapy are not common, but may include:
- Inflammation of the lung after radiation therapy to the breast, especially when chemotherapy is given at the same time.
- Arm lymphedema, especially when radiation therapy is given after lymph node dissection. For more information, see Lymphedema.
- In women younger than 45 years who receive radiation therapy to the chest wall after mastectomy, there may be a higher risk of developing breast cancer in the other breast.
Late effects of chemotherapy depend on the drugs used, but may include:
Late effects of targeted therapy with trastuzumab, lapatinib, or pertuzumab may include:
- Heart problems such as heart failure.
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.
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When Is Chemotherapy Used
Not all women with breast cancer will need chemo, but there are several situations in which chemo may be recommended:
- After surgery : Adjuvant chemo might be given to try to kill any cancer cells that might have been left behind or have spread but canât be seen, even on imaging tests. If these cells were allowed to grow, they could form new tumors in other places in the body. Adjuvant chemo can lower the risk of breast cancer coming back.
- Before surgery : Neoadjuvant chemo might be given to try to shrink the tumor so it can be removed with less extensive surgery. Because of this, neoadjuvant chemo is often used to treat cancers that are too big to be removed by surgery when first diagnosed . Also, by giving chemo before the tumor is removed, doctors can see how the cancer responds to it. If the first set of chemo drugs doesnt shrink the tumor, your doctor will know that other drugs are needed. It should also kill any cancer cells that have spread but canât be seen. Just like adjuvant chemo, neoadjuvant chemo can lower the risk of breast cancer coming back.
For certain types of breast cancer, if there are tumor cells still found at the time of surgery , you may be offered more chemotherapy after surgery to reduce the chances of the cancer coming back .
Stage 1b Breast Cancer
Stage 1B breast cancer can signify one of two possibilities:
- There is no tumor in the breast. Instead, groups of cancer cells between 0.2 millimeter and 2 millimeters are found in the lymph nodes.
- There is a tumor in the breast smaller than 2 centimeters. Groups of cancer cells between 0.2 millimeter and 2 millimeters also are found in the lymph nodes.
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