Early Stage Breast Cancer Treatment

Who Is Mainly Affected By Breast Cancer

Breast cancer is one of the most common cancers among women, second only to skin cancer. Its most likely to affect women over the age of 50.

Though rare, men can also develop breast cancer. Approximately 2,600 men develop male breast cancer every year in the United States, making up less than 1% of all cases.

Transgender women are more likely to develop breast cancer compared to cisgender men. Additionally, transgender men are less likely to develop breast cancer compared to cisgender women.

What age does breast cancer occur?

Breast cancer is most often diagnosed in adults over the age of 50, but it can occur at any age.

What race is most affected by breast cancer?

Overall, women who are non-Hispanic white have a slightly higher chance of developing breast cancer than women of any other race or ethnicity. Women who are non-Hispanic Black are almost as likely as non-Hispanic white women to develop the disease. Statistically, women who are Asian, Hispanic or Native American are the least likely to develop breast cancer.

Radiation Therapy Side Effects

The side effects of radiation therapy depend on the type of radiation therapy youre having. In general, the side effects tend to develop as treatment goes on and may be more troubling toward the end of treatment. Overall, the most common side effects are redness, swelling, and skin peeling in the area being treated.

Playing An Active Role

You play an active role in making treatment decisions by understanding your breast cancer diagnosis, your treatment options and possible side effects.

Together, you and your health care provider can choose treatments that fit your values and lifestyle.

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Stage 3 Breast Cancer

What is Stage 3 breast cancer?

Stage 3 breast cancer is when tumors are larger than earlier stages or are growing into nearby tissues, and the cancer has spread to nearby lymph nodes. There are three categories of Stage 3 breast cancer:

• Stage 3A breast cancer In some cases, Stage 3A breast cancer indicates that the cancer spread to four to nine area lymph nodes, and there may or may not be a tumor in the breast. In other cases, it can describe a cancer that has spread less but the tumor is larger than 5 centimeters.
• Stage 3B breast cancer Stage 3B breast cancer can mean that the cancer has spread to the chest wall or to the breasts skin, causing swelling or an ulcer. It may also mean that cancer has spread to up to nine axillary lymph nodes or lymph nodes near the breast bone.
• Stage 3C breast cancer Stage 3C breast cancer means the cancer may have spread to the chest wall or breasts skin, or it has spread to 10 or more nearby lymph nodes. It can also mean the cancer has also spread to lymph nodes above or below the collarbone.

What are the options for Stage 3 breast cancer treatment?

What is the Stage 3 breast cancer treatment timeline?

The treatment timeline for Stage 3 breast cancer depends greatly on the severity, extent of spreading, the type of treatment youre undergoing and how youre responding to those treatments. For most Stage 3 cases, treatment can last anywhere from six to 12 months with hormone therapy lasting many years after.

The Era Of Personalized Medicine

An important advance in the treatment of cancer is the development of more individualized cancer therapy. Information provided by genomic tests or from analysis of other characteristics of cancer cells can often help guide the selection of treatments that have the best chance of success for a particular patient. The Oncotype DX genomic test can identify many women with hormone positive breast cancer that can avoid chemotherapy treatment altogether.42

In the case of node-negative breast cancer and some early stage node positive cancers, adjuvant hormonal therapy and/or chemotherapy has been shown to benefit many, but the extent of the benefit varies by the likelihood of cancer recurrence. Some women with small node-negative and positive breast cancer, for example, have a low risk of recurrence and may not require adjuvant chemotherapy to further reduce recurrence risk. In contrast, women with larger tumors â or other poor prognostic factors, such as high tumor grade â are more likely to benefit from adjuvant therapy.

Although factors such as tumor size and lymph node involvement have been used to guide decisions about the need for adjuvant therapy genomic testing of tumor tissue may be more accurate. The expression, or activity, of certain genes has been linked with the likelihood of cancer recurrence and testing tumor tissue for the expression of these genes provides important information about prognosis and likely response to treatment.

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Radiation For Breast Cancer

Radiation therapy is treatment with high-energy rays that destroy cancer cells. Some women with breast cancer will need radiation, in addition to other treatments.

Depending on the breast cancer’s stage and other factors, radiation therapy can be used in several situations:

• After breast-conserving surgery, to help lower the chance that the cancer will come back in the same breast or nearby lymph nodes.
• After amastectomy, especially if the cancer was larger than 5 cm , if cancer is found in many lymph nodes, or if certain surgical margins, such as the skin or muscle, have cancer cells.
• If cancer has spread to other parts of the body, such as the bones, spinal cord, or brain.

Strategies To Improve Treatment

The development of more effective cancer treatments requires that new and innovative therapies be evaluated with cancer patients. Clinical trials are studies that evaluate the effectiveness of new drugs or treatment strategies. Areas of active investigation aimed at improving the treatment of early stage breast cancers include the following:

The development of stronger more precise medications that target HER2 is ongoing. Novel anti-HER2neu therapies are developed in patients with more advanced disease before being used in ESBC. Treatment of HER2 + Breast Cancer in Depthâ¦.

Immunotherapy: In the I-SPY clinical trial 181 women were treated with standard neoadjuvant chemotherapy and 69 were treated with 4 cycles of Keytruda plus weekly paclitaxel followed by adjuvant chemotherapy.

When added to standard neoadjuvant chemotherapy, Keytruda more than doubled the estimated complete response rates assessed at surgery for both HR-positive/ERBB2-negative and triple-negative breast cancer. The research suggests that adding the Keytruda checkpoint inhibitor in women with early-stage, high-risk, ERBB2-negative breast cancer is highly likely to provide additional benefit and will be studied in a phase 3 comparative clinical trial.

Triple Negative Breast Cancer

Poly polymerase inhibitor agents. The PARP inhibitors are being evaluated in clinical trials for patients with BRCA mutations and in TNBC.39

References:

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How Is Breast Cancer Treated

There are several breast cancer treatment options, including surgery, chemotherapy, radiation therapy, hormone therapy, immunotherapy and targeted drug therapy. Whats right for you depends on many factors, including the location and size of the tumor, the results of your lab tests and whether the cancer has spread to other parts of your body. Your healthcare provider will tailor your treatment plan according to your unique needs. Its not uncommon to receive a combination of different treatments, too.

Breast cancer surgery

Breast cancer surgery involves removing the cancerous portion of your breast and an area of normal tissue surrounding the tumor. There are different types of surgery depending on your situation, including:

Chemotherapy for breast cancer

Your healthcare provider may recommend chemotherapy for breast cancer before a lumpectomy in an effort to shrink the tumor. Sometimes, its given after surgery to kill any remaining cancer cells and reduce the risk of recurrence . If the cancer has spread beyond your breast to other parts of your body, then your healthcare provider may recommend chemotherapy as a primary treatment.

Radiation therapy for breast cancer

Radiation therapy for breast cancer is typically given after a lumpectomy or mastectomy to kill remaining cancer cells. It can also be used to treat individual metastatic tumors that are causing pain or other problems.

Hormone therapy for breast cancer

Immunotherapy for breast cancer

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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Accelerated Partial Breast Irradiation

After whole breast radiation or even after surgery alone, most breast cancers tend to come back very close to the area where the tumor was removed . For this reason, some doctors are using accelerated partial breast irradiation in selected women to give larger doses over a shorter time to only one part of the breast compared to the entire breast . Since more research is needed to know if these newer methods will have the same long-term results as standard radiation, not all doctors use them. There are several different types of accelerated partial breast irradiation:

• Intraoperative radiation therapy : In this approach, a single large dose of radiation is given to the area where the tumor was removed in the operating room right after BCS . IORT requires special equipment and is not widely available.

• 3D-conformal radiotherapy : In this technique, the radiation is given with special machines so that it is better aimed at the tumor bed. This spares more of the surrounding normal breast tissue. Treatments are given twice a day for 5 days or daily for 2 weeks.
• Intensity-modulated radiotherapy : IMRT is like 3D-CRT, but it also changes the strength of some of the beams in certain areas. This gets stronger doses to certain parts of the tumor bed and helps lessen damage to nearby normal body tissues.
• Brachytherapy: See brachytherapy below.

Biomarker Testing Is Used To Find Out Whether Breast Cancer Cells Have Certain Receptors

Healthy breast cells, and some breast cancer cells, have receptors that attach to the hormonesestrogen and progesterone. These hormones are needed for healthy cells, and some breast cancer cells, to grow and divide. To check for these biomarkers, samples of tissue containing breast cancer cells are removed during a biopsy or surgery. The samples are tested in a laboratory to see whether the breast cancer cells have estrogen or progesterone receptors.

Another type of receptor that is found on the surface of all breast cancer cells is called HER2. HER2 receptors are needed for the breast cancer cells to grow and divide.

For breast cancer, biomarker testing includes the following:

Sometimes the breast cancer cells will be described as triple negative or triple positive.

• Triple negative. If the breast cancer cells do not have estrogen receptors, progesterone receptors, or a larger than normal amount of HER2 receptors, the cancer cells are called triple negative.
• Triple positive. If the breast cancer cells do have estrogen receptors, progesterone receptors, and a larger than normal amount of HER2 receptors, the cancer cells are called triple positive.

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Adjuvant Chemotherapy Plus Hormonal Therapy

Researchers with the National Surgical Adjuvant Breast and Bowel Project have reported that the combination of adjuvant chemotherapy and hormonal therapy appears to increase survival over adjuvant hormonal therapy alone and may be the optimal treatment for women with node-negative, ER-positive breast cancer.

In a clinical trial involving over 1,500 women with node-negative, ER-positive breast cancer, patients underwent surgical removal of the cancer and half of the patients then received 5 years of hormonal therapy and the other half received 5 years of hormonal therapy plus chemotherapy. More of the women who were treated with the combination of chemotherapy and hormonal therapy lived cancer-free for 12 years or more. The 12- year cancer free survival was 89% in women receiving endocrine and chemotherapy compared to 79% for those treated with endocrine therapy alone.

Women aged 49 years or younger derived the most benefit in terms of cancer-free and overall survival from the addition of chemotherapy, while women over the age of 60 did not achieve a benefit from the addition of chemotherapy. The study results also suggested that women with a lower degree of estrogen receptor expression benefited more from chemotherapy than those with higher receptor expression.35

Stage 0 Breast Cancer

What is Stage 0 breast cancer?

Stage 0 breast cancer is when the cells that line the milk ducts have become cancerous. This type of cancer is called ductal carcinoma in situ , or non-invasive or pre-invasive breast cancer.

At this stage, the cancer has not spread to surrounding tissues. And while its considered non-invasive, its important to remember that it can still become invasive and spread beyond the milk ducts if it isnt treated.

What are the options for Stage 0 breast cancer treatment?

• Surgery Breast surgery is often the first step at Stage 0. Depending on the size of the tumor, how fast the cancer appears to be growing and your personal preferences, there are two types of surgical options:
• Lumpectomy A lumpectomy is a targeted surgery that removes the lump or tumor in question, and a small amount of normal tissue around it. This is commonly referred to as breast conservation surgery . In the United States, most women with Stage 0 breast cancer undergo a lumpectomy followed by radiation therapy.
• Mastectomy If the cancer has spread throughout the ducts and affects a large part of the breast, doctors may recommend a mastectomy. With this surgery, the entire breast is removed and possibly some lymph nodes as well.

What is the Stage 0 breast cancer treatment timeline?

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Endocrine Or Hormonal Therapy

The breasts, uterus and other female organs are composed of cells that contain estrogen receptors. When cells that have estrogen receptors become cancerous, exposure to estrogen increases the cancerâs growth. Cancer cells that have estrogen receptors are referred to as estrogen receptor-positive cancers.

The growth of ER-positive breast cancer cells can be prevented or slowed by reducing the exposure to estrogen. This is the goal of endocrine therapy for breast cancer. Clinical trials have demonstrated that five years of adjuvant endocrine therapy substantially reduce the risk of locoregional and distant recurrence, as well as the development of contralateral breast cancer, and death from breast cancer. Research shows that even in women who are disease free after 5 years of endocrine therapy there remains a steady risk of late recurrence 5 to 20 years after diagnosis.30-34

There are four main types of endocrine therapy – each type stops hormone-related growth by a different method. Options for endocrine therapy are partly based on menopausal status because estrogen and progesterone levels remain low after menopause starts. In premenopausal women, surgical removal of the ovaries or suppression of ovarian activity is often used to reduce estrogen exposure. Aromatase inhibitor drugs and tamoxifen are more commonly recommended for postmenopausal women.

Early Stage Breast Cancer

Dr. Erica Mayer discusses what is important for patients to know about early stage breast cancer following a diagnosis. Beginning with types of breast cancer, Dr. Mayer guides patients through understanding their treatment plan and health care team, recent advancements in research and treatments, and questions to ask.

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How Is Breast Cancer Staged

Breast cancer in men and women is staged the same, into five groups. This article will focus on early/moderate stage breast cancer in women. Learn more about male breast cancer here.

Staging is based on:

• The size of your tumor on the mammogram and what is found after surgery.
• Any evidence of spread to other organs .
• Surgery to test if your lymph nodes have cancer cells.

Staging is important because it helps guide your treatment options. Stages 0, I, and II are early or moderate stages.

The staging system is very complex. Below is a summary of the staging system. Talk to your provider about the stage of your cancer.

• Lobular carcinoma in situ : abnormal cells line a gland in the breast. This is a risk factor for future cancer, but this is not thought to be cancer itself.
• Ductal carcinoma in situ : abnormal cells linea duct in the breast. Women with DCIS have a higher risk of getting invasive breast cancer in that breast. Treatment options are similar to patients with Stage I breast cancers.