Breast Cancer (Facts, Stages) (cont.)

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Chemotherapy

Chemotherapy involves the use of drugs to kill rapidly-dividing cancer cells. Chemotherapy is added to the treatment regimen for some women. Chemotherapy may be given after surgery (known as adjuvant chemotherapy) or before surgery in certain cases (neoadjuvant chemotherapy). Most chemotherapy regimens involve combinations of drugs.

Targeted therapy

Targeted therapy involves drugs designed to target the HER2 protein on the surface of breast cancer cells in tumors that overexpress this protein. These therapies are given to women who have tumors that have been classified as HER2-positive. Trastuzumab (Herceptin) is a monoclonal antibody that blocks the tumor growth-promoting activity of HER2. Other drugs that target HER2 activity have also been developed.

Breast cancer treatment by stage

Stage 0: DCIS, or ductal carcinoma in situ, is breast cancer that has not become invasive. Recently, there has been a great deal of interest in the diagnosis of this condition and the potential for overdiagnosis and overtreatment, because most cases of DCIS will never turn into invasive cancer. Currently, surgical removal is used to treat DCIS, and radiation therapy is often given to reduce the risk of recurrence of the condition.

Stage 1 and 2 breast cancers are treated by removal of the cancer, either by a lumpectomy or mastectomy. Stage 1 cancers are small and either have not spread to the lymph nodes or have only spread to a tiny area within the lymph nodes. Stage 2 cancers are somewhat larger or have spread to a few lymph nodes. Lymph node removal, either a biopsy of a nearby lymph node (sentinel node biopsy) or removal of more lymph nodes, is typically done at surgery. Radiation therapy is typically given after breast conserving surgery (lumpectomy) or even after mastectomy in some cases. Following the surgery, if the tumor expresses hormone receptors, hormone therapy with tamoxifen or aromatase inhibitors (as described above) may be given. Drugs that target HER2 activity are given to those whose tumors overexpress this protein. Chemotherapy may also be given. Sometimes, neoadjuvant chemotherapy is given prior to surgery in order to shrink the tumor so that a less extensive surgical operation can be performed.

Stage 3 breast cancers are larger tumors that have spread to many lymph nodes or have spread to structures like the chest wall adjacent to the breast. These tumors have not spread to distant sites within the body. Stage 3 tumors are also treated with surgery, which may be followed by radiation therapy. Hormone therapy, chemotherapy, and drugs to target HER2 activity are often used, depending on the specific characteristics of the tumor. Chemotherapy may also be given prior to surgery (called neoadjuvant chemotherapy) for stage 3 tumors.

Stage 4 (metastatic) breast cancers have spread to other sites in the body. Because stage 4 tumors are widespread, systemic (body-wide) rather than local treatments are usually chosen. In most cases, a combination of chemotherapy, hormone therapy, and/or biologic therapy is the main treatment. Chemotherapy and radiation therapy may be done in some cases.

Clinical trials are often available to test new medications, combinations of drugs, and hormone therapies. Trials may also be designed to determine the proper length of therapy or drug dosing. Many people with breast cancer receive treatment through a clinical trial.

Medically Reviewed by a Doctor on 3/19/2014

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