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Breast Cancer Treatment Choices

Stage I and stage II early stages of breast cancer in which the cancer has spread beyond the lobe or duct and invaded nearby tissue . Stage I means that the tumor is no more than about an inch across and cancer cells have not spread beyond the breast. Stage II means one of the following: the tumor in the breast is less than 1 inch across and the cancer has spread to the lymph nodes under the arm; or the tumor is between 1 and 2 inches (with or without spread to the lymph nodes under the arm); or the tumor is larger than 2 inches but has not spread to the lymph nodes under the arm.

Women with early stage breast cancer may have breast-sparing surgery followed by radiation therapy to the breast, or they may have a mastectomy, with or without breast reconstruction to rebuild the breast. These approaches are equally effective in the early stage treatment of breast cancer. (Sometimes radiation therapy is also given after mastectomy.)

The choice of breast-sparing surgery or mastectomy depends mostly on the size and location of the tumor , the size of the woman's breast, certain features of the cancer, and how the woman feels about preserving her breast. With either approach, lymph nodes under the arm usually are removed.

Following first surgery or surgery and radiation therapy, many women with stage I breast cancer and the majority of those with stage II breast cancer receive chemotherapy and/or hormonal therapy. Adjuvant therapy is the name given to this extra breast cancer treatment. Neoadjuvant therapy is used when systemic therapy is administered to the tumor prior to surgery. The goal of systemic treatment is to eradicate any cancer cells that may still exist and stop the disease from returning in the breast or elsewhere.

Stage III is also called locally advanced cancer. In this stage, the tumor in the breast is large (more than 2 inches across) and the cancer has spread to the underarm lymph nodes; or the cancer is widespread in the lymph nodes beneath the arms; or the cancer has migrated to tissues close to the breast or to lymph nodes around the breastbone.

Inflammatory breast cancer is a type of locally advanced breast cancer. In this type of cancer the breast looks red and swollen (or inflamed) because cancer cells block the lymph vessels in the skin of the breast.

Patients with stage III breast cancer typically get systemic treatment to halt the spread of the disease in addition to local treatment to remove or eliminate the breast cancer. Surgery and/or radiation therapy to the breast and underarm may be used as local breast cancer treatments. Chemotherapy, hormonal therapy, or a combination of the two may be used as systemic treatment. Before or after local therapy, systemic treatment may be used to reduce the tumor or to stop the cancer from returning in the breast or elsewhere.

Cancer with metastases is stage IV. Other body parts have been affected by the disease, in addition to the breast and underarm lymph nodes.

Chemotherapy and/or hormonal therapy are given to women with stage IV breast cancer to kill cancer cells and regulate the condition. To manage the breast cancer, they might have surgery or radiation treatment. Other body malignancies may benefit from radiation treatment in terms of tumor management.

Recurrent cancer means the disease has come back in spite of the initial treatment. Even when a tumor in the breast seems to have been completely removed or destroyed, the disease sometimes returns because undetected cancer cells remained somewhere in the body after treatment.

Most recurrences appear within the first 2 or 3 years after treatment, but breast cancer can recur many years later.

A local recurrence of cancer is one that solely affects the surgical site. Breast cancer that has spread to other parts of the body is referred to as metastatic breast breast cancer. For recurring cancer, the patient may receive a single form of treatment or a mix of treatments.