Your Treatment Options
Many treatment options are available for breast cancer. The treatment you and your health care team choose for you depends on many things, such as:
- The stage of the cancer, which in most cases is the most important factor (See section 4)
- Your age
- Whether or not you are experiencing menopause
- Your general health
- The size of your breast
- The results of lab tests and tumor markers
- Your ability and agreement to receive radiation
Side effects are symptoms or problems you may have as a result of treatment (surgery or medications). Some side effects are common, others are rare. Many side effects can be treated to reduce their effect or managed so that you can continue to function normally. It is important to talk to your health care team about any side effects you are experiencing and to not stop medications or treatment because of side effects without consulting with your health care team. Side effects for each treatment type are listed below.
Most people with breast cancer today can choose between breast conservation surgery (also known as lumpectomy) and mastectomy. Breast conservation treatment is breast conservation surgery followed by radiation therapy. In most cases, breast conservation surgery and mastectomy are equally effective for people with early stage breast cancer (Stages I and II). However, there is no guarantee that the cancer will not return.
During a lumpectomy, a surgeon removes the tumor, a little normal breast tissue around the tumor, and some lymph nodes in the armpit. Radiation therapy is almost always given after a lumpectomy to decrease the risk of cancer coming back in the remaining breast tissue.
Possible side effects of lumpectomy
There may be a change in the shape of the breast or numbness in part of the breast. Infection, poor wound healing, bleeding, and a reaction to the drugs used in surgery (anesthesia) may occur after a lumpectomy.
A mastectomy is the surgical removal of the breast. There are different types of mastectomy, a total mastectomy (also know as simple mastectomy) and modified radical mastectomy. A mastectomy is most often recommended when:
- There are multiple areas of cancer within your breast
- The tumor is greater than 5 cm (2 inches)
- Your breast is small or shaped such that removal of the entire cancer will leave little breast tissue or a deformed breast
- You do not want or cannot have radiation therapy
Total Mastectomy is surgery that removes as much breast tissue as possible, the nipple, and some of the overlying skin of the breast. The lymph nodes in the armpit are NOT removed.
Modified Radical Mastectomy
Modified Radical Mastectomy is surgery that removes as much breast tissue as possible, the nipple, the tissue lining the muscles of the chest, and some lymph nodes in the armpit.
Modified Radical Mastectomy
Possible Side Effects of Mastectomy
Infection, poor wound healing, a reaction to the drugs used in surgery (anesthesia), and a collection of fluid or blood under the skin may occur after a mastectomy.
Removal of Lymph Nodes
Whether you have a lumpectomy or mastectomy, your surgeon will usually do a sentinel node biopsy to learn if cancer has spread to lymph nodes, without removing all of the lymph nodes. The sentinel node is the first lymph node to which cancer is likely to spread. When cancer spreads, the cancer cells may first appear in the sentinel node. If the sentinel node shows no cancer cells, then it is more than 97% likely that the other axillary nodes will also be cancer-free. If the sentinel node does show cancer cells, the surgeon will remove many more lymph nodes in the armpit axillary node dissection) to see how many other lymph nodes are involved.
Possible Side Effects of Lymph Node Removal
Numbness in the upper arm or armpit, or arm swelling called lymphedema may occur after lymph node removal. Lymphedema is the unhealthy buildup of fluid in your body that causes swelling. Careful management to avoid injury to the arm is often the best way to reduce the chance of lymphedema, but treatment is available for lymphedema. Other conditions may cause the same symptoms. A doctor should be consulted if any of the following problems occur:
- Swelling of an arm, which may include fingers
- A full or heavy feeling in an arm
- A tight feeling in the skin
- Trouble moving a joint in the arm
- Thickening of the skin, with or without skin changes such as blisters or warts
- A feeling of tightness when wearing clothing, shoes, bracelets, watches, or rings
- Trouble sleeping
- Loss of hair
Daily activities and the ability to work or enjoy hobbies may be affected by lymphedema. These symptoms may occur very slowly over time or more quickly if there is an infection or injury to the arm or leg.
For more information on lymphedema, visit: www.health.ny.gov/publications/0399/.
For more information about surgery for breast cancer, visit: www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-treating-surgery.
Systemic treatments are used to kill cancer cells throughout the body. They affect all of the cells in your body and not just the cancer cells in your breast. Systemic treatment can be given before (neoadjuvant therapy) or after (adjuvant therapy) surgery or radiation. Chemotherapy, hormonal therapy and targeted therapy are systemic treatments.
Chemotherapy is the use of drugs to kill cancer cells. Most often the drugs are injected into the bloodstream through an intravenous (IV) needle that is inserted into a vein. Other times, drugs may be given as pills. Chemotherapy is given in cycles. You get one treatment and are given a few weeks to rest before the next treatment. Most patients have chemotherapy in an outpatient clinic of the hospital, at the doctor's office, or at home. Rarely, patients need to stay in the hospital during treatment.
Each person reacts differently to chemotherapy. Some common side effects are:
- Being very tired (called fatigue)
- Loss of appetite
- Nausea and/or vomiting*
- Diarrhea or constipation
- Weight change
- Mouth and lip sores
- Short-term hair loss
- Lowered blood counts that can increase the risk of infections or bleeding
Other potential side effects associated with chemotherapy are changes in menstrual periods, bone thinning, tingling or numbness in hands and feet, changes in the color of the skin, and changes in concentration and memory (often called "chemobrain").
*The following suggestions may help with nausea or vomiting:
- Ask for drugs that reduce nausea and vomiting.
- Eat small meals often; do not eat 3 to 4 hours before your treatment.
- Eat popsicles, gelatin desserts, cream of wheat, oatmeal, baked potatoes, or fruit juices mixed with water.
- Chew your food thoroughly and relax during meals.
- Learn exercises to reduce stress.
Your body is less able to fight infections while you are on chemotherapy. The following steps can help you stay healthy while on chemotherapy:
- Avoid large crowds and people with colds and other contagious diseases.
- Bathe daily, wash your hands with soap or a hand sanitizer often, and gently brush your teeth after each meal.
- Wear gloves when you are gardening or doing other work that may expose your hands to dirt or sharp tools to protect hands against cuts.
- If you get a cut, keep the wound clean and covered.
- Eat a healthy diet and get plenty of rest.
For more information about chemotherapy, including a guide to cancer drugs, visit: www.cancer.org/docroot/ETO/ETO_1_5x_Guide_for_Patients_and_Families.asp.
Some breast cancers are sensitive to estrogen and progesterone, two hormones that are made by your body. Hormonal therapy keeps sensitive cancer cells from getting these hormones that the cancer needs to grow. This treatment uses drugs that may either block the hormones from reaching the cancer or reduce the level of hormones in the body. Occasionally, surgery to remove the ovaries which make estrogen and progesterone may be recommended. Tamoxifen is an example of a hormonal therapy.
Each person reacts differently to hormonal therapy. Some common side effects are:
- Hot flashes
- Vaginal discharge or irritation
- Weight gain
- Changes in menstruation
Other potential side effects associated with hormonal therapy include bone pain, diarrhea, decreased muscle mass and strength, and bone thinning.
For more information about hormonal therapy, visit: www.cancer.org/Cancer/BreastCancer/OverviewGuide/breast-cancer-overview-treating-hormone-therapy.
Targeted cancer therapies use drugs or other substances to specifically target changes in cells that cause cancer. These therapies only work against certain cell changes that may not happen in all people with breast cancer. Targeted therapies are generally less likely than chemotherapy to harm normal, healthy cells.
Each person reacts differently to targeted therapy. Some common side effects are:
- Rashes or swelling where the targeted therapy is injected
- Flu-like symptoms
- Diarrhea or vomiting
- High blood pressure
For more information about targeted therapy, visit: www.cancer.org/Cancer/BreastCancer/OverviewGuide/breast-cancer-overview-treating-targated-therapy.
Radiation therapy (also called radiotherapy) uses high-energy rays to kill cancer cells. Radiation may be given before or after surgery. Most patients receive external radiation, in which a machine delivers radiation to the part of the body affected by cancer. Radiation can also come from radioactive material placed directly in the breast. Some people may have both kinds of radiation. The amount of radiation therapy and how often you get it depends on the size of your tumor, the type of surgery that you have had, the type of radiation that you receive, and your and your health care team's preference.
Each person reacts differently to radiation therapy. Some common side effects are:
- Swelling and heaviness in the breast
- Sunburn-like skin changes in the treated area
Less common side effects of radiation therapy include armpit discomfort, chest pain, feeling as though your heart is racing, dry cough, and shortness of breath.
For more information about radiation therapy, visit: www.cancer.org/Treatment/TreatmentsandSideEffects/PhysicalSideEffects/DealingwithSymptomsatHome/caring-for-the-patient-with-cancer-at-home-radiation-therapy