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What Stage Of Breast Cancer Requires Chemotherapy

When Is Radiation Usually Used To Treat Stage 2 Breast Cancer

Many breast cancer patients can skip chemo, study finds

According to the American Cancer Society, radiation therapy may be used after a breast-conserving surgery, or lumpectomy, to mitigate the risk of cancer cells recurring in the same breast or nearby lymph nodes. After a mastectomy, an oncologist may determine that radiation is necessary if the tumor was larger than 5 cm, if there was lymph node involvement, or if cancer was found outside of surgical margins.

General Indications For Chemotherapy

We outline below some of the more common indications for needing chemotherapy. The decision to undergo chemotherapy also involves being healthy enough to tolerate the treatment. Deciding who needs chemotherapy and what type of chemotherapy to administer is one of the most difficult decisions made in medicine. Your medical oncologist will guide you.

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.

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Inflammatory Breast Cancer Requires Chemotherapy

If you have been diagnosed with inflammatory breast cancer, the first step is neoadjuvant chemotherapy before surgery. This type of cancer has a high likelihood of spreading to the lymph nodes and other parts of the body. Starting chemotherapy as soon as possible is essential to treating this aggressive breast cancer. A mastectomy is performed after chemotherapy, followed by radiation to the area of the mastectomy to lessen the chance of cancer growing back in that area.

What Type Of Drug Treatment Might I Get

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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:

  • Chemotherapy
  • 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.

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When Is Chemotherapy Used To Treat Early

The first treatment for early-stage breast cancer usually includes surgery and sometimes radiation. Your doctor may also talk to you about added treatment, such as chemotherapy and hormone therapy, that may help keep cancer from coming back.

It isn’t possible for all women to know for sure who will benefit from added treatment. But if you have early-stage, estrogen receptor positive breast cancer with no cancer in the lymph nodes, you may have a gene test. Gene tests, such as the Oncotype DX, may be done on the cancerous tissue that was removed to look for tumor markers. These tests can give your doctor important information about whether chemotherapy will help you.

The type of added treatment you have depends on the stage and classification of your breast cancer:

Stage 3 Breast Cancer

What is Stage 3 breast cancer?

Stage 3 breast cancer is when tumors are larger than earlier stages or are growing into nearby tissues, and the cancer has spread to nearby lymph nodes. There are three categories of Stage 3 breast cancer:

  • Stage 3A In some cases, Stage 3A breast cancer indicates that the cancer spread to four to nine area lymph nodes, and there may or may not be a tumor in the breast. In other cases, it can describe a cancer that has spread less but the tumor is larger than 5 centimeters.
  • Stage 3B Stage 3B breast cancer can mean that the cancer has spread to the chest wall or to the breasts skin, causing swelling or an ulcer. It may also mean that cancer has spread to up to nine axillary lymph nodes or lymph nodes near the breast bone.
  • Stage 3C Stage 3C breast cancer means the cancer may have spread to the chest wall or breasts skin, or it has spread to 10 or more nearby lymph nodes. It can also mean the cancer has also spread to lymph nodes above or below the collarbone.

What are the treatment options for Stage 3 breast cancer?

Stage 3 breast cancer treatment timeline

The treatment timeline for Stage 3 breast cancer depends greatly on the severity, extent of spreading, the type of treatment youre undergoing and how youre responding to those treatments. For most Stage 3 cases, treatment can last anywhere from six to 12 months with hormone therapy lasting many years after.

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Chemotherapy Regimens For Early

At some point, your medical oncologist will recommend a chemotherapy plan for you. Also called a chemotherapy regimen, the plan will have important details about your treatment, including:

  • which drugs youre receiving
  • the order in which you receive them
  • the amount of each drug
  • how often and how long you will need chemotherapy

Most women with early-stage breast cancer receive chemotherapy for approximately three to six months. Theres time in between treatments to allow your body to recover. If you are receiving targeted therapy for early HER2-positive breast cancer, treatment could last up to a year.

For some people, doctors may recommend a dose-dense chemotherapy regimen. Dose-dense chemotherapy means there is less time between treatments. You will not need to have a larger dose of chemotherapy.

Research has shown that dose-dense chemotherapy can improve survival and lower the risk of the breast cancer coming back compared to a traditional chemotherapy schedule. Dose-dense chemotherapy does not result in more side effects.

Starting With Neoadjuvant Therapy

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Most often, these cancers are treated with neoadjuvant chemotherapy . For HER2-positive tumors, the targeted drug trastuzumab is given as well, sometimes along with pertuzumab . This may shrink the tumor enough for a woman to have breast-conserving surgery . If the tumor doesnt shrink enough, a mastectomy is done. Nearby lymph nodes will also need to be checked. A sentinel lymph node biopsy is often not an option for stage III cancers, so an axillary lymph node dissection is usually done.

Often, radiation therapy is needed after surgery. If breast reconstruction is done, it is usually delayed until after radiation is complete. In some cases, additional chemo is given after surgery as well.

After surgery, some women with HER2-positive cancers will be treated with trastuzumab for up to a year. Many women with HER2-positive cancers will be treated first with trastuzumab followed by surgery and then more trastuzumab for up to a year. If after neoadjuvant therapy, any residual cancer is found at the time of surgery, trastuzumab may be changed to a different drug, called ado-trastuzumab emtansine, which is given every 3 weeks for 14 doses. For people with hormone receptor-positive cancer in the lymph nodes who have completed a year of trastuzumab, the doctor might also recommend additional treatment with an oral drug called neratinib for a year.

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How Chemotherapy Is Given

Many chemotherapy drugs for breast cancer are given in liquid form, as intravenous infusions or injections, but some are available as pills or tablets.

Some drugs may be given alone, and other drugs are combined to work together. When chemo drugs are given in combination, the treatment is called a regimen.

Some of the common regimens are:

  • ACT: Adriamycin and Cytoxan followed by Taxol
  • CMF: Cytoxan, methotrexate, and 5-FU
  • AC: Adriamycin and Cytoxan
  • CAF or FAC: Cytoxan, Adriamycin, and 5-FU
  • CEF or FEC: Cytoxan, Ellence , and 5-FU
  • TC: Taxotere and Cytoxan

What Is The Cost Of The Test

Oncotype DX costs about $4,000 but, according to Genomic Health, 90% of insured Americans carry an insurance policy that will cover the testing.

If your insurance does not cover this specific test, Dr. Gormans office will help you contact your insurance company to try to receive more financial assistance. Insurance companies may choose to help cover the test since the cost of Chemo and radiation are more expensive.

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Moving Genomic Testing Into Practice

This study is a big deal, said Dr. Timothy Byun, a medical oncologist with The Center for Cancer Prevention and Treatment at St. Joseph Hospital in Southern California, who was not involved in the study.

In an interview with Healthline, Byun said the study may result in fewer breast cancer patients getting chemotherapy, at least in European countries.

In the United States, many of us have already been using the Oncotype DX test to help guide our decisions, said Byun. It uses a 21-gene score. It gives similar information, but we dont know if theres a 100 percent correlation with the MammaPrint test.

Byun referred to the recent TAILORx Trial using the 21-gene test. It found that low-risk patients did well without chemotherapy.

That study showed the test could select a cohort of patients with a 99 percent chance of five-year survival without distant metastasis. For those women, the risks of chemotherapy arent justifiable.

Researchers are still waiting for this data to mature, cautions Byun.

We know that when oncologists see patients after surgery, we look at traditional clinical indicators to guide our decision-making process as to benefits and harms of chemotherapy, he said.

With the information currently available, its likely that some breast cancer patients get unnecessary chemotherapy.

Theres a caveat, according to Byun. Genomic studies, for the most part, have included only estrogen-receptor positive breast cancer patients.

Adjuvant And Neoadjuvant Drugs

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  • Ixabepilone
  • Eribulin

Although drug combinations are often used to treat early breast cancer, advanced breast cancer more often is treated with single chemo drugs. Still, some combinations, such as paclitaxel plus gemcitabine, are commonly used to treat advanced breast cancer.

For cancers that are HER2-positive, one or more drugs that target HER2 may be used with chemo.

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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.

Feeling Unwell Or Tired

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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Treatment For Stage 1 Breast Cancer

Doctors can offer a variety of treatment options for stage 1 breast cancer, although surgery is the primary treatment.

Surgery

A lumpectomy or mastectomy are both viable surgical options for people with stage 1 breast cancer. A doctor will decide what surgery is most appropriate depending on the location of the primary tumor, how large it is, the size of the breast, family history, genetics, and the persons preference.

Radiation therapy

Radiation therapy is a standard treatment for stage 1 breast cancer. However, a doctor may not recommend radiation therapy for people over 70 years old, particularly if hormone therapy is suitable.

Hormone therapy

If the breast cancer is ER+ or PR+, hormone therapy may be effective. Hormone therapy works by preventing the growth of estrogen, which helps cancer grow. Hormone therapy can reach cancer cells in the breast as well as other areas of the body and reduces the risk of the cancer coming back.

Chemotherapy

Before recommending chemotherapy, a doctor will test to see whether the cancer is hormone receptive.

If the test results show that the cancer is not receptive to estrogen and progesterone or to another protein called human epidermal growth factor receptor 2 , it is known as triple-negative breast cancer .

Hormone therapy is ineffective against this cancer type, and people who have TNBC will usually need chemotherapy.

Stage 2 breast cancer also has subcategories known as 2A and 2B.

Stage 2A breast cancer is an invasive cancer where:

Side Effects Of Breast Cancer Chemotherapy

How to Treat Stage II (2) Breast Cancer

Chemotherapy usually works by attacking rapidly dividing cells. This means that chemotherapy can harm not only cancer cells but also healthy cells that are dividing rapidly, like the ones that cause your hair to grow.

Whether you have side effects from breast cancer chemotherapy will depend on the details of your treatment plan. The care teams at MSK are committed to helping you feel your best during and after treatment. During treatment, well watch carefully for your reaction to the drugs and adjust the drugs or dose as necessary. Well also continue to monitor you for possible long-term effects after your treatment ends.

We offer a variety of other specialized services to support you during your treatment. Many MSK patients find that our Integrative Medicine Service can be a valuable part of their treatment plan. Programs include massage, acupuncture, hypnotherapy, meditation, visualization, music therapy, and nutritional counseling.

One side effect of chemotherapy can be hair loss. MSK offers scalp cooling to help minimize hair loss. Learn more about scalp cooling, or ask your care team for more information.

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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.

At What Stage Of Cancer Is Chemotherapy Used

The decision to use chemotherapy may vary depending on the aggressiveness, stage and type of cancer. Usually, chemotherapy may be used for all stages in most cancer types. Chemotherapy is a type of medicine or combination of medications that is used to treat or kill cancer cells.

Cancer treatment may include more than one type of therapy . The following describes the common ways that chemotherapy treatments are used

  • Adjuvant therapy: Chemotherapy may be used after surgery to reduce the risk of cancer recurrence .
  • Neoadjuvant therapy: Chemotherapy may be given before surgery to shrink the tumor. This is to help the surgery be more successful.
  • Concurrent therapy: Chemotherapy may be adjusted with other therapies . It is mostly used for aggressive or stubborn cancer types.
  • Palliative chemotherapy: This may also be used to relieve symptoms, improve quality of life and extend life for people with advanced cancer.

Common type of chemotherapy drugs are as follows

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Is There A Breast Cancer Cure

There is currently no cure for metastatic breast cancer, or breast cancer that has spread to distant parts of the body. However, early stages of breast cancer that remain localized are highly treatable 99 percent of people who receive treatment in the earliest stages of breast cancer live for 5 years or longer after diagnosis, according to the American Cancer Society.

How Quickly Do Breast Cancer Tumors Grow From Stage To Stage

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Cancer cells divide and multiply quickly in such a way that as a tumor gets bigger, it divides and grows even faster. The average doubling time for breast cancer tumors is between 50 and 200 days. Breast cancer tumor growth rate is impacted by hormonal factors, such as hormone receptor status and HER2 status.

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