Treatment:

Treatment is based on many factors, including:

• Type and stage of the cancer
• Whether the cancer is sensitive to certain hormones
• Whether the cancer overproduces (overexpresses) a gene called HER2/neu

In general, cancer treatments may include:

• Chemotherapy medicines to kill cancer cells
• Radiation therapy to destroy cancerous tissue
• Surgery to remove cancerous tissue -- a lumpectomy removes the breast lump; mastectomy removes all or part of the breast and possible nearby structures

Hormonal therapy is prescribed to women with ER-positive breast cancer to block certain hormones that fuel cancer growth.

• An example of hormonal therapy is the drug tamoxifen. This drug blocks the effects of estrogen, which can help breast cancer cells survive and grow. Most women with estrogen-sensitive breast cancer benefit from this drug.
• Another class of hormonal therapy medicines called aromatase inhibitors, such as exemestane (Aromasin), have been shown to work just as well or even better than tamoxifen in postmenopausal women with breast cancer. Aromatase inhibitors block estrogen from being made.

Targeted therapy, also called biologic therapy, is a newer type of cancer treatment. This therapy uses special anticancer drugs that target certain changes in a cell that can lead to cancer. One such drug is trastuzumab (Herceptin). It may be used for women with HER2-positive breast cancer.

Cancer treatment may be local or systemic.

• Local treatments involve only the area of disease. Radiation and surgery are forms of local treatment.
• Systemic treatments affect the entire body. Chemotherapy is a type of systemic treatment.

Most women receive a combination of treatments. For women with stage I, II, or III breast cancer, the main goal is to treat the cancer and prevent it from returning (curing). For women with stage IV cancer, the goal is to improve symptoms and help them live longer. In most cases, stage IV breast cancer cannot be cured.

• Stage 0 and DCIS -- Lumpectomy plus radiation or mastectomy is the standard treatment. There is some controversy on how best to treat DCIS.
• Stage I and II -- Lumpectomy plus radiation or mastectomy with some sort of lymph node removal is the standard treatment. Hormone therapy, chemotherapy, and biologic therapy may also be recommended following surgery.
• Stage III -- Treatment involves surgery, possibly followed by chemotherapy, hormone therapy, and biologic therapy.
• Stage IV -- Treatment may involve surgery, radiation, chemotherapy, hormonal therapy, or a combination of these treatments.

After treatment, some women will continue to take medications such as tamoxifen for a period of time. All women will continue to have blood tests, mammograms, and other tests after treatment.

Women who have had a mastectomy may have reconstructive breast surgery, either at the same time as the mastectomy or later.

Support Groups:

Talking about your disease and treatment with others who share common experiences and problems can be helpful. See: Cancer support group

Expectations (prognosis):

New, improved treatments are helping persons with breast cancer live longer than ever before. However, even with treatment, breast cancer can spread to other parts of the body. Sometimes, cancer returns even after the entire tumor is removed and nearby lymph nodes are found to be cancer-free.

How well you do after being treated for breast cancer depends on many things. The more advanced your cancer, the poorer the outcome. Other factors used to determine the risk for recurrence and the likelihood of successful treatment include:

• Location of the tumor and how far it has spread
• Whether the tumor is hormone receptor-positive or -negative
• Tumor markers, such as HER2
• Gene expression
• Tumor size and shape
• Rate of cell division or how quickly the tumor is growing

After considering all of the above, your doctor can discuss your risk of having a recurrence of breast cancer.

Complications:

You may experience side effects or complications from cancer treatment. For example, radiation therapy may cause temporary swelling of the breast (lymphedema), and aches and pains around the area.

Lymphedema may start 6 to 8 weeks after surgery or after radiation treatment for cancer.

It can also start very slowly after your cancer treatment is over. You may not notice symptoms until 18 to 24 months after treatment. Sometimes it can take years to develop.

Ask your doctor about the side effects you may have during treatment.

Calling your health care provider:

Contact your health care provider for an appointment if:

• You have a breast or armpit lump
• You have nipple discharge

Also call your health care provider if you develop symptoms after being treated for breast cancer, such as:

• Nipple discharge
• Rash on the breast
• New lumps in the breast
• Swelling in the area
• Pain, especially chest pain, abdominal pain, or bone pain