Breast cancer is the most common cancer in women, but it can also occur in men. In 2009, the National Cancer Institute reported 192,370 cases of breast cancer in women and 1,910 cases in men. The treatment for breast cancer depends on the stage of the disease at diagnosis, from Stage 0 to Stage IV. The stage is assigned by doctors based on size of the tumor, whether the tumor has spread to nearby lymph nodes or adjacent tissues, and whether there is spread to other areas of the body. Radiology and laboratory tests also influence treatment decisions. The individual's menopause status and general health also affect choice of therapy. The National Comprehensive Cancer Network, an alliance of 21 of the world's leading cancer centers, writes clinical practice guidelines that are universally accepted worldwide and describes treatment options as surgery, chemotherapy, radiation therapy, hormone therapy and targeted therapy.
Observation
In cases of lobular carcinoma in situ, Stage 0, observation may be recommended as the first line of treatment, according to the NCCN Breast Cancer Treatment Guidelines. Depending on menopausal stage, drugs may be used to block hormones. Removal of the breasts, or bilateral mastectomy, with reconstruction may be used in special circumstances.
Breast-conserving Surgery
Breast-conserving surgery is commonly called lumpectomy. This means that the breast cancer is removed without removing the entire breast. It may also be called a segmental or partial mastectomy. If an excisional biopsy--removal of the tumor to determine if it is cancer--is done and the surgeon removes the entire lump, no more breast surgery may be needed. Testing and removal of the lymph nodes under the arm for cancer cells is necessary, often called sentinel lymph node biopsy.
Mastectomy
Mastectomy is the removal of the breast that contains the tumor. The surgeon removes the entire breast and some underarm lymph nodes during a total, or simple, mastectomy. If most or all of the lymph nodes in the underarm area and lymph nodes in the chest muscle are removed along with the whole breast, the procedure is called a modified radical mastectomy.
Reconstruction
If the breast or a large portion of the breast is removed, reconstruction of the breast by a plastic surgeon may be done. Reconstruction rebuilds the area where breast tissue is removed using the patient's muscle, fat or skin or an implant. While not a treatment for breast cancer, reconstruction or preparation for reconstruction may need to be done in conjunction with the initial removal of the breast tumor, according to the American Society of Plastic Surgeons.
Radiation Therapy
Radiation therapy is used to kill any remaining cells that were not removed during surgery. Using a large machine, high energy rays are directed at breast area after careful treatment planning. The patient usually receives treatments five days a week for up to six weeks. This external beam radiation therapy affects only the treated areas. Internal radiation therapy, often called brachytherapy, may also be an option for some women. Thin catheters are placed in the breast, radioactive material is passed through the catheter for a few minutes, and then the radiation source is removed. Brachytherapy is usually given for five days for breast cancer patients.
Hormone Therapy
Hormone therapy, sometimes called anti-hormone therapy, is used if laboratory tests show that a tumor has receptors--areas on the cell that attract substances needed for cell growth--that can be blocked with hormones. Drugs may be used to interrupt the cells' ability to use natural hormones, such as estrogen and progesterone for growth.
Chemotherapy
Chemotherapy is used before surgery or after surgery. Pre-surgery chemotherapy is used to shrink large tumors or in cases of inflammatory breast cancer. It may allow a woman to have breast-conserving surgery rather than having to have the entire breast removed. Post-surgery chemotherapy is a systemic treatment, given through the blood stream or by pill, to kill any remaining cancer cells not removed by surgery. Chemotherapy as part of the treatment plan decreases the chance that the cancer will come back, according to the National Cancer Institute.
Targeted Therapy
Targeted therapy uses agents such as monoclonal antibodies that block the growth of breast cancer cells by interfering with proteins or other factors on the cell surface. These therapies are based on gene changes in the cells with drugs specifically developed for a particular target on a cell. Targeted therapies are usually used with chemotherapy.
