Treatment Option by Stage

Ductal Carcinoma In Situ (DCIS)

Treatment of ductal carcinoma in situ (DCIS) may include the following:

• Breast-conserving surgery and radiation therapy with or without tamoxifen.
• Total mastectomy with or without tamoxifen.
• Breast-conserving surgery without radiation therapy.

Lobular Carcinoma In Situ (LCIS)

Treatment of lobular carcinoma in situ (LCIS) may include the following:

• Biopsy to diagnose the LCIS followed by regular examinations and regular mammograms to find any changes as early as possible. This is called observation.
• Tamoxifen to reduce the risk of developing breast cancer.
• Bilateral prophylactic mastectomy. This treatment choice is sometimes used in women who have a high risk of getting breast cancer. We believe that this is a more aggressive treatment than is needed.

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:

• Breast-conserving surgery to remove only the cancer and some surrounding breast tissue, followed by lymph node dissection and radiation therapy.
• Modified radical mastectomy with or without breast reconstruction surgery.
• Sentinel lymph node biopsy followed by surgery.

Adjuvant therapy (treatment given after surgery to increase the chances of a cure) may include the following:

• Radiation therapy to the lymph nodes near the breast and to the chest wall after a modified radical mastectomy.
• Systemic chemotherapy with or without hormone therapy.
• Hormone therapy.
• A clinical trial of trastuzumab (Herceptin) combined with systemic chemotherapy.
• A clinical trial of bisphosphonates combined with chemotherapy and/or hormone therapy.

Stage IIIB and inoperable stage IIIC breast cancer

Treatment of stage IIIB and inoperable stage IIIC breast cancer may include the following:

• Systemic chemotherapy.
• Systemic chemotherapy followed by surgery (breast-conserving surgery or total mastectomy), with lymph node dissection followed by radiation therapy. Additional systemic therapy (chemotherapy, hormone therapy, or both) may be given.
• Clinical trials testing new anticancer drugs, new drug combinations, and new ways of giving treatment.

Stage IV and metastatic breast cancer

Treatment of stage IV or metastatic breast cancer may include the following:

• Hormone therapy and/or systemic chemotherapy with or without trastuzumab (Herceptin).
• Tyrosine kinase inhibitor therapy with lapatinib combined with capecitabine.
• Radiation therapy and/or surgery for relief of pain and other symptoms.
• Bisphosphonate drugs to reduce bone disease and pain when cancer has spread to the bone.
• Clinical trials testing new systemic chemotherapy and/or hormone therapy.
• Clinical trials of new combinations of trastuzumab (Herceptin) with anticancer drugs.
• Clinical trials of new combinations of lapatinib with anticancer drugs.
• Clinical trials testing other approaches, including high-dose chemotherapy with stem cell transplant.

Chemotherapy

Medical Oncologists may recommend chemotherapy (treatment using drugs) following surgery to kill cancer cells that may have spread outside the breast. The drugs are usually administered intravenously (into a vein). Chemotherapy may be recommended before surgery if the breast tumor is large, the lymph nodes are involved or the tumor is attached to the chest wall muscles or skin.

Chemotherapy may also be recommended in cases of inflammatory breast cancer.

Most patients receive chemotherapy after they have healed from the operation and before they receive radiation. We choose the chemotherapy drugs and sequence of treatment based on the details of each patient′s tumor characteristics.

Radiation Therapy

Radiation therapy involves the use of high-energy beams to kill cancer cells and shrink tumors. Patients who undergo radiation therapy, consult with a radiation oncologist before treatment begins. Radiation may be recommended if:

• Breast cancer treatment includes a Breast Conserving Surgery.
• The invasive tumor is more than 5 centimeters in size at the time of the mastectomy
• Many lymph nodes contain cancer cells
• Skin is involved

Hormone Therapy

The term hormone therapy refers to the use of drugs that either block estrogen from reaching cancer breast cells or reduce the amount of estrogen produced by the body to reduce the risk of cancer recurrence.

• Drugs such as tamoxifen or fulvestrant block estrogen from reaching breast cancer cells
• Aromatase inhibitors reduce the amount of estrogen produced by the body.

Hormone therapy is most effective for patients whose tumor cells express (produce) the estrogen receptor. Hormone therapy is not recommended for patients who have tumors that are estrogen negative. For premenopausal patients with tumors that are estrogen receptor or progesterone receptor positive (sensitive to hormones), medications or removal of the ovaries may also be recommended to prevent cancer recurrence.

Biological and Other Therapies

Dharamshila Hospital offers many targeted therapies, including lapatinib and trastuzumab or Herceptin therapy, which is often used to treat breast cancers that produce an abnormal amount of human epidermal growth factor receptor 2 (HER2neu). Targeted therapies offer the benefit of killing the specific target cells and hence, give better outcomes.