Will I Need Chemotherapy After A Total Mastectomy
A total mastectomy is the surgical removal of the entire breast to treat breast cancer. A physician may recommend this treatment on its own or in combination with another therapy, such as chemotherapy. When chemotherapy is provided after surgery, it is called adjuvant chemotherapy. Whether or not chemotherapy is recommended following a total mastectomy will depend on many different factors, including the patients overall health, age and medical history as well as the type, stage and nature of the breast cancer.
Complementary And Alternative Treatments
Some people with breast cancer might be interested in exploring complementary or alternative treatments like vitamins, herbs, acupuncture, and massage.
These treatments are used alongside traditional breast cancer therapies to treat cancer or relieve cancer symptoms and uncomfortable side effects of treatments like chemotherapy. You can explore these treatments at any stage of breast cancer.
Examples of alternative therapy include:
- using massage to relax
- using peppermint tea to reduce nausea
- using cannabis to relieve pain
While some alternative medicine treatments might help you feel more comfortable, its important to keep in mind that many are unproven and could be harmful to your health. To be safe, talk with your doctor about alternative treatments youre interested in pursuing.
Breast cancer that spreads to other parts of the body can cause pain, such as bone pain, muscle pain, headaches, and discomfort around the liver. Talk with your doctor about pain management.
Options for mild to moderate pain include acetaminophen and nonsteroidal anti-inflammatory drugs , such as ibuprofen.
For severe pain in a later stage, your doctor may recommend an opioid such as morphine, oxycodone, hydromorphone, or fentanyl. These opioids have the potential for addiction, so they are only recommended in certain cases.
While breast cancer stage has a lot to do with treatment options, other factors can impact your treatment options as well.
Inflammatory Breast Cancer Treatment
Inflammatory breast cancer is an uncommon and aggressive type of breast cancer caused by cancer cells blocking lymph vessels in the skin.
All IBC cases are classified as at least stage 3 breast cancer. If the cancer is metastatic , its considered stage 4.
Treatments for IBC depend on what stage the cancer is in.
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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 treatment options for Stage 0 breast cancer?
- 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.
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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Outlook By Hr And Her2 Status
Outlook also varies based on tumor characteristics, such as subtype.
For example, here are the 5-year relative survival rates for different combinations of HR and HER2 status:
- 92% for HR-positive, HER2-negative cancer
- 89% for HR-positive, HER2-positive cancer
- 83% for HR-negative, HER2-positive cancer
- 77% for HR-negative, HER2-negative cancer
If Cancer Is Found Tests Are Done To Study The Cancer Cells
- how quickly the cancer may grow.
- how likely it is that the cancer will spread through the body.
- how well certain treatments might work.
- how likely the cancer is to .
Tests include the following:
Based on these tests, breast cancer is described as one of the following types:
- HER2/neu positive or .
This information helps the doctor decide which treatments will work best for your cancer.
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How Often Does Stage 1 Breast Cancer Come Back After Treatment
If stage 1 cancer is treated comprehensively, it rarely comes back. A new, unrelated breast cancer is more likely to emerge after stage 1 breast cancer is treated than a recurrence. Your healthcare provider will recommend a surveillance schedule for you so that new breast cancer or a recurrence can be identified and treated as quickly as possible.
What Are The Side Effects Of Chemo Versus Endocrine Therapy How Does Each Impact A Womans Health
Side effects of Chemotherapy include hair loss, nausea, damage to the heart and nerves, and an increased risk of both infection and rare leukemia later in life.
Less severe, Endocrine Therapy increases menopausal-type symptoms such as hot flashes. Occasionally it also increases joint pain, muscle pain, and weight gain. One of the Endocrine Therapy drug options Tamoxifen rarely may increase the chances of cancer in the uterus. Most patients tolerate it very well.
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What Type Of Drug Treatment Might I Get
Most women with breast cancer in stages I to III will get some kind of drug therapy as part of their treatment. This may include:
- Hormone therapy
- HER2 targeted drugs, such as trastuzumab and pertuzumab
- Some combination of these
The types of drugs that might work best depend on the tumors hormone receptor status, HER2 status, and other factors.
What Is Neoadjuvant Therapy
Neoadjuvant therapy is a treatment approach which focuses on this type of reverse order. The idea is to first shrink the tumor with chemotherapy before any next steps, specifically surgery.
This approach not only can improve surgical options, but also allows for a better assessment of the patients response to the chemotherapy, Dr. Moore says. It can also inform better recommendations for follow-up treatments after surgery. The approach doesnt work for everyone, but its certainly worth discussing with your doctor to find out if youre a candidate.
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Factors Your Physician Will Consider To Determine If Chemotherapy Is Recommended
If your physician has recommended that you have a total mastectomy, you may be wondering if your unique circumstances may require that you receive chemotherapy as well. Some of the factors that influence this decision include:
- The type of cancer Chemotherapy may not be recommended for certain forms of breast cancer, such as in situ cancers, that are unlikely to spread to other areas. For other types of cancers, such as triple negative breast cancers or HER2-positive breast cancers, chemotherapy may be recommended following the total mastectomy because these forms of cancer are typically more aggressive.
- The location of cancer cells If cancer is detected in the lymph nodes or has spread to areas outside of the breast tissue, chemotherapy will likely be recommended to remove any cancer cells that remain following the surgery.
- Previous chemotherapy treatments If a patient has previously received chemotherapy and subsequently developed cancer again, it may not be recommended because it was not effective the first time.
- The age of the patient Women who are premenopausal are more likely to have aggressive forms of breast cancer. This may also influence a physicians recommendation to include chemotherapy after a total mastectomy.
If you would like to learn more about the breast cancer treatment options that may be best for you, such as a total mastectomy and chemotherapy, call or fill out a new patient registration form online to schedule an appointment at Moffitt.
What Questions Should I Ask My Healthcare Provider
You may want to ask your provider:
- What type of breast cancer recurrence do I have?
- Has the cancer spread outside the breast?
- What stage is the breast cancer?
- What is the best treatment for this type of breast cancer?
- What are the treatment risks and side effects?
- Should I look out for signs of complications?
A note from Cleveland Clinic
Most breast cancer recurrences respond well to treatments. You may be able to try new drugs or combination therapies in development in clinical trials. Your healthcare provider can discuss the best treatment option based on your unique situation.
Last reviewed by a Cleveland Clinic medical professional on 03/24/2021.
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Breast Cancer Support And Resources
There are many resources and support groups for breast cancer survivors. Theres no obligation to stick with a group. You can try it out and move on whenever youre ready. You might be surprised to learn that you have a lot to offer others as well.
The American Cancer Society has a variety of support services and programs. You can call the 24/7 helpline at 800-227-2345, visit the website, or download the Life After Treatment Guide.
If you like having information at your fingertips, download the free Breast Cancer Healthline app. The app lets you connect with others who have a similar diagnosis and understand what youre going through.
After Breast Cancer Has Been Diagnosed Tests Are Done To Findout If Cancer Cells Have Spread Within The Breast Or To Other Parts Of Thebody
The process used to find out whether the has spread within the or to otherparts of the body is called .The information gathered from the staging process determines the of the disease. It isimportant to know the stage in order to plan treatment. The results of some of the tests used to are also used to stage the disease.
The following tests and procedures also may be used inthe staging process:
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Staging And Management Of The Axilla
It is often assumed that preoperative imaging is useful in selecting patients undergoing BCT who require axillary dissection. However, the clinical question has shifted from the identification of any nodal metastases to identification of patients with 3 or more nodal metastases who are not candidates for sentinel node biopsy alone, and current imaging modalities do not reliably make this distinction. Pilewskie at al examined the utility of preoperative imaging in predicting the need for additional axillary surgery in 425 patients with clinical T1-2 N0 tumors and 1 or 2 positive sentinel nodes. Among patients with abnormal axillary nodes identified by mammogram, axillary ultrasound, or MRI, 71% did not require ALND using Z0011 criteria. Even among patients with a needle biopsy demonstrating nodal metastases, only 45% required ALND. Thus, preoperative axillary imaging in clinically node-negative patients should be reserved for those undergoing mastectomy where the finding of any nodal disease is an indication for ALND or preoperative chemotherapy to downstage the axilla.
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When To Consider Joining A Clinical Trial
If youre newly diagnosed with early or locally advanced breast cancer, consider joining a clinical trial before starting treatment. For most people, treatment doesnt usually start right after diagnosis. So, theres time to look for a clinical trial that youre eligible for and fits your needs.
Once youve begun standard treatment for early or locally advanced breast cancer, it can be hard to join a clinical trial.
Learn more about clinical trials.
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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.
What Are The Types Of Breast Cancer Recurrence
If you develop cancer in the opposite, untreated breast , you receive a new breast cancer diagnosis. This isnt the same as breast cancer recurrence.
When breast cancer returns, it may be:
- Local: Cancer returns in the same breast or chest area as the original tumor.
- Regional: Cancer comes back near the original tumor, in lymph nodes in the armpit or collarbone area.
- Distant: Breast cancer spreads away from the original tumor to the lungs, bones, brain or other parts of the body. This is metastatic cancer, often referred to as stage 4 breast cancer.
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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 can’t 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 can’t 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 2 Cancer Treatment Options
In general, stage 2 cancers tend to be treated locally with surgery and/or radiation. At times, chemotherapy or other drug therapies may also be a part of stage 2 cancer treatment. Below, find stage 2 cancer treatment options for the five most common cancers.
Stage 2 breast cancer treatment: Stage 2 breast cancer tends to be most commonly treated with surgerya lumpectomy or mastectomyand radiation treatment afterward. During the surgery, doctors check the nearby lymph nodes for cancer, too. Most patients also have medication as part of their treatment plan: either chemotherapy, targeted therapy, hormone therapy or a combination.
Stage 2 lung cancer treatment: Stage 2 lung cancer is typically treated with surgery. Some people may also have chemotherapy after surgery. For patients who cant have surgery, radiation may be a treatment option.
Stage 2 prostate cancer treatment: For stage 2 prostate cancer, treatment depends on the patients symptoms, age and overall health. If the patient is older and isnt experiencing symptoms, doctors may simply keep an eye on how the tumor is doing and treat it if theres any drastic change. However, stage 2 cancers are more likely to spread without treatment than stage 1 cancers. Treatment options may include surgery, surgery followed by radiation, radiation only, or radiation with hormone therapy.
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Breast Cancer: Types Of Treatment
Have questions about breast cancer? Ask here.
ON THIS PAGE: You will learn about the different types of treatments doctors use for people with breast cancer. Use the menu to see other pages.
This section explains the types of treatments that are the standard of care for early-stage and locally advanced breast cancer. Standard of care means the best treatments known. When making treatment plan decisions, you are strongly encouraged to consider clinical trials as an option. A clinical trial is a research study that tests a new approach to treatment. Doctors want to learn whether the new treatment is safe, effective, and possibly better than the standard treatment. Clinical trials can test a new drug and how often it should be given, a new combination of standard treatments, or new doses of standard drugs or other treatments. Some clinical trials also test giving less treatment than what is usually done as the standard of care. Clinical trials are an option to consider for treatment and care for all stages of cancer. Your doctor can help you consider all your treatment options. Learn more about clinical trials in the About Clinical Trials and Latest Research sections of this guide.