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Breast Cancer
Summary Type: Treatment
Summary Audience: Patients
Summary Language: English
Summary Description: Expert-reviewed information summary about the treatment of breast cancer.
Breast Cancer
General Information About Breast Cancer
Breast cancer is a disease in which malignant (cancer) cells
form in the tissues of the breast.
The breast is made up of lobes and ducts . Each breast has 15 to 20 sections called
lobes, which have many smaller sections called lobules . Lobules end in dozens of tiny bulbs that
can produce milk. The lobes, lobules, and bulbs are linked by thin tubes called
ducts. Anatomy of the breast, showing lymph nodes and lymph vessels.
Each breast also has blood
vessels and lymph
vessels . The lymph vessels carry an almost colorless fluid called lymph . Lymph
vessels lead to organs called lymph
nodes . Lymph nodes are small bean-shaped structures that are
found throughout the body. They filter substances in a fluid called lymph and help fight
infection and disease. Clusters of lymph nodes are found near the breast in the
axilla (under the arm), above the
collarbone, and in the chest.
The most common type of breast cancer is ductal
carcinoma , which begins in the cells of the ducts. Cancer that begins in the
lobes or lobules is called lobular carcinoma and is more often found in both
breasts than are other types of breast cancer. Inflammatory breast cancer is an uncommon type of
breast cancer in which the breast is warm, red, and swollen.
Age and health history can affect the risk of developing breast
cancer.
Anything that increases your chance of getting a disease
is called a risk factor . Risk factors for breast cancer include the following:
- Older age.
- Menstruating at an
early age.
- Older age at first birth or never having given birth.
- A personal history of breast cancer or benign (noncancer) breast disease.
- A mother or sister with breast cancer.
- Treatment with radiation therapy to the breast/chest.
- Breast tissue that is dense on a mammogram .
- Taking hormones such as estrogen and progesterone .
- Drinking alcoholic beverages.
- Being white.
Breast cancer is sometimes caused by inherited gene mutations
(changes).
The genes in cells carry
the hereditary information that is
received from a person’s parents. Hereditary breast cancer makes up
approximately 5% to 10% of all breast cancer. Some altered genes related to
breast cancer are more common in certain ethnic groups.
Women who have an altered gene related to breast cancer and who
have had breast cancer in one breast have an increased risk of developing
breast cancer in the other breast. These women also have an increased risk of
developing ovarian cancer, and may
have an increased risk of developing other cancers. Men who have an altered
gene related to breast cancer also have an increased risk of developing this
disease. (For more information, refer to the PDQ summary on
Male Breast Cancer Treatment.)
Tests have been developed that can detect altered genes. These
genetic tests are sometimes done for
members of families with a high risk of cancer. (Refer to the PDQ summaries on
Screening for Breast
Cancer, Prevention of
Breast Cancer, and Genetics of Breast and Ovarian Cancer for
more information.)
Tests that examine the breasts are used to detect (find) and
diagnose breast cancer.
A doctor should be seen if changes in the breast are noticed. The
following tests and procedures may be used:
- Mammogram : An
x-ray of the breast.
Mammography of the right breast.
- Biopsy : The removal
of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. If a lump in the breast is
found, the doctor may need to cut out a small piece of the lump. Four types of
biopsies are as follows:
- Excisional
biopsy : The removal of an entire lump or suspicious tissue.
- Incisional
biopsy : The removal of part of a lump or suspicious tissue.
- Core biopsy :
The removal of part of a lump or suspicious tissue using a wide needle.
- Needle biopsy :
The removal of part of a lump, suspicious tissue, or fluid, using a thin needle. This procedure is also called a fine-needle biopsy.
- Estrogen and
progesterone receptor test : A test to measure the amount of estrogen and progesterone (hormones ) receptors in cancer tissue. If cancer is found in the breast, tissue from the tumor is checked in the laboratory to find out whether estrogen and progesterone could affect the way cancer grows. The test results show whether hormone therapy may stop the cancer from growing.
Certain factors affect prognosis (chance of recovery) and treatment options.
The prognosis (chance of recovery) and treatment options depend on the following:
- The stage
of the cancer (whether it is in the breast only or has spread to lymph nodes or other places
in the body).
- The type of breast cancer.
- Estrogen-receptor and progesterone-receptor levels in the tumor tissue.
- A woman’s age,
general health, and menopausal status (whether a woman
is still having menstrual periods ).
- Whether the cancer has just been diagnosed or has recurred (come back).
Stages of Breast Cancer
After breast cancer has been diagnosed, tests are done to find
out if cancer cells have spread within the breast or to other parts of the
body.
The process used to find out whether the cancer has spread within the breast or to other
parts of the body is called staging .
The information gathered from the staging process determines the
stage of the disease. It is
important to know the stage in order to plan treatment.
The following stages are used for breast cancer:
Stage 0 (carcinoma in situ)
There are 2 types of breast carcinoma in situ :
Pea, peanut, walnut, and lime show tumor sizes.
Stage I
In stage I , the tumor
is 2 centimeters or smaller and has not spread outside the
breast .
Stage IIA
In stage IIA :
- no tumor is found in the breast , but cancer is found in the axillary lymph nodes (the
lymph nodes under the arm);
or
- the tumor is 2 centimeters or smaller and has spread
to the axillary lymph nodes;
or
- the tumor is larger than 2 centimeters but not larger than 5 centimeters and has not
spread to the axillary lymph nodes.
Stage IIB
In stage IIB , the tumor
is either:
- larger than 2 centimeters but not larger than 5 centimeters and has spread
to the axillary lymph nodes ; or
- larger than 5 centimeters but has not
spread to the axillary lymph nodes.
Stage IIIA
In stage IIIA :
- no tumor is found in the breast , but cancer is found in axillary lymph nodes that are attached to each other or to other structures; or
- the tumor is 5 centimeters or smaller and has spread
to axillary lymph nodes that are attached to each other or to other structures; or
- the tumor is larger than 5 centimeters and has spread to axillary
lymph nodes that may be attached to each other or to other
structures.
Stage IIIB
In stage IIIB , the
cancer may be any size and:
- has spread to tissues near the breast (the skin or
chest wall , including the ribs and
muscles in the chest); and
- may have spread to lymph nodes within the breast or under the arm.
Stage IIIC
In stage IIIC , the
cancer :
- has spread to lymph nodes beneath the collarbone and near the neck; and
- may have spread to lymph nodes within the breast or under the arm and to tissues near the breast.
Stage IIIC breast cancer is divided into operable and inoperable stage IIIC.
In operable stage IIIC, the cancer:
- is found in 10 or more of the lymph nodes under the arm; or
- is found in the lymph nodes beneath the collarbone and near the neck on the same side of the body as the breast with cancer ; or
- is found in lymph nodes within the breast itself and in lymph nodes under the arm.
In inoperable stage IIIC breast cancer, the cancer has spread to the lymph nodes above the collarbone and near the neck on the same side of the body as the breast with cancer.
Stage IV
In stage IV , the cancer
has spread to other organs of the body, most often the bones,
lungs , liver , or brain.
Inflammatory Breast Cancer
In inflammatory breast
cancer , the breast looks red and swollen and feels warm. The
redness and warmth occur because the cancer cells block the lymph vessels in the skin. The skin of the breast
may also show the pitted appearance called peau
d’orange (like the skin of an orange). Inflammatory breast cancer may be stage IIIB , stage IIIC , or stage IV .
Inflammatory breast cancer of the left breast showing peau d’orange and inverted nipple.
There are different types of treatment for patients with breast
cancer.
Different types of treatment are available for patients with breast
cancer . Some treatments are standard
(the currently used treatment), and some are being tested in
clinical trials . Before starting
treatment, patients may want to think about taking part in a clinical trial. A
treatment clinical trial is a research study meant to help improve current
treatments or obtain information on new treatments for patients with cancer .
When clinical trials show that a new treatment is better than the
standard treatment, the new
treatment may become the standard treatment.
Clinical trials are taking place in many parts of the country.
Information about ongoing clinical trials is available from the
NCI Web site. Choosing the most appropriate cancer treatment is a
decision that ideally involves the patient, family, and health care
team.
Four types of standard treatment are used:
Surgery
Most patients with breast cancer have surgery to remove the cancer from the breast. Some
of the lymph nodes under the arm
are usually taken out and looked at under a microscope to see if they contain
cancer cells .
Breast-conserving
surgery , an operation to remove the cancer but not the breast
itself, includes the following:
Breast-conserving surgery. Dotted lines show area containing the tumor that is removed and some of the lymph nodes that may be removed.Patients who are treated with breast-conserving surgery may also have some of the lymph nodes under the arm removed for biopsy . This procedure is called lymph node dissection . It may be done at the same time as the breast-conserving surgery or after. Lymph node dissection is done through a separate incision .
Other types of surgery include the following:
- Total mastectomy : Surgery to remove the whole breast that has cancer. This procedure is also called a simple mastectomy. Some of the lymph nodes under the arm may be removed for biopsy at the same time as the breast surgery or after. This is done through a separate incision. Total mastectomy. Dotted line shows entire breast is removed. Some lymph nodes under the arm may also be removed.
- Modified radical
mastectomy : Surgery to remove the whole breast that has cancer, many of the lymph nodes under
the arm, the lining over the chest muscles, and sometimes, part of the
chest wall muscles. Modified radical mastectomy. Dotted line shows entire breast and some lymph nodes are removed. Part of the chest wall muscle may also be removed.
- Radical
mastectomy : Surgery to remove the breast that has cancer, chest wall muscles under the breast, and all of the lymph nodes under the arm. This procedure is sometimes called a Halsted radical mastectomy.
Even if the doctor removes all the cancer that can be seen at
the time of the surgery, some patients may be given radiation therapy ,
chemotherapy , or
hormone therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to
increase the chances of a cure, is called adjuvant
therapy .
If a patient is going to have a mastectomy,
breast reconstruction (surgery to
rebuild a breast’s shape after a mastectomy) may be considered. Breast
reconstruction may be done at the time of the mastectomy or at a future time.
The reconstructed breast may be made with the patient’s own (nonbreast) tissue
or by using implants filled with saline or silicone gel . Before the decision to get an implant is
made, patients can call the Food and Drug Administration's (FDA) Center for Devices and Radiologic Health at
1-888-INFO-FDA (1-888-463-6332) or visit the FDA's Web site for more information on breast implants.
Radiation therapy
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds , wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.
Chemotherapy
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy ). When chemotherapy is placed directly into the spinal column , an organ , or a body cavity such as the abdomen , the drugs mainly affect cancer cells in those areas (regional chemotherapy ). The way the chemotherapy is given depends on the type and stage of the cancer being treated.
Hormone therapy
Hormone therapy is a cancer treatment that removes hormones or blocks their action and stops cancer cells from growing. Hormones are substances produced by glands in the body and circulated in the bloodstream. Some hormones can cause certain cancers to grow. If tests show that the cancer cells have places where hormones can attach (receptors ), drugs, surgery, or radiation therapy are used to reduce the production of hormones or block them from working.
Hormone therapy with tamoxifen is often given to patients with early
stages of breast cancer and those
with metastatic breast cancer (cancer
that has spread to other parts of the body). Hormone therapy with tamoxifen or
estrogens can act on cells all over the body and may increase the chance of
developing endometrial cancer.
Women taking tamoxifen should have a pelvic exam every year to look for any
signs of cancer. Any vaginal
bleeding, other than menstrual
bleeding, should be reported to a doctor as soon as possible.
Hormone therapy with an aromatase inhibitor is given to some postmenopausal women who have hormone-dependent breast cancer. Hormone-dependent breast cancer needs the hormone estrogen to grow. Aromatase inhibitors decrease the body's estrogen by blocking an enzyme called aromatase from turning androgen into estrogen. Aromatase inhibitors are also being tested in clinical trials to compare them to hormone therapy with tamoxifen for the treatment of metastatic breast cancer.
New types of treatment are being tested in clinical trials.
These include the following:
Sentinel lymph node biopsy followed by surgery
Sentinel lymph node biopsy is the removal of the sentinel lymph node during surgery. The sentinel lymph node is the first lymph node to receive lymphatic drainage from a tumor. It is the first lymph node the cancer is likely to spread to from the tumor. A radioactive substance and/or blue dye is injected near the tumor. The substance or dye flows through the lymph ducts to the lymph nodes. The first lymph node to receive the substance or dye is removed. A pathologist views the tissue under a microscope to look for cancer cells. If cancer cells are not found, it may not be necessary to remove more lymph nodes. After the sentinel lymph node biopsy, the
surgeon removes the tumor (breast-conserving surgery or mastectomy).
Sentinel lymph node biopsy. Radioactive substance and/or blue dye is injected near the tumor (first panel), the injected material is followed visually or with a probe (middle panel), and the first lymph nodes to take up the material are removed and checked for cancer cells (last panel).
High-dose chemotherapy with stem cell transplant
High-dose chemotherapy with stem cell transplant is a way of giving high doses of chemotherapy and replacing blood -forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the blood or bone marrow of the patient or a donor and are frozen and stored. After the chemotherapy is completed, the stored stem cells are thawed and given back to the patient through an infusion . These reinfused stem cells grow into (and restore) the body’s blood cells.
Studies have shown that high-dose chemotherapy followed by stem cell transplant does not work better than standard chemotherapy in the treatment of breast
cancer. Doctors have decided that, for now, high-dose chemotherapy should be tested only in clinical trials. Before taking part in such a trial, women should
talk with their doctors about the serious side
effects, including death, that may be caused by high-dose chemotherapy.
Monoclonal antibodies as adjuvant therapy
Monoclonal antibody therapy is a cancer treatment that uses antibodies made in the laboratory, from a single type of immune system cell . These antibodies can identify substances on cancer cells or normal substances that may help cancer cells grow. The antibodies attach to the substances and kill the cancer cells, block their growth, or keep them from spreading. Monoclonal antibodies are given by infusion . They may be used alone or to carry drugs , toxins , or radioactive material directly to cancer cells. Monoclonal antibodies are also used in combination with chemotherapy as adjuvant therapy .
Trastuzumab (Herceptin) is a monoclonal antibody that blocks the effects of the growth factor protein HER2 , which transmits growth signals to breast cancer cells. About one-fourth of patients with breast cancer have tumors that may be treated with trastuzumab combined with chemotherapy.
This summary section refers to specific treatments under study in
clinical trials, but it may not mention every new treatment being studied.
Information about ongoing clinical trials is available from the
NCI Web site.
Treatment Options by Stage
Ductal Carcinoma In Situ (DCIS)
Treatment of ductal carcinoma in situ (DCIS) may include the following:
This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Web site.
Lobular Carcinoma In Situ (LCIS)
Treatment of lobular carcinoma in situ (LCIS) may include the following:
This summary section refers to specific treatments under study in clinical trials, but it may not mention every new treatment being studied. Information about ongoing clinical trials is available from the NCI Web site.
Stage I, Stage II, Stage IIIA, and Operable Stage IIIC Breast Cancer
Treatment of stage I ,
stage II , stage IIIA , and operable stage IIIC breast cancer may include the following:
Adjuvant
therapy (treatment given after surgery to
increase the chances of a cure ) may include the following:
This summary section refers to specific treatments under study in
clinical trials, but it may not mention every new treatment being studied.
Information about ongoing clinical trials is available from the
NCI Web site.
Stage IIIB, Inoperable Stage IIIC, Stage IV, and Metastatic Breast Cancer
Stage IIIB and inoperable stage IIIC breast cancer
Treatment of stage IIIB and inoperable stage IIIC breast cancer may include the following:
This summary section refers to specific treatments under study in
clinical trials, but it may not mention every new treatment being studied.
Information about ongoing clinical trials is available from the
NCI Web site.
Stage IV and metastatic breast cancer
Treatment of stage IV or
metastatic breast cancer may include
the following:
This summary section refers to specific treatments under study in
clinical trials, but it may not mention every new treatment being studied.
Information about ongoing clinical trials is available from the
NCI Web site.
Treatment Options for Inflammatory Breast Cancer
Treatment of inflammatory breast
cancer may include the following:
This summary section refers to specific treatments under study in
clinical trials, but it may not mention every new treatment being studied.
Information about ongoing clinical trials is available from the
NCI Web site.
Treatment Options for Recurrent Breast Cancer
Treatment of recurrent
breast cancer (cancer that has come
back after treatment) in the breast or chest
wall may include the following:
Changes to This Summary (06/14/2007)
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
Editorial changes were made to this summary.
To Learn More
Call
For more information, U.S. residents may call the National Cancer Institute's (NCI's) Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) Monday through Friday from 9:00 a.m. to 4:30 p.m. Deaf and hard-of-hearing callers with TTY equipment may call 1-800-332-8615. The call is free and a trained Cancer Information Specialist is available to answer your questions.
Web sites and Organizations
The NCI Web site provides online access to information on cancer, clinical trials, and other Web sites and organizations that offer support and resources for cancer patients and their families. There are also many other places where people can get materials and information about cancer treatment and services. Local hospitals may have information on local and regional agencies that offer information about finances, getting to and from treatment, receiving care at home, and dealing with problems associated with cancer treatment.
Publications
The NCI has booklets and other materials for patients, health professionals, and the public. These publications discuss types of cancer, methods of cancer treatment, coping with cancer, and clinical trials. Some publications provide information on tests for cancer, cancer causes and prevention, cancer statistics, and NCI research activities. NCI materials on these and other topics may be ordered online or printed directly from the NCI Publications Locator. These materials can also be ordered by telephone from the Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237), TTY at 1-800-332-8615.
LiveHelp
The NCI's LiveHelp service, a program available on several of the Institute's Web sites, provides Internet users with the ability to chat online with an Information Specialist. The service is available from 9:00 a.m. to 11:00 p.m. Eastern time, Monday through Friday. Information Specialists can help Internet users find information on NCI Web sites and answer questions about cancer.
Write
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- NCI Public Inquiries Office
- Suite 3036A
- 6116 Executive Boulevard, MSC8322
- Bethesda, MD 20892-8322
About PDQ
PDQ is a comprehensive cancer database available on NCI's Web site.
PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ is available online at NCI's Web site. PDQ is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government's focal point for biomedical research.
PDQ contains cancer information summaries.
The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries are available in two versions. The health professional versions provide detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions provide current and accurate cancer information.
The PDQ cancer information summaries are developed by cancer experts and reviewed regularly.
Editorial Boards made up of experts in oncology and related specialties are responsible for writing and maintaining the cancer information summaries. The summaries are reviewed regularly and changes are made as new information becomes available. The date on each summary ("Date Last Modified") indicates the time of the most recent change.
PDQ also contains information on clinical trials.
Before starting treatment, patients may want to think about taking part in a clinical trial. A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about new treatments, the risks involved, and how well they do or do not work. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard."
Listings of clinical trials are included in PDQ and are available online at NCI's Web site. Descriptions of the trials are available in health professional and patient versions. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237); TTY at 1-800-332-8615.
2007-06-14
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