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.
Diagnostic Tests That Inform The Clinical Stage
Many methods are used to detect and stage cancer. Some of the common tests include:
Biopsy: The doctor uses a needle to extract breast tissue or fluid, which is then sent to a lab. There, various techniques are used to examine different attributes, such as hormone receptor or HER2 status.
Tumor markers: Rapidly dividing cancerous cells interrupt some of the normal mechanisms of cell growth. This causes the cell to overproduce certain molecules. Lab tests detect these compounds, known as tumor markers, in blood or tissue samples.
Imaging techniques: Several different scans are used to examine characteristics of your cancer. Below are some of the noninvasive imaging techniques you might encounter:
- MRI scans use magnets and radio waves to generate detailed pictures of your tissues.
- CT scans use X-rays to look at your organs. Nuclear scans trace the flow of an injected safe radioactive dye in your body.
- PET scans are similar to nuclear scans but specifically examine glucose consumption in the bodysince cancer cells use more glucose than normal cells.
- Ultrasound imaging uses sound waves to see inside your body.
What Are The Types Of Breast Cancer
There are several different types of breast cancer, including:
Can cancer form in other parts of the breast?
When we say breast cancer, we usually mean cancers that form in milk ducts or lobules. Cancers can also form in other parts of your breast, but these types of cancer are less common. These can include:
- Angiosarcoma. This rare type of cancer begins in the cells that make up the lining of blood or lymph vessels.
- Phyllodes tumors. Starting in the connective tissue, phyllodes tumors are rare. Theyre usually benign , but they can be malignant in some cases.
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The Grading System Is Used To Describe How Quickly A Breast Tumor Is Likely To Grow And Spread
The grading system describes a tumor based on how abnormal the cancer cells and tissue look under a microscope and how quickly the cancer cells are likely to grow and spread. Low-grade cancer cells look more like normal cells and tend to grow and spread more slowly than high-grade cancer cells. To describe how abnormal the cancer cells and tissue are, the pathologist will assess the following three features:
- How much of the tumor tissue has normal breast ducts.
- The size and shape of the nuclei in the tumor cells.
- How many dividing cells are present, which is a measure of how fast the tumor cells are growing and dividing.
For each feature, the pathologist assigns a score of 1 to 3 a score of 1 means the cells and tumor tissue look the most like normal cells and tissue, and a score of 3 means the cells and tissue look the most abnormal. The scores for each feature are added together to get a total score between 3 and 9.
Three grades are possible:
- Total score of 3 to 5: G1 .
- Total score of 6 to 7: G2 .
- Total score of 8 to 9: G3 .
Treatment Of Locoregional Recurrent Breast Cancer
For information about the treatments listed below, see the Treatment Option Overview section.
Treatment of locoregional recurrentbreast cancer , may include the following:
- Targeted therapy .
- A clinical trial of a new treatment.
See the Treatment of Metastatic Breast Cancer section for information about treatment options for breast cancer that has spread to parts of the body outside the breast, chest wall, or nearby lymph nodes.
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.
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How Tumor Grade Is Determined
In most cases, doctors need to study a sample of tissue from the tumor to decide if it is cancer and, if it is, its grade. They obtain this tissue by doing a biopsy, a procedure in which they remove all or part of the tumor. A specialist called a pathologist determines the grade of your tumor by studying samples from the biopsy under a microscope. The pathologist describes the findings in a pathology report, which also contains other details about your diagnosis.
Cells that look more normal might be called well-differentiated in the pathology report. And cells that look less normal might be called poorly differentiated or undifferentiated. Based on these and other features of how cells look under the microscope, the pathologist will assign a number to describe the grade.
Different factors are used to decide the grade of different cancers. To learn about the factors that go into deciding the grade of your cancer, find your type of cancer in the PDQ® cancer treatment summaries for adult and childhood cancers.
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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The Tnm System The Grading System And Biomarker Status Are Combined To Find Out The Breast Cancer Stage
Here are 3 examples that combine the TNM system, the grading system, and the biomarker status to find out the Pathological Prognostic breast cancer stage for a woman whose first treatment was surgery:
If the tumor size is 30 millimeters , has not spread to nearby lymph nodes , has not spread to distant parts of the body , and is:
- Grade 1
- PR-
The cancer is stage IV .
Stage 4 Breast Cancer
What is Stage 4 breast cancer?
In Stage 4, the breast cancer has metastasized, which means the disease has spread to distant parts of your body. When breast cancer spreads, it can often invade the lungs, liver and bones, sometimes making its way to the brain or other organs.
What are the options for Stage 4 breast cancer treatment?
- Systemic therapies A combination of systemic therapies are often recommended at specific times during the treatment of Stages 1-3. But in stage four, these therapies are the primary treatment and include:
- Hormone therapy This type of therapy can help slow or stop the growth of cancerous cells.
- Chemotherapy This therapy can destroy cancerous cells throughout your body.
- Targeted drug therapies Like chemotherapy, these targeted drugs help reach cancer in distant areas of the body. But depending on your type of cancer, HER2 status and hormone receptor status, different targeted drugs can work alongside chemotherapy or even better than chemotherapy.
- Immunotherapy This therapy helps raise your bodys natural immune response to fight of the cancer.
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What Is External Beam Radiation Therapy
During external beam radiation therapy, a beam of radiation is directed through the skin to the cancer and the immediate surrounding area in order to destroy the main tumor and any nearby cancer cells. To minimize side effects, the treatments are typically given five days a week, Monday through Friday, for a number of weeks. This allows doctors to get enough radiation into the body to kill the cancer while giving healthy cells time each day to recover.
The radiation beam is usually generated by a machine called a linear accelerator. The linear accelerator, or linac, is capable of producing high-energy X-rays and electrons for the treatment of your cancer. Using high-tech treatment planning software, your treatment team controls the size and shape of the beam, as well as how it is directed at your body, to effectively treat your tumor while sparing the surrounding normal tissue. Several special types of external beam therapy are discussed in the next sections. These are used for specific types of cancer, and your radiation oncologist will recommend one of these treatments if he or she believes it will help you.
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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.
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Menstrual Changes And Fertility Issues
For younger women, changes in menstrual periods are a common side effect of chemo. Premature menopause and infertility may occur and could be permanent. If this happens, there is an increased risk of heart disease, bone loss, and osteoporosis. There are medicines that can treat or help prevent bone loss.
Even if your periods stop while you are on chemo, you may still be able to get pregnant. Getting pregnant while on chemo could lead to birth defects and interfere with treatment. If you have not gone through menopause before treatment and are sexually active, its important to discuss using birth control with your doctor. It is not a good idea for women with hormone receptor-positive breast cancer to take hormonal birth control , so its important to talk with both your oncologist and your gynecologist about what options would be best for you. When women have finished treatment , they can safely go on to have children, but it’s not safe to get pregnant while being treated.
If you think you might want to have children after being treated for breast cancer, talk with your doctor soon after being diagnosed and before you start treatment. For some women, adding medicines, like monthly injections with a luteinizing hormone-releasing hormone analog, along with chemo, can help them have a successful pregnancy after cancer treatment. To learn more, see Female Fertility and Cancer.
Local Treatment: Surgery And Radiation
If you receive a diagnosis of stage 1 breast cancer, your doctor may recommend local treatments such as surgery and radiation therapy to treat your breast cancer at the site.
Both lumpectomy and mastectomy are options for stage 1 breast cancer. Your doctor will help determine what is right for you based on the tumor size, grade, and level of spread.
- Lumpectomy. Also known as breast-conserving surgery, a lumpectomy is the least invasive surgery for breast cancer. With this procedure, a surgeon will remove the tumor and some surrounding tissue, but will leave as much of your breast as possible so that it looks a lot like the original breast.
- Mastectomy. A mastectomy involves the removal of the entire breast. There are different types of mastectomies. Some types of mastectomies involve the removal of the lymph nodes. Other types can preserve the breast skin or the nipple and areola, especially with early stage breast cancer.
Doctors typically recommend radiation therapy after a lumpectomy for stage 1 breast cancer treatment. Radiation therapy helps destroy any cancer cells that may have been left behind after the surgery. This helps lower the chance of the breast cancer coming back.
Radiation is less often needed after a mastectomy with stage 1 breast cancer.
Beyond local treatments, your doctor might recommend systemic treatments for stage 1 breast cancer.
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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.
Permission To Use This Summary
PDQ is a registered trademark. The content of PDQ documents can be used freely as text. It cannot be identified as an NCI PDQ cancer information summary unless the whole summary is shown and it is updated regularly. However, a user would be allowed to write a sentence such as NCIs PDQ cancer information summary about breast cancer prevention states the risks in the following way: .
The best way to cite this PDQ summary is:
PDQ® Adult Treatment Editorial Board. PDQ Breast Cancer Treatment . Bethesda, MD: National Cancer Institute. Updated < MM/DD/YYYY> . Available at: . Accessed < MM/DD/YYYY> .
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What Does It Mean To Have Stage 1 Breast Cancer
In Stage 1 breast cancer, cancer is evident, but it is contained to only the area where the first abnormal cells began to develop. The breast cancer has been detected in the early stages and can be very effectively treated.
Stage 1 can be divided into Stage 1A and Stage 1B. The difference is determined by the size of the tumor and the lymph nodes with evidence of cancer.
Risk Of Heart Disease From Breast Cancer Radiation
Although radiation exposure from breast cancer treatment is associated with a small risk of subsequent heart disease, the risk is lower than it was 20 years ago, according to the results of a study published in JAMA Internal Medicine.9
Radiation is used after surgery to kill any remaining cancer cells and this decreases the risk of local recurrence and improves survival. Like any treatment however, radiation carries risksâincluding an increased risk of heart disease when radiation is used on the left breast, which is closer to the heart.
Because long-term breast cancer survival rates have improved dramatically in recent decades, researchers continue to look for ways to minimize long-term treatment-related complications. Researchers conducted an analysis to evaluate the risk of developing heart disease as a result of radiation treatment to the left breastâand found that the risk varies depending on the underlying risk of heart disease.
They report that the average risk of developing heart disease as a result of radiation exposure for breast cancer treatment is less than one percent. The risk increases for woman who already have a high underlying risk of developing heart diseaseâin these cases, the risk may be as high as 1 in 30. In contrast, women who already have a very low underlying risk of heart disease may face odds as low as 1 in 3000, which is a tiny risk.
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