Treatment of Breast Cancer depends on the stage means how much cancer cells spread in the organs of the body. Based on their seriousness about spread cancer cells in the body, the stage described by doctors upon diagnosis limits. As the doctors categorize stages 0 through 4, its treatment also varies with the stages of breast cancer. In this article, we will discuss the treatment of Breast cancer according to the stages.
Treatment of Stage 0 (Non-invasive) Breast Cancer
There are two types of non-invasive type of breast cancer. First is Ductal Carcinoma in Situ (DCIS) and the second type is Lobular Carcinoma in Situ (LCIS). As the treatment varies with the type of cancer, we will discuss the treatment of each type separately.
What is the Treatment of Ductal Carcinoma in Situ (DCIS)?
Women having breast cancer type DCIS, can choose Breast-conserving Therapy and Simple Mastectomy. Lymph node removal (Axillary Dissection) usually not needed on this stage. Moreover, lumpectomy without radiation therapy is an option only for women in whom a small area of low-grade DCIS. Most women require radiation therapy who have a lumpectomy.
Mastectomy becomes necessary if the area of DCIS is very large or DCIS cannot be completely removed by lumpectomy. If DCIS is estrogen receptor-positive, treatment with tamoxifen for 5 years after surgery can lower the risk that another DCIS or Invasive cancer (High stage cancer) will develop in another breast. The patient should discuss the advantages and disadvantages of this option with their doctors.
What is the Treatment of Lobular Carcinoma in Situ (LCIS)?
No immediate or active treatment is recommended for most women with lobular carcinoma in situ (LCIS), as this condition is not considered true cancer. However, having LCIS increases the risk that invasive cancer will develop later, so close follow- up is very important. This follow- up usually includes yearly mammograms and clinical breast examinations.
Women with LCIS may also want to talk with their doctors about the benefits and limits of being screened yearly with magnetic resonance imaging (MRI) in addition to mammograms. Close monitoring of both breasts is important because women with LCIS in one breast have the same increased risk for cancer to develop in either breast.
Treatment of Invasive Breast Cancer by Stage
In the early stage of an invasive type of cancer, breast-conserving surgery is recommended if the tumor size is size. Although, a mastectomy is also an option of the treatment of small size tumor cells. In case of large size of the tumor, breast-conserving surgery is the option, if and only if neo-adjuvant chemotherapy shrinks the tumor size small enough to allow the surgery. hence, in either case, there is an utter need to check lymph nodes. If nodes contain cancerous cells, they have to remove it. Radiotherapy also needs in breast-conserving surgery. In the case of tumor size larger than half of an inch (1cm), Adjuvant systematic therapy is typically recommended.
Breast Cancer Treatment of Stage 1
Stage 1 cancers are still relatively small and have not spread to the lymph nodes or any other organs of the body. Following the recommended treatment are as follows:
Local Therapy:
Stage 1 cancers can also be treated with breast-conserving surgery like lumpectomy or partial mastectomy. The lymph must have to be evaluated with axillary lymph node dissection. After a mastectomy, breast reconstruction surgery can be one at the same time of surgery or later. It is highly recommended to give radiation therapy to kill microscopic cancerous cells. Although, studies from the treated cancer cases show that, not undergoing radiation therapy increases the chance of recurrence.
Adjuvant Systematic Therapy:
Mostly, adjuvant hormone therapies us being discussed by the specialist with all women who have hormone receptor-positive breast cancer, no matter the size of the tumor. Women having tumor size about 0.5cm, likely to be more beneficial with hormone therapy.
Adjuvant chemotherapy is usually not offered by a specialist having a tumor size of less than 1cm. But in an unfavorable feature like high grade, hormone receptor-negative, HER2 positive or a high score on one of the gene pattern tests, Adjuvant therapy is recommended.
Breast Cancer Treatment of Stage 2
Stage II cancers are larger and/or have spread to a few nearby lymph nodes.
Local Therapy:
Surgery and radiation therapy options for stage II cancers are similar to those for stage I tumors. For stage II cancers, however, radiation therapy may be considered after mastectomy if the tumor is larger than 5 cm or if the cancer cells are found in several lymph nodes.
Adjuvant Systematic Therapy:
Adjuvant systemic therapy is recommended for women with stage II breast cancer. It may involve hormone therapy, chemotherapy, trastuzumab, or some combination of these therapies, depending on the woman’s age, whether the cancer is ER– or PR–positive, and cancer’s HER2/neu status.
Neo-Adjuvant Therapy:
Women who would like to have breast-conserving therapy for tumors larger than 2 cm in width) is to have neoadjuvant (presurgical) chemotherapy, hormone therapy, and/or trastuzumab to shrink the tumor. If the neoadjuvant treatment shrinks the tumor enough, the woman may be able to have breast-conserving surgery (such as a lumpectomy) followed by radiation therapy and/or hormone therapy (if the tumor is hormone-receptor-positive). Further chemotherapy may also be considered. If the neoadjuvant therapy does not cause the tumor to shrink enough for breast-conserving surgery to be an option, a mastectomy may be required. This mastectomy may be followed by a different type of chemotherapy.
Hormone therapy may be given if the tumor is hormone receptor-positive. Hormone therapy can be given both before and after surgery.
Stage 3 Breast Cancer Treatment
Cancer may be removed by breast-conserving surgery (such as a lumpectomy) with follow- up radiation therapy, or it may be removed by modified radical mastectomy (with or without breast reconstruction). Sentinel lymph node biopsy or axillary lymph node dissection is also done. Radiation therapy may be used after mastectomy if the tumor is larger than 5 cm or if cancer has spread to several lymph nodes.
Neoadjuvant therapy may be an option for women who would like to have breast-conserving surgery. Surgery is usually followed by adjuvant chemotherapy, hormone therapy, and/or trastuzumab. Adjuvant chemotherapy may also be given, and adjuvant hormone therapy is offered to all women with hormone receptor-positive breast cancers.
Treatment of Stage 4 Breast Cancer
Stage IV cancers have spread beyond the breast and lymph nodes to other parts of the body. Although surgery and/or radiation may be useful in some situations, they are very unlikely to cure these cancers. Therefore, systemic therapy is the main treatment. Depending on many factors, this treatment may include hormone therapy, chemotherapy, targeted therapies such as trastuzumab or bevacizumab, or some combination of these treatments.
Trastuzumab may extend life for women with stage IV HER2- positive cancer if it is given with the first chemotherapy dose. It is not known whether giving trastuzumab at the same time as hormone therapy has this same benefit or for how long a woman should remain on trastuzumab.