Stage 0 (DCIS)
Most women with ductal carcinoma in situ (DCIS), also known as non-invasive breast cancer, have breast-conserving surgery, also known as lumpectomy followed by radiation therapy. For some women over the age of 70 who have an early diagnosed breast cancer and the tumor is hormone receptor positive, they may be a candidate to forego radiation therapy. Though Stage 0 breast cancer is the very earliest that breast cancer can be diagnosed, there are situations in which there is a lot of DCIS within the breast tissue. In some situations, it may be necessary to have a mastectomy performed. Some women also may choose to have a mastectomy. Women with DCIS may receive Tamoxifen to reduce the risk of developing invasive breast cancer in the future.
Stages 1, 2, 3A, and Some 3C
Women with Stage 1, Stage 2, Stage 3A, or operable Stage 3C breast cancer may have a combination of treatments. (Operable means the cancer can be treated with surgery.)
Some may have breast-conserving surgery followed by radiation therapy to the breast. This choice is common for women with Stage I or II breast cancer. Some may 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 and/or the tumor was very close to the chest wall, the doctor usually will suggest radiation therapy after mastectomy.
The choice between breast-conserving surgery (followed by radiation therapy) and mastectomy depends on many factors:
The size of the tumor in relationship to the size of the breast
The location of the tumor within the breast
Whether multiple tumors are found within the breast (which requires mastectomy)
Whether the patient carries a breast cancer gene
Certain features of the cancer itself
How the woman feels about surgery changing her breast appearance
How the woman feels about radiation therapy
The woman's ability to travel to a radiation treatment center
The patient’s age
The patient’s health conditions
It is important to note that some women decide to do bilateral mastectomies for peace of mind. Although women without a known genetic cause for their breast cancer have a relatively low rate of developing breast cancer in the opposite healthy breast, still there is a trend currently for women to opt for bilateral mastectomies with immediate reconstruction.
Breast reconstruction is a covered benefit by health insurance companies and is required to be covered by a federal law passed in 1998 for women diagnosed with breast cancer. It is not considered cosmetic surgery but instead part of a woman’s treatment to restore her silhouette and psychological well being.
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 are advised to 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 3B and Some Stage 3C
Women with Stage 3B (including inflammatory breast cancer) or inoperable Stage 3C 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, known as an axillary node dissection. After a mastectomy, a woman may receive radiation therapy to the chest and underarm area.
Breast-conserving 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. This may be possible for someone with stage III breast cancer if they received neoadjuvant chemotherapy and the tumor was successfully shrunk to be smaller as a result. Women with inflammatory breast cancer are never a candidate for breast conserving surgery, even though chemotherapy is given first. This is because the breast cancer began within the underlying skin of the breast; therefore, all of that skin must be surgically removed.
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 4 and Recurrent
Women with Stage 4 breast cancer will be treated based on where the cancer returned. If the cancer returned in the chest area or within the breast tissue that remained after surgery, the doctor may suggest surgery, radiation therapy, chemotherapy, hormone therapy, or a combination.
Women with Stage 4 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 need supportive care along with anti-cancer treatments. Anti-cancer treatments are given to slow the progress of the disease, and whenever possible to control the cancer, treating it as a chronic illness. 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. Today more and more research is taking place regarding Stage 4 breast cancer, which is increasing the treatment options for patients diagnosed with metastatic breast cancer. It is not unusual, particularly for women whose tumors are estrogen receptor positive, to live a decade or more while maintaining quality of life.