Breast Cancer Treatment Options by Stage
Your treatment options depend on the stage of your disease and these factors:
- The size of the tumor in relation to the size of your breast
- The results of lab tests (such as whether the breast cancer cells need hormones to grow)
- Whether you have gone through menopause
- Your general health
Below are brief descriptions of common treatments for each stage. Other treatments may be appropriate for some women. Research studies (clinical trials) can be an option at all stages of breast cancer. See Taking Part in Cancer Research. Stage 0 (DCIS)
Most women with DCIS have breast-sparing surgery followed by radiation therapy. Some women instead choose to have a total mastectomy. Women with DCIS may receive tamoxifen to reduce the risk of developing invasive breast cancer. Stages I, II, IIIA, and some IIIC
Women with Stage I, II, IIIA, or operable IIIC breast cancer may have a combination of treatments. (Operable means the cancer can be treated with surgery.)
Some may have breast-sparing surgery followed by radiation therapy to the breast. This choice is common for women with Stage I or II breast cancer. Others decide to have a mastectomy.
With either approach, women (especially those with Stage II or IIIA breast cancer) often have lymph nodes under the arm removed.
Whether or not radiation therapy is used after mastectomy depends on the extent of the cancer. If cancer cells are found in 1 to 3 lymph nodes under the arm or if the tumor in the breast is large, the doctor sometimes suggests radiation therapy after mastectomy. If cancer cells are found in more than 3 lymph nodes under the arm, the doctor usually will suggest radiation therapy after mastectomy.
The choice between breast-sparing surgery (followed by radiation therapy) and mastectomy depends on many factors:
- The size, location, and stage of the tumor
- The size of the woman's breast
- Certain features of the cancer
- How the woman feels about how surgery will change her breast
- How the woman feels about radiation therapy
- The woman's ability to travel to a radiation treatment center
Some women have chemotherapy before surgery. This is called neoadjuvant therapy (treatment before the main treatment). Chemotherapy before surgery may shrink a large tumor so that breast-sparing surgery is possible. Women with large Stage II or IIIA breast tumors often choose this treatment.
After surgery, many women receive adjuvant therapy. Adjuvant therapy is treatment given after the main treatment to lower the chance of breast cancer returning. Radiation treatment is local therapy that can kill any remaining cancer cells in and near the breast. Women may also have hormone therapy, chemotherapy, targeted therapy, or a combination. These systemic therapies can destroy cancer cells that remain anywhere in the body. They can prevent or delay the cancer from coming back in the breast or elsewhere.
Stage IIIB and some Stage IIIC
Women with Stage IIIB (including inflammatory breast cancer) or inoperable Stage IIIC breast cancer have chemotherapy first, and then may be offered other treatments. (Inoperable means the cancer can't be treated with surgery without first shrinking the tumor.) They may also have targeted therapy.
If the chemotherapy or targeted therapy shrinks the tumor, then surgery may be possible:
- Mastectomy: The surgeon removes the breast. In most cases, the lymph nodes under the arm are removed. After surgery, a woman may receive radiation therapy to the chest and underarm area.
- Breast-sparing surgery: In rare cases, the surgeon removes the cancer but not the breast. The lymph nodes under the arm are usually removed. After surgery, a woman may receive radiation therapy to the breast and underarm area.
After surgery, the doctor will likely recommend chemotherapy, targeted therapy, hormone therapy, or a combination. This therapy may help prevent the disease from coming back in the breast or elsewhere. Stage IV and Recurrent
Women with recurrent breast cancer will be treated based on where the cancer returned. If the cancer returned in the chest area, the doctor may suggest surgery, radiation therapy, chemotherapy, hormone therapy, or a combination.
Women with Stage IV breast cancer or recurrent cancer that has spread to the bones, liver, or other areas usually have hormone therapy, chemotherapy, targeted therapy, or a combination. Radiation therapy may be used to control tumors in certain parts of the body. These treatments are not likely to cure the disease, but they may help a woman live longer.
Many women have supportive care along with anticancer treatments. Anticancer treatments are given to slow the progress of the disease. Supportive care helps manage pain, other symptoms of cancer, or the side effects of treatment (such as nausea). This care can help a woman feel better physically and emotionally. Supportive care does not aim to extend life. Some women with advanced cancer decide to have only supportive care.