Breast Evaluation and Treatment Program

Breast Cancer

About the Treatments

Members of the Breast Cancer multidisciplinary team: Dr. Katherine Tkaczuk, medical oncologist; Dr. Anil Dhople, radiation oncologist; and Dr. Robert Buras, surgical oncologist

There are four primary treatment options for patients with breast cancer:

surgery
radiation therapy
chemotherapy
hormone therapy

Three treatment options currently being tested in clinical trials include:

biologic therapy (using the body's immune system to fight cancer)
bone marrow transplantation
peripheral blood stem cell transplantation

Surgery

Most patients with breast cancer have surgery to remove the cancer from the breast. Usually some of the lymph nodes under the arm are also taken out and looked at under a microscope to see if there are any cancer cells. Different types of operations are used.

Surgeries that conserve the breast include the following:

Lumpectomy (sometimes called excisional biopsy or wide excision) is the removal of the lump in the breast and some of the tissue around it. It is usually followed by radiation therapy to the part of the breast that remains. Most doctors also take out some of the lymph nodes under the arm.
Partial or segmental mastectomy is the removal of the cancer as well as some of the breast tissue around the tumor and the lining over the chest muscles below the tumor. Usually some of the lymph nodes under the arm are taken out. In most cases, radiation therapy follows.

Other types of surgery:

Total or simple mastectomy is the removal of the breast. Sometimes lymph nodes under the arm are also taken out.
Modified radical mastectomy is the removal of the breast, many of the lymph nodes under the arm, the lining over the chest muscles, and sometimes part of the chest wall muscles. This is the most common operation for breast cancer.
Radical mastectomy (also called the Halsted radical mastectomy) is the removal of the breast, chest muscles, and all of the lymph nodes under the arm. For many years, this was the operation used most, but now it is used only when the tumor has spread to the chest muscles.

If a patient is going to have a mastectomy, breast reconstruction (making a new breast mound) may be considered. The breast reconstruction may be done at the time of the mastectomy or at some future time. The breast may be made with the patient's own tissue from another part of the body or by using implants. Different types of implants can be used. The U.S. Food and Drug Administration has restricted the use of breast implants filled with silicone gel to clinical trials. Saline-filled breast implants, which contain salt water rather than silicone gel, may also be used.

Even if a doctor removes all the cancer that is found at the time of the operation, a patient may be given radiation therapy, chemotherapy, or hormone therapy after surgery to try to kill any cancer cells that might be left. Therapy given after an operation when there are no visible cancer cells is called adjuvant therapy.

Radiation Therapy

Radiation therapy is the use of high-energy x-rays to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external radiation therapy) or from putting materials that produce radiation (radioisotopes) through thin plastic tubes into the area where the cancer cells are found (internal radiation therapy).

Chemotherapy

Chemotherapy is the use of drugs to kill cancer cells. Most anticancer drugs are injected into a vein (IV) or a muscle; some are given by mouth. Chemotherapy is a systemic treatment, meaning that the drugs flow through the bloodstream to nearly every part of the body to kill cancerous cells. It is generally given in cycles; a treatment period is followed by a recovery period, then another treatment period, and so on.

Monoclonal Antibodies

Monoclonal antibodies are made synthetically in a laboratory and targeted to specific proteins on cancer cells. Twenty-five percent of women diagnosed with breast cancer have the protein (HER2NEU) on their tumor cells. These women can be treated with the monoclonal antibody, called Herceptin.

Hormone (Anti-Estrogen) Therapy

Hormone therapy is used to change the way hormones in the body help cancers grow. This may be done by using drugs that change the way hormones work or by surgery to take out organs that make hormones, such as the ovaries. Hormone therapy with tamoxifen is often given to patients with early stages of breast cancer. Hormone therapy with tamoxifen or estrogens can act on cells all over the body and may increase a woman's chance of getting cancer of the uterus. Women receiving hormone therapy should see a doctor for a pelvic examination every year. Any vaginal bleeding other than menstrual bleeding should be reported to a doctor as soon as possible.

Biologic Therapy

Biologic therapy uses materials made by the body itself or made synthetically in a laboratory to boost, direct or restore the body's natural defenses against disease. Biological therapy is sometimes called biological response modifier (BRM) therapy or immunotherapy. This treatment is currently only being given in clinical trials.

Bone Marrow Transplantation

Bone marrow transplantation is a new treatment that is being studied in clinical trials. Sometimes breast cancer becomes resistant to treatment with radiation therapy or chemotherapy. Very high doses of chemotherapy may then be used to treat the cancer. Because the high doses of chemotherapy can destroy the bone marrow, marrow is taken from the bones before treatment and frozen.

The patient is then given high-dose chemotherapy with or without radiation therapy to treat the cancer. The marrow that was taken out is then thawed and injected back into the patient to replace the marrow that was destroyed. This type of transplant is called an autologous transplant. If the marrow that is given back is taken from another person, the transplant is called an allogeneic transplant. The chances of recovery are greater in hospitals that do more than five bone marrow transplantations per year. This form of treatment is not recommended outside of a clinical trial.

Peripheral Blood Stem Cell Transplant

A peripheral blood stem cell transplant is another type of autologous transplant in which the patient's blood is passed through a machine that removes the stem cells (immature cells from which all blood cells develop) and then returns the blood back to the patient. This procedure is called leukapheresis and it usually takes 3 or 4 hours to complete. The stem cells are treated with drugs to kill any cancer cells and then frozen until they are transplanted back into the patient. This procedure may be done alone or with an autologous bone marrow transplant.

This page was last updated on: September 29, 2009.