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Choosing the Right Breast Cancer Treatment

The primary treatment for breast cancer is surgery to remove the cancer. There are three main types of surgery:

Breast cancer patients with early-stage cancer may opt for breast-conserving surgery -- either a lumpectomy (wide local excision) -- removal only of the "lump" of tumor as well as the normal breast tissue closely surrounding the tumor, or partial mastectomy -- removal of the tumor and a larger portion of surrounding breast tissue. This is usually followed by radiation therapy.

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If the cancer is advanced, if there is a high risk of recurrence, or if the surgeon cannot remove all necessary breast tissue (surgical margins) with breast-conserving surgery, the surgeon may recommend a mastectomy, which is complete removal of the breast. Some women choose to have breast reconstruction following mastectomy.

At the time of surgery, most patients also have either axillary node dissection or sentinel lymph node biopsy to determine if the breast cancer cells have spread to the lymph nodes. These procedures remove lymph nodes from the armpit to test them for cancer cells. Sentinel lymph node biopsies have largely replaced axillary node dissection.

Surgery is often combined with additional treatments, known as adjuvant therapy, to destroy any remaining cancer cells. Sometimes, the additional treatment may be given before surgery (called neoadjuvant therapy) when the breast cancer has been found to have already spread widely. These methods of treatment include:

Treatment for breast cancer will depend on your:

  • Personal preferences.
  • Overall health.
  • Stage of the breast cancer, including whether cancer has spread to your lymph nodes.
  • The type of cancer and whether the cancer is an aggressive type.
  • Whether you have gone through menopause.
  • Whether the cancer you have depends on female hormones to grow. If it is "sensitive" to the female hormones, then the cancer is called "endocrine-receptor positive" (ER and/or PR positive). If not, it is ER/PR negative. This is determined by testing a tissue sample in the lab.
  • The presence of other markers suggestive of aggressive cancer, such as the HER2 oncogene.

Most doctors who treat cancer patients in the U.S. follow national guidelines set by the National Comprehensive Cancer Network (NCCN)  and/or the American Society of Clinical Oncology (ASCO), which have helped improve patient care. Still, treatment will vary based on your needs and circumstances.

Before you begin treatment for breast cancer, print out these questions to ask your specialists so you can better understand your care: Questions to Ask.

 

WebMD Medical Reference

Reviewed by Arnold Wax, MD on May 09, 2012
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