Treatment Options for Breast Cancer

Learn about surgery and the other main treatments for breast cancer.

There are several treatment options for breast cancer. Often, more than one treatment is used. Here are brief definitions of the main treatments, followed by more-detailed information about each therapy.

  • Surgery is usually done to remove the cancer.
  • Radiation therapy is the use of high-dose x-rays to kill cancer cells or keep them from dividing and growing.
  • Chemotherapy is the use of anti-cancer medications to kill or stop the growth of cancer cells.
  • Hormonal therapy is the use of hormones that block the growth of cancer cells.
  • Biological therapy (targeted therapy or immunotherapy) uses the immune system to fight cancer

Surgery
Types of surgery that may be done for breast cancer include:

  • Lumpectomy. A surgeon removes the breast cancer, a little normal breast tissue around the lump, and some lymph nodes under the arm. The surgeon tries to totally remove the cancer while altering the breast as little as possible. Lumpectomy is usually followed by radiation therapy to destroy any remaining cancer cells.
  • Total mastectomy. The surgeon removes the entire breast. Some lymph nodes under the arm may also be taken out.
  • Partial mastectomy. This surgery saves as much of the breast as possible. Some breast tissue is removed, as well as the lining over the chest muscles below the tumor and usually some of the lymph nodes under the arm. Radiation therapy usually follows.
  • Modified radical mastectomy. The surgeon removes the breast, some of the lymph nodes under the arm, the lining over the chest muscles, and sometimes part of the chest wall muscles.
  • Radical mastectomy. The surgeon removes the breast, chest muscles, and all the lymph nodes under the arm. This was the standard operation for many years, but now it is used only rarely when the cancer is large or has spread to the chest muscles.
  • Sentinel node biopsy. The surgeon removes the lymph nodes close to the tumor to check whether the cancer is local or has spread (metastasized). If no cancer is found in these nodes, the surgeon may not need to take out any other lymph nodes.

Radiation therapy
High-energy x-rays are used to destroy cancer cells that might still be present in the breast tissue. Radiation therapy is often used after a lumpectomy or mastectomy, but it is usually delayed until the breast has time to heal.

Possible side effects include fatigue, breast swelling, and skin reactions, such as itching, redness, and peeling. Radiation to the breast does not cause hair loss, vomiting, or diarrhea.

Chemotherapy
Even when a lump is small, cancer cells may have broken off and spread outside the breast. Doctors can use chemotherapy to destroy them, using either a single drug or a combination of drugs.

Chemotherapy medications are often injected into the bloodstream through a needle in a vein, but sometimes they are given as a pill.

Possible side effects vary depending on the medication and dose, but may include hair loss, loss of appetite, mouth sores, nausea, vomiting, diarrhea, fatigue, and infections.

Hormonal therapy
Some tumors rely on hormones to grow, so any remaining cancer cells may continue to be stimulated by your hormones. Hormonal therapy can prevent your hormones from reaching any remaining cancer cells.

Tamoxifen is one of the most common drugs used for hormonal therapy. Estrogen stimulates the growth of some tumors. Tamoxifen keeps estrogen from binding to cancer cells. The benefits are generally considered to far outweigh the risks, but you should be aware that tamoxifen use can increase the risk of uterine cancer.

Possible side effects of hormonal therapy include hot flashes, fatigue, vaginal dryness or spotting, and mood problems.

Biological therapy
Antibodies are proteins made by the immune system that are directed against foreign and infectious agents, called antigens. Monoclonal antibodies are drugs that provide specific anti-tumor action within the human body. Trastuzumab (Herceptin) is a monoclonal antibody that is often used along with chemotherapy to treat HER2-positive breast cancer. About 1 in 4 women with breast cancer have this type.

Biological therapy is also called targeted therapy, or immunotherapy.

Possible side effects include fever, nausea, vomiting, weakness, and diarrhea. There is also a small risk of heart damage that could lead to heart failure.