Immunotherapy As An Emerging Treatment
Immunotherapy is a relatively new treatment option, and while it hasnt been approved by the Food and Drug Administration for breast cancer yet, its a promising area.
Immunotherapy works by raising the bodys natural defenses to fight off the cancer. It has fewer side effects than chemotherapy and is less likely to cause resistance.
Pembrolizumab is an immune checkpoint inhibitor. Its a type of immunotherapy that has shown particular promise in the treatment of metastatic breast cancer.
It works by blocking specific antibodies that make it harder for the immune system to fight the cancer. This allows the body to fight back more efficiently. A 2016 study found 37.5 percent of patients with triple-negative breast cancer saw a benefit from the therapy.
Because immunotherapy isnt FDA approved yet, treatment is mostly available through clinical trials at this time.
How Is Breast Cancer Staged
Breast cancer in men and women is staged the same, into five groups. This article will focus on advanced stage breast cancer in women. Learn more about male breast cancer here.
Breast cancer is staged into five groups. 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 line a 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.
This article will focus on treatment for advanced stage breast cancer .
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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Breast Cancer Staging Guidelines
The TNM system is the most widely used cancer staging system and looks at the following cancer characteristics:
- Tumor The size of the tumor and whether it has grown into nearby tissue.
- Node Whether the cancer has spread to nearby lymph nodes. And if so, how many.
- Metastasis Indicates whether the cancer has spread to distant organs, like the lungs or liver.
But when it comes to breast cancer staging, the TNM system was expanded to include additional cancer characteristics, including:
- Estrogen-receptor status or progesterone-receptor status Whether the cancer has estrogen or progesterone receptors. A positive status means the cancer can use either hormone to grow.
- HER2 status Whether the cancer produces HER2, a protein that promotes the growth of cancer cells.
- Grade Indicates how much the cancer cells look like healthy cells.
- Oncotype DX recurrence score Indicates how likely a group of genes may respond to treatment, depending on ER, PR and HER2 status.
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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Stage 2 Breast Cancer Treatment
Stage 2 breast cancers are typically treated with multiple types of therapies to kill as much of the cancer as possible and lower the risk of it recurring These therapies include:
- Surgery to remove the primary tumor
- Surgery to remove or biopsy lymph nodes
- Other therapies based on the characteristics of the tumor
For stage 2 breast cancer, surgery may involve either breast-conserving surgery or a total mastectomy, which removes the entire breast and related structures. Many patients decide to have breast reconstruction surgery during or after a mastectomy to maintain the look of symmetry between the breasts.
Your doctor will test your lymph nodes for cancer, likely during the same surgery. Lymph node testing may be performed with a sentinel lymph node biopsy or an axial lymph node dissection. A sentinel lymph node is the first lymph node where the cancer is likely to spread. An axial lymph node dissection removes a greater number of lymph nodes and may be needed if a biopsy shows signs of cancer spread.
Many patients with stage 2 breast cancer have radiation therapy, especially those who have breast-conserving surgery. If testing on the removed lymph nodes finds signs of cancer, those undergoing mastectomy will also require radiation therapy.
Treatment Of Breast Cancer Stages I
The stage of your breast cancer is an important factor in making decisions about your treatment.
Most women with breast cancer in stages I, II, or III are treated with surgery, often followed by radiation therapy. Many women also get some kind of systemic drug therapy . In general, the more the breast cancer has spread, the more treatment you will likely need. But your treatment options are affected by your personal preferences and other information about your breast cancer, such as:
- If the cancer cells have hormone receptors. That is, if the cancer is estrogen receptor -positive or progesterone receptor -positive.
- If the cancer cells have large amounts of the HER2 protein
- How fast the cancer is growing
- Your overall health
- If you have gone through menopause or not
Talk with your doctor about how these factors can affect your treatment options.
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What Is Stage Iii Breast Cancer
In stage III breast cancer, the cancer has spread further into the breast or the tumor is a larger size than earlier stages. It is divided into three subcategories.
Stage IIIA is based on one of the following:
- With or without a tumor in the breast, cancer is found in four to nine nearby lymph nodes.
- A breast tumor is larger than 50 millimeters, and the cancer has spread to between one and three nearby lymph nodes.
In stage IIIB, a tumor has spread to the chest wall behind the breast. In addition, these factors contribute to assigning this stage:
- Cancer may also have spread to the skin, causing swelling or inflammation.
- It may have broken through the skin, causing an ulcerated area or wound.
- It may have spread to as many as nine underarm lymph nodes or to nodes near the breastbone.
In stage IIIC, there may be a tumor of any size in the breast, or no tumor present at all. But either way, the cancer has spread to one of the following places:
- ten or more underarm lymph nodes
- lymph nodes near the collarbone
- some underarm lymph nodes and lymph nodes near the breastbone
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, also known as therapies, 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 encouraged to discuss with your doctor whether clinical trials are an option. A clinical trial is a research study that tests a new approach to treatment. Doctors learn through clinical trials whether a 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 drug or radiation treatment or doing less extensive surgery than what is usually done as the standard of care. Clinical trials are an option 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.
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Why Is Staging Important
During your initial diagnosis, you and your cancer team will work together to develop a treatment plan. Staging allows you to answer the following questions:
- How does this cancer typically progress?
- Which treatments may work?
Some of the staging may be even more in-depth, but in general, its designed to prepare a more tailored approach to your disease. Your care team will be able to explain any new terms and what they mean for you.
Expert cancer care
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.
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How Is Stage 4 Breast Cancer Treatedand Whats The Survival Rate
While every stage 4 breast cancer diagnosis is differentwhich means the methods used to treat it will also differthis stage of breast cancer is usually treated systemically , since the cancer has already spread to other areas of the body. Systemic treatments usually include options like hormone therapy, chemotherapy, targeted therapy, and immunotherapy, according to the NCI.
Still, those treatments vary depending on a variety of factors, including where the cancer is located, as well as the patients symptoms, overall health, and previous cancer treatmentsand patients are closely monitored throughout treatment for the best outcome. Patients are generally started on the treatment of best reflex or biology and followed closely using scans, with change in treatments as needed if the current treatment is not resulting and either shrinkage or stability of the breast cancer, Dr. Tripathy explains.
In addition to more standard systemic treatment options, Dr. Tripathy explains that there are newer technologies being increasingly usedlike ones that sequence the DNA of cancerous tumor cells for more specified treatmentsas well as various clinical trials designed to offer more options and possibly better outcomes to those dealing with the disease.
What Causes Breast Cancer
Breast cancer develops when abnormal cells in your breast divide and multiply. But experts dont know exactly what causes this process to begin in the first place.
However, research indicates that are several risk factors that may increase your chances of developing breast cancer. These include:
- Age. Being 55 or older increases your risk for breast cancer.
- Sex. Women are much more likely to develop breast cancer than men.
- Family history and genetics. If you have parents, siblings, children or other close relatives whove been diagnosed with breast cancer, youre more likely to develop the disease at some point in your life. About 5% to 10% of breast cancers are due to single abnormal genes that are passed down from parents to children, and that can be discovered by genetic testing.
- Smoking. Tobacco use has been linked to many different types of cancer, including breast cancer.
- Alcohol use. Research indicates that drinking alcohol can increase your risk for certain types of breast cancer.
- Obesity. Having obesity can increase your risk of breast cancer and breast cancer recurrence.
- Radiation exposure. If youve had prior radiation therapy especially to your head, neck or chest youre more likely to develop breast cancer.
- Hormone replacement therapy. People who use hormone replacement therapy have a higher risk of being diagnosed with breast cancer.
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Neoadjuvant Chemotherapy Neoadjuvant Her2
With neoadjuvant chemotherapy, all the chemotherapy to treat the breast cancer is usually given before surgery . If the tumor doesnt get smaller with the first combination of chemotherapy drugs, other combinations can be tried.
If your tumor is HER2-positive, you may get neoadjuvant trastuzumab and neoadjuvant pertuzumab , but not at the same time as the chemotherapy drug doxorubicin .
If your tumor is estrogen receptor-negative, progesterone receptor-negative and HER2-negative with a high risk of recurrence, you may get neoadjuvant pembrolizumab . Pembrolizumab is an immunotherapy drug.
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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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.
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.
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Checking The Lymph Nodes
The usual treatment is surgery to remove the cancer. Before your surgery you have an ultrasound scan to check the lymph nodes in the armpit close to the breast. This is to see if they contain cancer cells. If breast cancer spreads, it usually first spreads to the lymph nodes close to the breast.
Depending on the results of your scan you might have:
- a sentinel lymph node biopsy during your breast cancer operation
- surgery to remove your lymph nodes
You may have other treatments after surgery.