Breast Cancer Treatment

Am Fam Physician. 2010;81(11):1347-1349

See related article on breast cancer treatment

What can I expect after being diagnosed with breast cancer?

If you have breast cancer, you will probably be treated by a team that includes a surgeon, an oncologist (cancer specialist), a radiation therapist, and your family doctor. Breast cancer treatment is complex and depends on many things.

Treatment usually includes surgery to remove the cancer (tumor), followed by radiation and/or medicines, such as chemotherapy, hormone therapy, and antibody therapy. Sometimes chemotherapy is used before surgery if the tumor is large. If the cancer has spread to the lymph nodes, they will also be removed. Lymph nodes fight infection all over your body and drain fluid back into your blood. The armpit lymph nodes drain fluid away from the breast toward your armpit. These may be the first lymph nodes affected by breast cancer that is spreading outside of your breasts.

Understanding the reasons for different treatments can help you work with your doctors to choose the best treatment for you. Your doctors will offer you treatments based on:

Tumor size
Whether the cancer has spread to other parts of the breast, to the lymph nodes, or to other parts of your body
Whether the cancer grows in response to the hormones estrogen or progesterone
Whether the cancer overproduces the protein ERBB2, which means it may respond to a medicine called trastuzumab (brand: Herceptin)
Whether this is a previously treated cancer that has come back
Other conditions affecting your health
Your age, life expectancy, and preferences

When is surgery needed?

Surgery is done when the entire detectable cancer can be removed. Cancers that have spread beyond the breast and lymph nodes are not usually treated with surgery.

Breast-conserving surgery (often called a lumpectomy [lum-PECK-to-me]) removes the tumor in a way that keeps the normal shape of the breast. It is offered to patients with small tumors that have not spread to any lymph nodes. A mastectomy (mas-TEK-to-me) is surgery that removes the entire breast. This is done for large tumors, cancer that is in more than one part of the breast, or cancer that has spread to any lymph nodes.

How do doctors know if it has spread to the lymph nodes?

Doctors can often feel the lymph nodes in your armpit. Abnormally large or firm nodes may be cancer. Any suspicious nodes are removed with surgery and tested for cancer. If the lymph nodes feel normal, surgeons may only remove the first node next to the breast. This node is called the sentinel node. If this node does not contain cancer, removal of the rest of the armpit lymph nodes may not be necessary.

Surgery to remove the armpit lymph nodes is extensive and may lead to complications, such as arm swelling and pain. Balancing the benefit of avoiding this serious surgery with the chance that the cancer is in the nodes is one of the hardest parts of deciding about lymph-node surgery.

What are hormone blockers?

Some breast cancers, but not all, grow in response to hormones. Medicines that block hormones stop the growth and spread of these cancers. They have side effects your doctor can explain, but the biggest risk is getting a blood clot. Some cancers do not respond to hormone blockers.

Hormone blockers are only used after menopause, when your body doesn’t produce as many natural hormones. Before menopause, women may be offered surgery (removal of ovaries) or medicines to stop hormones from making tumors grow.

What is chemotherapy?

Chemotherapy uses medicines to attack cancer cells. Many of these medicines also attack healthy cells, so chemotherapy has more side effects. These medicines are often given through an IV tube at a hospital or clinic. If you have a large tumor, cancer in the lymph nodes, or a cancer that doesn’t respond to hormone blockers, you may be offered chemotherapy. This can be a hard choice because these medicines can make you feel sick at first. Your doctor can explain the risks and benefits of chemotherapy.

What is radiation therapy?

Radiation therapy uses high-energy beams to kill or slow cancer growth. It is often used after surgery to kill cancer cells that could not be removed during surgery. One risk is that radiation may damage healthy tissue. Your doctor can explain the risks and side effects, and help you decide whether this is a good option for you.

How can I help myself through treatment?

Have a support system. Breast cancer treatment requires a team approach that includes family and friends. Tell them about the difficult decisions and consider having them come with you to doctor visits. They may be able to help you with processing information and making choices. Breast cancer patient support groups can be a good source of advice and support. Go to http://www.cancer.org/docroot/COM/COM_0.asp to find a support group near you, or go to http://www.cancercare.org/get_help/supportgroups.php to find an online support group.

Keep up with primary care. Getting your flu shot, stopping smoking, and keeping your blood pressure or diabetes under control is important to avoid complications and fight your cancer. Your family doctor can help you with this.

Eat a healthy diet and get exercise. Being physically fit and eating a healthy diet may help you recover from surgery and medical therapy faster, and help you feel better overall.

Treat depression and anxiety. Depression and anxiety are common with any cancer diagnosis. Counseling, psychotherapy, and medicines are effective and may help you. Tell your doctor if you feel depressed or anxious.

Manage pain. Tell your doctor about any pain you have. Pain may indicate a problem your doctor should know about. There are many ways your doctor can treat your pain.

Communicate with your doctors. Breast cancer treatment involves strong emotions and feeling unwell. You may also receive a lot of information during your treatment. All of this can be overwhelming. Complex medical terminology and decision making is difficult for anyone to absorb. Ask your doctors to slow down, rephrase, repeat, and give you time to express your understanding of your options.