Breast Cancer Treatment, Part 2

by National Cancer Institute

(Page 4 of 4)

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. The presence of 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 examination 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.

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 (the first lymph node the cancer is likely to spread to from the tumor) during surgery. 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 for biopsy. 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).

High-dose chemotherapy with stem cell transplant

High-dose chemotherapy with stem cell transplant is a method 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:

• Breast-conserving surgery with or without radiation therapy or hormone therapy.
• Total mastectomy with or without hormone therapy.
• Clinical trials testing breast-conserving surgery and hormone therapy with or without radiation therapy.

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:

• Biopsy to diagnose the LCIS followed by regular examinations and regular mammograms to find any changes as early as possible. This is referred to as 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. Most surgeons believe that this is a more aggressive treatment than is needed.

• Clinical trials testing cancer prevention drugs.

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:

• 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.

• A clinical trial evaluating 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.

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:

• 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.

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:

• Hormone therapy and/or systemic chemotherapy with or without trastuzumab (Herceptin).

• Radiation therapy and/or surgery for relief of pain and other symptoms.

• Clinical trials testing new systemic chemotherapy and/or hormone therapy.

• Clinical trials of new combinations of trastuzumab (Herceptin) with anticancer drugs.

• Clinical trials testing other approaches, including high-dose chemotherapy with stem cell transplant.

• Bisphosphonate drugs to reduce bone disease and pain when cancer has spread to the bone.

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:

• Surgery (radical or modified radical mastectomy), radiation therapy, or both.
• Systemic chemotherapy or hormone therapy.
• A clinical trial of trastuzumab (Herceptin) combined with systemic chemotherapy.

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