Treatment options are based on the type of breast cancer, its stage and grade, whether the cancer cells are sensitive to hormones, overall health and patient preferences. Most women undergo surgery for breast cancer and also receive additional treatment, such as chemotherapy, hormone therapy, biologic therapy or radiation. Patients who have no detectable cancer after surgery are often given additional treatment to help keep the cancer from coming back. This is known as adjuvant therapy. Both systemic therapy (like chemotherapy, hormone therapy, and targeted therapy) and radiation can be used as adjuvant therapy. Some patients are given treatment, such as chemotherapy or hormone therapy, before surgery. The goal of this treatment is to shrink the tumor in the hope it will allow a less extensive operation to be done. This is called neoadjuvant therapy. Many patients who get neoadjuvant therapy may not need adjuvant therapy.
In early stage breast cancer (Stage I and II) surgery (either a mastectomy or breast conservation consisting of lumpectomy and radiation) is the standard of care because the tumor is still contained in the breast and may be in nearby lymph nodes. Depending on the size of the tumor, histology, receptor status and lymph node involvement patients may then need adjuvant chemotherapy or radiation. In locally advanced breast cancer (Stage III) the cancer still hasn't spread far beyond the breast and nearby lymph nodes. However, in this stage there typically are many lymph nodes involved or the tumor is so large it extends to the chest wall or involves the skin of the breast. Surgery continues to play an important role and chemotherapy may be given before surgery to shrink the tumor and may also be given additionally after surgery. Radiation is usually always recommended after a lumpectomy in this stage and depending on the final histology of the tumor and nodes it may also be recommended after a mastectomy.
In stage IV breast cancer, the cancer has spread elsewhere in the body. Commonly affected areas may include the bones, brain, lungs, or liver. Because multiple areas may be involved, focused treatments like surgery or radiation alone may not be sufficient. Usually chemotherapy is the cornerstone of therapy for this stage of breast cancer and helps to slow down the growth of the cancer. So far, treatment of stage IV breast cancer does not provide a cure for the disease. By shrinking the cancer, treatment can slow down the disease, improve quality of life and help to improve overall survival. Although patients with stage IV breast cancer may live for years, it is usually life-threatening at some point in the disease process.