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What Stage Of Breast Cancer Needs Chemotherapy

How Often Does Stage 1 Breast Cancer Come Back After Treatment

Study: Many with early stages of breast cancer don’t need chemotherapy

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 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.

How Long Do You Take Oral Chemotherapy

Chemotherapy in either form is usually given in cycles over a period of a few weeks at a time, but this may vary depending on the specifics of your treatment plan.

If you have advanced cancer and chemotherapy is being used to slow the progression of cancer or to relieve its symptoms, it may be used for longer periods of time if youre tolerating it well and it improves your quality of life.

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Stage 1b Breast Cancer Means One Of The Following Descriptions Applies:

Lymph nodes have cancer evidence with small clusters of cells between the approximate size of a pinprick to the approximate width of a grain of rice .

AND EITHER No actual tumor is found in the breast.

OR The tumor is smaller than the approximate size of a peanut .

Similar to stage 0, breast cancer at this stage is very treatable and survivable. When breast cancer is detected early, and is in the localized stage , the 5-year relative survival rate is 100%.

What Are Breast Cancer Stages

Chemotherapy for Breast Cancer

Stages of breast cancer are designated as Stage 0 through Stage IV and recurrent breast cancer. Staging of breast cancer is used by doctors to describe if the cancer has spread, how far it has spread, and to help determine a treatment plan.

Staging is determined by using a combination of a physical exam, a mammogram and sizing of tumor, and examination of the tumor and lymph nodes after surgical removal. Treatment will be determined based on the size of the tumor, grade of the disease, and health of the woman.

Staging uses the TNM designation and stages 0 through IV. TNM staging system helps to describe the tumor stage. Stage 0 is the least advanced cancer while Stage IV is the most advanced. Treatment will be determined based on the size of the tumor, grade of the disease, and health of the woman. The tumor Grade describes how fast a tumor grows, with 1 being the slowest and 3 the fastest.

List of breast cancer stages

Stage 0: Ductal carcinoma in situ alone, is considered non-invasive cancer, meaning it is localized to the original area and has not spread into the lymph nodes. This type of cancer is limited to the cells of the milk ducts but has not invaded nearby tissues. A lumpectomy and radiation therapy may be recommended at this stage of breast cancer.

Chemotherapy is not necessary for women with DCIS, but oral hormone therapy may be recommended to help prevent the cancer from returning.

  • tamoxifen

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How A Breast Cancers Stage Is Determined

Your pathology report will include information that is used to calculate the stage of the breast cancer that is, whether it is limited to one area in the breast, or it has spread to healthy tissues inside the breast or to other parts of the body. Your doctor will begin to determine this during surgery to remove the cancer and look at one or more of the underarm lymph nodes, which is where breast cancer tends to travel first. He or she also may order additional blood tests or imaging tests if there is reason to believe the cancer might have spread beyond the breast.

Will The Nhs Fund An Unlicensed Medicine

It’s possible for your doctor to prescribe a medicine outside the uses it’s licensed for if they’re willing to take personal responsibility for this ‘off-licence’ use of treatment.

Your local clinical commissioning group may need to be involved, as it would have to decide whether to support your doctor’s decision and pay for the medicine from NHS budgets.

Page last reviewed: 28 October 2019 Next review due: 28 October 2022

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What Are The Risks Of Chemotherapy

Different chemotherapy medicines tend to cause different side effects. Many women do not have problems with these side effects, while other women are bothered a lot. There are other medicines you can take to treat the side effects of chemo.

Talk to your doctor about the type of chemotherapy medicine that he or she is planning to give you. Ask about any side effects that the chemo may cause.

Short-term side effects can include:

  • Nausea and vomiting.
  • Hair thinning or hair loss.
  • Mouth sores.
  • Increased chance of bruising, bleeding, and infection.
  • Memory and concentration problems.

Long-term side effects of chemotherapy can include:

  • Early menopause, which means not being able to have children anymore. It also can include symptoms like hot flashes, vaginal dryness, and thinning bones .
  • Concentration problems that may last for many months after your treatments are finished.
  • In rare cases, heart damage and a higher risk of other types of cancers, such as leukemia.

What Matters Most To You

New breast cancer study finds most patients don’t need chemotherapy

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to have chemotherapy after surgery

Reasons not to have chemotherapy

I want to do everything possible to treat the breast cancer.

I would rather wait and see if the cancer comes back before I have more treatment.

I would have strong feelings of failure if the breast cancer returned.

I know there’s no way to know for sure whether chemo would keep the cancer from coming back.

I want to have the added treatment and be done with it.

I would be comfortable having frequent follow-ups, without the added treatment.

I feel ready to deal with the possible side effects of chemo.

I am very worried about the side effects.

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Systemic Treatments For Stage 1 Breast Cancer

Systemic treatments, often termed add-on or adjuvant treatments, treat breast cancer throughout your body and not just at the site of the tumor.

These treatments help destroy cancer cells that have spread beyond your breast but are still too small to be spotted. They include the therapies outlined below.

Chemotherapy

Doctors may recommend chemotherapy, also called chemo, after surgery to help destroy any undetected cancer cells. Chemotherapy may also lower your risk of the cancer coming back at a later stage.

Chemotherapy may be recommended for a smaller tumor if:

  • Any cancer cells were found in the lymph nodes.
  • You score high on a gene test such as Oncotype DX, which shows whether chemotherapy could help treat your breast cancer and if its likely to come back after surgery.
  • The cancer cells are progesterone receptor- and estrogen receptor-negative.
  • The breast cancer cells are positive for human epidermal growth factor receptor 2 various therapies can target these receptors.

Hormone therapy

Hormone therapy can be used to help slow down the growth of cancer cells in people with estrogen receptor-positive or progesterone receptor-positive cancer cells. Hormone therapy works by blocking hormone receptors on the cancer cells or by lowering the amount of estrogen produced in your body.

Its important to ask your doctor about the potential side effects of hormone therapy before you begin this treatment, so can you know what to expect.

Targeted therapy

M Categories For Breast Cancer

M followed by a 0 or 1 indicates whether the cancer has spread to distant organs — for example, the lungs, liver, or bones.

M0: No distant spread is found on x-rays or by physical exam.

cM0: Small numbers of cancer cells are found in blood or bone marrow , or tiny areas of cancer spread are found in lymph nodes away from the underarm, collarbone, or internal mammary areas.

M1: Cancer has spread to distant organs as seen on imaging tests or by physical exam, and/or a biopsy of one of these areas proves cancer has spread and is larger than 0.2mm.

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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.

    How Do Oncologists Determine Whether Someone Can Skip Chemotherapy

    Sample Breast Cancer Chemotherapy Schedules and Cycles

    Several factors are used to determine the need for chemotherapy for early stage breast cancer. The size of the cancer and whether the cancer has spread to the lymph nodes are two of the clinical features that are used.

    Hormone receptor status is also a strong determinant of the need for chemotherapy. While many people with HER2-positive and triple-negative breast cancer do require chemotherapy, we can safely avoid chemotherapy in some people with hormone receptor-positive breast cancer.

    The Oncotype DX test analyzes genes in cancer cells to help determine whether cancer will spread or reappear, and whether chemotherapy is needed in addition to anti-estrogen medications to reduce the chance of cancer spreading or returning.

    You may be eligible for the Oncotype DX Breast Recurrence Score test if you have early stage, estrogen receptor-positive , or HER2-negative breast cancer. This test is a huge advance because it does allow many people with this subtype of breast cancer to skip chemotherapy.

    In ER-positive breast cancer, if the Oncotype DX is in the range where there isnt a chemotherapy benefit, anti-estrogen medications will be used to reduce the risk of recurrence. These medications include aromatase inhibitors and tamoxifen.

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    Most Women In The Mid

    The new study looked at the 6,711 women from the trial who fell in the mid-range of 11 to 25. The goal of the study was to find out if these women could safely skip the chemotherapy.

    Following surgery, the women were randomly assigned to receive chemotherapy followed by hormone therapy, or hormone therapy alone. The study was intended to measure invasive disease-free survival, the proportion of women who had not died, or had their cancer return, or developed a new cancer. Results were very similar between the 2 groups.

    • Five years after treatment, the rate of invasive disease-free survival was 93.1% for those who had chemo and 92.8% for those who did not.
    • Nine years after treatment, the rate of invasive disease-free survival was 84.3% for those who had chemo and 83.3% for those who did not.

    Rates of overall survival were also very similar between the 2 groups.

    • Five years after treatment, the rate of overall survival was 98.1% for those who had chemo and 98.0% for those who did not.
    • Nine years after treatment, the rate of overall survival was 93.8% for those who had chemo and 93.9% for those who did not.

    Key Points To Remember

    • Chemotherapy is sometimes used after surgery for early-stage breast cancer to help lower the chances that your breast cancer will come back.
    • Some types of cancer have a very small chance of coming back. Women who have those types of cancer may not need chemo. There are gene tests that may show whether having chemo will help you reduce your chances that the cancer will return.
    • Your age, type of cancer, tumor size, and hormone receptor status have an effect on how well chemo will work to keep your cancer from coming back.
    • Different medicines used for chemo have different side effects. Your doctor can give you other medicines to help you deal with side effects like nausea and vomiting. Some women are bothered a lot by the side effects, but some aren’t.
    • The drugs used for chemo can be very expensive. Insurance policies don’t always cover the whole cost. If you have no insurance, your doctor may be able to help you find drug companies or organizations that will help you pay for this treatment.

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    Are There Any Lasting Side Effects Of Chemotherapy

    Sometimes people do experience problems that may not go away. For example, some of the drugs used for breast cancer may weaken the heart. Your doctor may check your heart before, during, and after treatment. A rare side effect of chemotherapy is that occasionally, years after treatment, a few women have developed leukemia .Some chemotherapy drugs can damage the ovaries. If you have not gone through menopause yet, you may have hot flashes and vaginal dryness. Your menstrual periods may no longer be regular or they may stop. You may become infertile .

    Feeling Unwell Or Tired

    Good news for breast cancer victim: Many not need chemotherapy

    Many women do not feel as healthy after chemo as they did before. There is often a residual feeling of body pain or achiness and a mild loss of physical functioning. These changes may be very subtle and happen slowly over time.

    Fatigue is another common problem for women who have received chemo. This may last a few months up to several years. It can often be helped, so its important to let your doctor or nurse know about it. Exercise, naps, and conserving energy may be recommended. If you have sleep problems, they can be treated. Sometimes fatigue can be a sign of depression, which may be helped by counseling and/or medicines.

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    The Tnm Staging System

    The breast cancer staging system, called the TNM system, is overseen by the American Joint Committee on Cancer . The AJCC is a group of cancer experts who oversee how cancer is classified and communicated. This is to ensure that all doctors and treatment facilities are describing cancer in a uniform way so that the treatment results of all people can be compared and understood.

    In the past, stage number was calculated based on just three clinical characteristics, T, N, and M.

    The T category describes the original tumor:

    • HER2 status: are the cancer cells making too much of the HER2 protein?

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      Oncotype DX score, if the cancer is estrogen-receptor-positive, HER2-negative, and there is no cancer in the lymph nodes

    Adding information about tumor grade, hormone-receptor status, HER2 status, and possibly Oncotype DX test results has made determining the stage of a breast cancer more complex, but also more accurate.

    In general, according to experts, the new staging system classifies triple-negative breast cancer at a higher stage and classifies most hormone receptor-positive breast cancer at a lower stage.

    You also may see or hear certain words used to describe the stage of the breast cancer:

    • Distant: The cancer is found in other parts of the body as well.

    The updated AJCC breast cancer staging guidelines have made determining the stage of a cancer a more complicated but accurate process. So, the characteristics of each stage below are somewhat generalized.

    How Long Does Chemotherapy Take For Breast Cancer

    Typically, you receive chemotherapy in cycles. You may receive chemo every week or every two, three or even four weeks. Cycles are usually two to three treatments long. Each cycle includes a rest period to allow your body to recover. For example, you may have the same treatment every Monday for three weeks. Then you have an extra week to recover before repeating the cycle. Many people have multiple treatment cycles in a row. Treatment may last three to six months.

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    Combination Drug Therapy For Early

    Combination drug therapy means that you receive more than one type of drug at a time.

    Combining drug therapies allows your care team to increase the chances that your treatment will be effective against the breast cancer. If a tumor becomes resistant to one drug, your treatment may still be effective because the tumor responds to the second or third drug in the combination you receive.

    Combination therapy can be given before or after breast surgery. Most women receive a combination of two or three drugs at the same time. Some of these drugs are breast cancer targeted therapies. These drugs work by targeting specific molecules involved in breast cancer development.

    Here are some of the drug combinations that MSKs medical oncologists commonly prescribe:

    Dose-Dense AC-T

    • Doxorubicin and cyclophosphamide, followed by paclitaxel
    • Used to treat early-stage breast cancer, particularly in younger women or women with aggressive disease
    • Given intravenously before or after surgery

    Dose-Dense AC-TH

    • Doxorubicin and cyclophosphamide, followed by paclitaxel and trastuzumab
    • Used to treat early-stage HER2-positive breast cancer
    • Given intravenously before or after surgery

    Dose-Dense AC-THP

    • Doxorubicin and cyclophosphamide, followed by paclitaxel, trastuzumab, and pertuzumab
    • Used to treat early-stage breast cancer
    • Given intravenously before or after surgery
    • Used to treat early-stage breast cancer
    • Given intravenously or by pill after surgery, depending on what your doctor recommends

    TCHP

    Stages Of Breast Cancer: Stage Iiib

    Early stage breast cancer: How to know whether to forgo chemo

    A stage IIIb breast cancer is one in which the tumor may be of any size but it has grown into the chest wall or the skin of the breast. A stage IIIb designation also applies if there is evidence of either

    • axillary lymph node metastasis
    • internal mammary node metastasis

    presenting in such a way as to suggest that total surgical removal is not possible.

    There is a unique type of breast cancer, inflammatory breast cancer, that causes the breast to appear red and swollen. This is because the cancer cells block some of the lymphatic vessels. Inflammatory breast cancers tend to have a poorer prognosis and are generally stage IIIb at least.

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