Breast Cancer: Types Of Treatment
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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.
Facts You Should Know About Breast Cancer
What is the medical definition of breast cancer?
- Early stage breast cancer usually doesnt cause any symptoms or signs.
- Sometimes it is possible to feel a lump in the breast, but it is important to remember that most breast lumps are not cancerous .
- Breast cancer is usually not painful.
Is there a cure for breast cancer?
- Treatments are available for breast cancer that include surgery, hormone therapy radiation therapy, and for some types of cancer, chemotherapy.
- The exact type of treatment will depend on the type of breast cancer that is present and certain specific biomarkers that are found in the cancer cells.
- For many common types of breast cancer, survival rates and outcomes are excellent when the cancer is discovered in an early stage.
Who is at risk for breast cancer?
- Although breast cancer can affect anyone, women are at greater risk than men.
- The risk of breast cancer also increases with age.
- People with a personal or family history of breast cancer are also at increased risk.
What Is Breast Cancer
Breast cancer is a disease in which cells in the breast grow out of control. There are different kinds of breast cancer. The kind of breast cancer depends on which cells in the breast turn into cancer.
Breast cancer can begin in different parts of the breast. A breast is made up of three main parts: lobules, ducts, and connective tissue. The lobules are the glands that produce milk. The ducts are tubes that carry milk to the nipple. The connective tissue surrounds and holds everything together. Most breast cancers begin in the ducts or lobules.
Breast cancer can spread outside the breast through blood vessels and lymph vessels. When breast cancer spreads to other parts of the body, it is said to have metastasized.
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How Can I Protect Myself From Breast Cancer
Follow these three steps for early detection:
- Get a mammogram. The American Cancer Society recommends having a baseline mammogram at age 35, and a screening mammogram every year after age 40. Mammograms are an important part of your health history. Recently, the US Preventive Services Task Force came out with new recommendations regarding when and how often one should have mammograms. These include starting at age 50 and having them every two years. We do not agree with this, but we are in agreement with the American Cancer Society and have not changed our guidelines, which recommend yearly mammograms starting at age 40.
- Examine your breasts each month after age 20. You will become familiar with the contours and feel of your breasts and will be more alert to changes.
- Have your breast examined by a healthcare provider at least once every three years after age 20, and every year after age 40. Clinical breast exams can detect lumps that may not be detected by mammogram.
Types Of Breast Cancer
There are many types of breast cancer, and many different ways to describe them. Its easy to get confused over a breast cancer diagnosis.
The type of breast cancer is determined by the specific cells in the breast that are affected. Most breast cancers are carcinomas, which are tumors that start in the epithelial cells that line organs and tissues throughout the body. When carcinomas form in the breast, they are usually a more specific type called adenocarcinoma, which starts in cells in the ducts or the lobules .
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Categorizations Of Breast Cancer Survivors
Many cancer organizations find the current definition of breast cancer survivorship too broad. The definition applies those who have just been diagnosed and those who are 20-year survivors into the same group. From a clinical standpoint, not all breast cancer survivors are alike.
To specifically designate where someone is in their breast cancer journey, some oncologists use different functional terms. For example, there are people who are acute survivors and those that are long-term survivors. There is also an area in the middle in which people have had their breast cancer for some time but are still in either active treatment, or receiving maintenance or preventive treatment.
Here’s a sense of how breast cancer survivors may be categorized:
In Situ Vs Invasive Breast Cancers
The type of breast cancer can also refer to whether the cancer has spread or not. In situ breast cancer is a cancer that starts in a milk duct and has not grown into the rest of the breast tissue. The term invasive breast cancer is used to describe any type of breast cancer that has spread into the surrounding breast tissue.
Invasive breast cancer has spread into surrounding breast tissue. The most common types are invasive ductal carcinoma and invasive lobular carcinoma. Invasive ductal carcinoma makes up about 70-80% of all breast cancers.
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Are There Different Types Of Breast Cancer
The breasts are made of fat, glands, and connective tissue. The breast has several lobes, which split into lobules that end in the milk glands. Tiny ducts run from the many tiny glands, connect together, and end in the nipple.
- These ducts are where 80% of breast cancers occur. Ductal cancer is breast cancer that arises in the ducts.
- Cancer developing in the lobules is termed lobular cancer. About 10%-15% of breast cancers are of this type.
- Other less common types of breast cancer include inflammatory breast cancer, medullary cancer, phyllodes tumor, angiosarcoma, mucinous carcinoma, mixed tumors, and a type of cancer involving the nipple termed Paget’s disease.
Precancerous changes, called in situ changes, are common.
- In situ is Latin for “in place” or “in site” and means that the changes haven’t spread from where they started .
- Ductal carcinoma in situ is the medical term for in situ changes that occur in the ducts. Routine mammography may identify DCIS.
- Lobular carcinoma in situ refers to abnormal-appearing cells in the milk-producing lobules of the breast. This is considered a non-cancerous condition that increases a woman’s risk for breast cancer.
When cancers spread into the surrounding tissues, they are termed infiltrating cancers. Cancers spreading from the ducts into adjacent spaces are termed infiltrating ductal carcinomas. Cancers spreading from the lobules are infiltrating lobular carcinomas.
How Do You Prevent Breast Cancer From Growing
Whats on this page Keep Weight in Check. Be Physically Active. Eat Your Fruits & Vegetables and Avoid Too Much Alcohol. Dont Smoke. Breastfeed, If Possible. Avoid Birth Control Pills, Particularly After Age 35 or If You Smoke. Avoid Post-Menopausal Hormones. Tamoxifen and Raloxifene for Women at High Risk.
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How Breast Cancer Spreads
Breast cancer can spread when the cancer cells get into the blood or lymph system and are carried to other parts of the body.
The lymph system is a network of lymph vessels found throughout the body that connects lymph nodes . The clear fluid inside the lymph vessels, called lymph, contains tissue by-products and waste material, as well as immune system cells. The lymph vessels carry lymph fluid away from the breast. In the case of breast cancer, cancer cells can enter those lymph vessels and start to grow in lymph nodes. Most of the lymph vessels of the breast drain into:
- Lymph nodes under the arm
- Lymph nodes around the collar bone
- Lymph nodes inside the chest near the breast bone
If cancer cells have spread to your lymph nodes, there is a higher chance that the cells could have traveled through the lymph system and spread to other parts of your body. The more lymph nodes with breast cancer cells, the more likely it is that the cancer may be found in other organs. Because of this, finding cancer in one or more lymph nodes often affects your treatment plan. Usually, you will need surgery to remove one or more lymph nodes to know whether the cancer has spread.
Still, not all women with cancer cells in their lymph nodes develop metastases, and some women with no cancer cells in their lymph nodes develop metastases later.
Does A Benign Breast Condition Mean That I Have A Higher Risk Of Getting Breast Cancer
Benign breast conditions rarely increase your risk of breast cancer. Some women have biopsies that show a condition called hyperplasia . This condition increases your risk only slightly.
When the biopsy shows hyperplasia and abnormal cells, which is a condition called atypical hyperplasia, your risk of breast cancer increases somewhat more. Atypical hyperplasia occurs in about 5% of benign breast biopsies.
What Is The Treatment For Her2
Specialized breast cancer treatments, known as targeted therapies, have been developed to treat breast cancers that express the HER2 protein. Targeted therapies are newer forms of cancer treatment that specifically attack cancer cells and do less damage to normal cells than traditional chemotherapy. Targeted therapies for HER2-positive breast cancer include the following:
- Trastuzumab is an antibody against the HER2 protein Adding treatment with trastuzumab to chemotherapy given after surgery has been shown to lower the recurrence rate and death rate in women with HER2-positive early breast cancers. Using trastuzumab along with chemotherapy has become a standard adjuvant treatment for these women.
- Pertuzumab also works against HER2-positive breast cancers by blocking the cancer cell’s ability to receive growth signals from HER2.
- Lapatinib is another drug that targets the HER2 protein and maybe given combined with chemotherapy. It is used in women with HER2-positive breast cancer that is no longer helped by chemotherapy and trastuzumab.
- T-DM1 or ado-trastuzumab emtansine is a combination of Herceptin and the chemotherapy medication emtansine. Kadcyla was designed to deliver emtansine to cancer cells by attaching it to Herceptin.
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18. Targeted therapies: Targeted therapies for metastatic breast cancer are treatments that target specific characteristics of cells, such as a protein that allows the cancer cells to grow in a rapid or abnormal way. Targeted therapies are generally less likely than chemotherapy to harm normal, healthy cells. Some targeted therapies are antibodies that work like the antibodies made naturally by our immune systems. These types of targeted therapies are sometimes called immune targeted therapies.
19. Treatment break: Living with metastatic breast cancer can be like running a long race where you need to pace yourself. Sometimes you may need to take a break from treatment so your body can rest and recover, especially if youre having troubling side effects. Talk to your medical team about your quality of life, your goals, and any special events you have coming up so you can develop a treatment plan that includes breaks when you need them.
20. Unresectable: With respect to metastatic breast cancer, unresectable means the cancer cant be removed completely with surgery.
Written by: Jamie DePolo, senior editor
This content was developed with contributions from the following experts:
Jennifer Armstrong, M.D., breast oncologist at Paoli Hematology-Oncology Associates in Paoli, PA, and Breastcancer.org Professional Advisory Board member
Funding and support provided by Pfizer Oncology.
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Evaluation After Cancer Diagnosis
After cancer is diagnosed, doctors usually consult a team of cancer specialists , including surgeons, cancer drug treatment specialists, and radiologists , to determine which tests should be done and to plan treatment.
If cancer cells are detected, the biopsy sample is analyzed to determine the characteristics of the cancer cells, such as
Whether the cancer cells have estrogen or progesterone receptors
How many HER2 receptors are present
How quickly the cancer cells are dividing
For some types of breast cancer, genetic testing of the cancer cells
This information helps doctors estimate how rapidly the cancer may spread and which treatments are more likely to be effective.
Tests may include
A chest x-ray to determine whether the cancer has spread
Blood tests, including a complete blood count , liver tests, and measurement of calcium, also to determine whether the cancer has spread
When cancer is diagnosed, a stage Staging Cancer Cancer is suspected based on a person’s symptoms, the results of a physical examination, and sometimes the results of screening tests. Occasionally, x-rays obtained for other reasons, such as… read more is assigned to it. The stage is a number from 0 to IV that reflects how extensive and aggressive the cancer is:
Staging the cancer helps doctors determine the appropriate treatment and the prognosis.
Many factors go into determining the stage of breast cancer, such as the TNM classification system.
The TNM classification is based on the following:
What Is A Sentinel Lymph Node
A network of lymphatic vessels and lymph nodes drain fluid from the tissue in the breast. The lymph nodes are designed to trap foreign or abnormal cells that may be contained in this fluid. Sometimes cancer cells pass through the nodes into the lymphatic vessels and spread to other parts of the body.
Although fluid from breast tissue eventually drains to many lymph nodes, the fluid usually drains first through one or only a few nearby lymph nodes. Such lymph nodes are called sentinel lymph nodes because they are the first to warn that cancer has spread.
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This Glossary Will Help You Decode The Confusing Medical Terminology
If you or a loved one has recently been diagnosed with breast cancer, you are likely overwhelmed by this news. You might also be confused by the specifics of your diagnosis, which is probably chock-full of medical jargon, and might sound or read something like this: L IDC, grade 1, ER+ PR+ HER2-, pT2N0M0 stage I disease.
The following glossary of terms will help you decipher what it all means:
L or R: The L or R stands for left or right, indicating in which breast the cancer is located.
IDC or ILC: Breast cancer starts when a specific type of breast tissue cell goes awry and becomes cancerous. Naming where the breast cancer started is known as histology. IDC and ILC refer to the two most common histologies, or breast cell subtypes.
The I in both stands for invasive or infiltrating, which means that the breast cancer has spread from a single cell into surrounding breast tissue.
The second letter refers to where the cancer originated.
- Infiltrating ductal carcinoma means that the cancer started in cells that line the breasts milk ducts. This is the most common type of breast cancer, representing 76% of breast cancer cases.
- Invasive lobular carcinoma means that the cancer started in the milk-producing glands, called lobules. This is the second most common histologic subtype, representing 8% of breast cancer cases.
The histology matters because it helps doctors predict how someones breast cancer will behave. It sometimes affects treatment decisions.
How Do Tamoxifen Raloxifene Anastrozole And Exemestane Reduce The Risk Of Breast Cancer
If you are at increased risk for developing breast cancer, four medications tamoxifen , raloxifene , anastrozole , and exemestane may help reduce your risk of developing this disease. These medications act only to reduce the risk of a specific type of breast cancer called estrogen receptor-positive breast cancer. This type of breast cancer accounts for about two-thirds of all breast cancers.
Tamoxifen and raloxifene are in a class of drugs called selective estrogen receptor modulators . These drugs work by blocking the effects of estrogen in breast tissue by attaching to estrogen receptors in breast cells. Because SERMs bind to receptors, estrogen is blocked from binding. Estrogen is the fuel that makes most breast cancer cells grow. Blocking estrogen prevents estrogen from triggering the development of estrogen-receptor-positive breast cancer.
Anastrozole and exemestane are in a class of drugs called aromatase inhibitors . These drugs work by blocking the production of estrogen. Aromatase inhibitors do this by blocking the activity of an enzyme called aromatase, which is needed to make estrogen.
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Keeping Personal Health Records
You and your doctor should work together to develop a personalized follow-up care plan. Be sure to discuss any concerns you have about your future physical or emotional health. ASCO offers forms to help keep track of the cancer treatment you received and develop a survivorship care plan when treatment is completed. At the conclusion of active treatment, ask your doctor to provide you with a treatment summary and a survivorship care plan.
This is also a good time to talk with your doctor about who will lead your follow-up care. Some survivors continue to see their oncologist, while others transition back to the care of their family doctor, another health care professional, or a specialized survivorship clinic. This decision depends on several factors, including the type and stage of cancer, side effects, health insurance rules, and your personal preferences.If a doctor who was not directly involved in your cancer care will lead your follow-up care, be sure to share your cancer treatment summary and survivorship care plan forms with them and with all future health care providers. Details about your cancer treatment are very valuable to the health care professionals who will care for you throughout your lifetime.
The next section in this guide is Survivorship. It describes how to cope with challenges in everyday life after a cancer diagnosis. Use the menu to choose a different section to read in this guide.