After you have finished the course of chemotherapy, your ovaries should start producing oestrogen again. But this doesn't always happen and you may enter an early menopause. This is more likely in women over 40, as they're closer to menopausal age. If your breast cancer has spread beyond the breast and lymph nodes to other parts of your body, chemotherapy won't cure the cancer, but it may shrink the tumour, relieve your symptoms and help lengthen your life. Some breast cancers are stimulated to grow by the hormones oestrogen or progesterone, which are found naturally in your body.
These types of cancer are known as hormone receptor-positive cancers. Hormone therapy works by lowering the levels of hormones in your body or by stopping their effects. You'll probably have hormone therapy after surgery and chemotherapy, but it's sometimes given before surgery to shrink a tumour, making it easier to remove. Hormone therapy may be used as the only treatment for breast cancer if your general health prevents you having surgery, chemotherapy or radiotherapy.
Tamoxifen stops oestrogen from binding to oestrogen-receptor-positive cancer cells. It's taken every day as a tablet or liquid. This type of medication works by blocking aromatase, a substance that helps produce oestrogen in the body after the menopause. Before the menopause, oestrogen is made by the ovaries. Three aromatase inhibitors may be offered.
These are taken as a tablet once a day. Ablation can be carried out using surgery or radiotherapy. Ovarian suppression involves using a medication called goserelin, which is a luteinising hormone-releasing hormone agonist LHRHa.
Your periods will stop while you're taking it, although they should start again once your treatment is complete. Goserelin is taken as an injection once a month and can cause menopausal side effects, including:. Some breast cancers are stimulated to grow by a protein called human epidermal growth factor receptor 2 HER2. These cancers are called HER2-positive. Biological therapy works by stopping the effects of HER2 and helping your immune system to fight off cancer cells. If you have high levels of the HER2 protein and are able to have biological therapy, you'll probably be prescribed a medicine called trastuzumab.
Antibodies occur naturally in your body and are made by your immune system to destroy harmful cells, such as viruses and bacteria. Trastuzumab is usually given intravenously, through a drip. It's also sometimes available as an injection under the skin a subcutaneous injection. You'll have the treatment in hospital. Each treatment session takes up to 1 hour, and the number of sessions you need will depend on whether you have early or more advanced breast cancer. On average, you'll need a session once every 3 weeks for early breast cancer, and weekly sessions if your cancer is more advanced.
Trastuzumab can cause side effects, including heart problems. If you have been through the menopause, you may be offered bisphosphonates zoledronic acid or sodium clodronate. Recent research has shown they may help to reduce the risk of breast cancer spreading to your bones and elsewhere in your body. Bisphosphonates will probably be given to you at the same time as chemotherapy, either directly into a vein or as tablets. Dealing with cancer can be a huge challenge for both patients and their families.
It can cause emotional and practical difficulties. Many women have to cope with the removal of part or all of a breast, which can be very upsetting.
It often helps to talk about your feelings or other difficulties with a trained counsellor or therapist. You can ask for this kind of help at any stage of your illness. There are various ways to find help and support. Your hospital doctor, specialist nurse or GP can refer you to a counsellor. However, women who have undesirable side effects while taking an AI may have fewer side effects with a different AI for unclear reasons. Women who have not gone through menopause and who are not getting shots to stop the ovaries from working see below should not take AIs, as they do not block the effects of estrogen made by the ovaries.
Often, doctors will monitor blood estrogen levels in women whose menstrual cycles have recently stopped, or those whose periods stop with chemotherapy, to be sure that the ovaries are no longer producing estrogen. Ovarian suppression or ablation. Ovarian suppression is the use of drugs to stop the ovaries from producing estrogen. Ovarian ablation is the use of surgery to remove the ovaries.
These options may be used in addition to another type of hormonal therapy for women who have not been through menopause. For ovarian suppression, gonadotropin or luteinizing releasing hormone GnRH or LHRH drugs are used to stop the ovaries from making estrogen, causing temporary menopause. Goserelin Zoladex and leuprolide Eligard, Lupron are types of these drugs. They are given by injection every 1 to 3 months and stop the ovaries from making estrogen.
The effects of GnRH drugs go away if treatment is stopped. For ovarian ablation, surgery to remove the ovaries is used to stop estrogen production. While this is permanent, it can be a good option for women who are done having children, especially since the cost is typically lower over the long term.
Tamoxifen for 5 years, followed by an AI for up to 5 years. This would be a total of 10 years of hormonal therapy. Tamoxifen for 2 to 3 years, followed by 2 to 8 years of an AI for a total of 5 to 10 years of hormonal therapy. In general, women with stage I cancer should expect to take hormonal therapy for 5 years. As noted above, premenopausal women should not take only AIs, as they will not work.
Options for adjuvant hormonal therapy for premenopausal women include the following:. Tamoxifen for 5 years. Then, treatment is based on whether or not they have gone through menopause in those 5 years. If a woman has not gone through menopause after the first 5 years of treatment, she can continue tamoxifen for another 5 years, for a total of 10 years of tamoxifen. If a woman goes through menopause during the first 5 years of treatment, she can continue tamoxifen for an additional 5 years or switch to an AI for 5 more years.
Only women who are clearly postmenopausal should consider taking an AI. For women with stage I or stage II cancer with a higher risk of recurrence who may consider also having chemotherapy. For women who cannot take tamoxifen for other health reasons, such as having a history of blood clots. Ovarian suppression is not recommended in addition to another type of hormonal therapy in the following situations:.
This information is based on ASCO recommendations for adjuvant endocrine therapy for women with hormone receptor-positive breast cancer. Please note this link takes you to another ASCO website. These treatments are very focused and work differently than chemotherapy. This type of treatment blocks the growth and spread of cancer cells while limiting damage to healthy cells.
Not all tumors have the same targets. To find the most effective treatment, your doctor may run tests to identify the genes, proteins, and other factors in your tumor. In addition, research studies continue to find out more about specific molecular targets and new treatments directed at them.
Learn more about the basics of targeted treatments. The first approved targeted therapies for breast cancer were hormonal therapies. Talk with your doctor about possible side effects of specific medications and how they can be managed. Bone modifying drugs block bone destruction and help strengthen bone. They may be used to prevent cancer from recurring in the bone or to treat cancer that has spread to the bone. Certain types are also used in low doses to prevent and treat osteoporosis. Osteoporosis is the thinning of the bones.
For people with breast cancer that has not spread, receiving bisphosphonates after breast cancer treatment may help to prevent a recurrence. ASCO recommends zoledronic acid Reclast, Zometa or clodronate multiple brand names as options to help prevent a bone recurrence for women who have been through menopause. Clodronate is only available outside of the United States. Please note that this link takes you to a separate ASCO website. You may have other targeted therapy options for breast cancer treatment, depending on several factors. Many of the following drugs are used for advanced or metastatic breast cancer.
Immunotherapy, also called biologic therapy, is designed to boost the body's natural defenses to fight the cancer. It uses materials made either by the body or in a laboratory to improve, target, or restore immune system function. Different types of immunotherapy can cause different side effects. Common side effects include skin reactions, flu-like symptoms, diarrhea, and weight changes. Talk with your doctor about possible side effects for the immunotherapy recommended for you. Learn more about the basics of immunotherapy. Age should never be the only factor used to determine treatment options.
Systemic treatments, such as chemotherapy, often work as well for older patients as younger patients. However, older patients may be more likely to have side effects that impact their quality of life. For example, older patients may have a higher risk of developing heart problems from trastuzumab.
This is more common for patients who already have heart disease and for those who receive certain combinations of chemotherapy. They should also ask about potential side effects and how they can be managed. Cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer. Palliative care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs.
Any person, regardless of age or type and stage of cancer, may receive this type of care.
And it often works best when it is started right after a cancer diagnosis. People who receive palliative care along with treatment for the cancer often have less severe symptoms, better quality of life, and report they are more satisfied with treatment. Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments similar to those meant to get rid of the cancer, such as chemotherapy, surgery, or radiation therapy.
Research has shown that some integrative or complementary therapies may be helpful to manage symptoms and side effects. ASCO agrees with recommendations from the Society for Integrative Oncology on several complementary options to help manage side effects during and after breast cancer treatment. These include:.
Meditation, relaxation, yoga, massage, and music therapy for depression and to improve other mood problems. Learn more about recommendations on integrative therapy for managing the side effects of breast cancer and its treatment on a different ASCO website. People may have concerns about if or how their treatment may affect their sexual health and their ability to have children in the future.
People are encouraged to talk with the health care team about these topics prior to starting treatment. Before treatment begins, talk with your doctor about the goals of each treatment in the treatment plan. You should also talk about the possible side effects of the specific treatment plan and palliative care options. During treatment, your health care team may ask you to answer questions about your symptoms and side effects and to describe each problem. Be sure to tell the health care team if you are experiencing a problem.
This helps the health care team treat any symptoms and side effects as quickly as possible. It can also help prevent more serious problems in the future. Learn more about the importance of tracking side effects in another part of this guide. Learn more about palliative care in a separate section of this website. If the cancer returns after treatment for early-stage disease, it is called recurrent cancer. When breast cancer recurs, it may come back in the following parts of the body:.
Back to top. How 'exergaming' can help people with Parkinson's. If the sentinel lymph node is cancer-free, research has shown that it is likely that the remaining lymph nodes will also be free of cancer. For women who have a high risk of cancer recurrence. Saline implants sometimes "ripple" at the top or shift with time, but many women do not find it bothersome enough to replace. A chemotherapy regimen, or schedule, usually consists of a combination of drugs given in a specific number of cycles over a set period of time. It's possible for your doctor to prescribe a medication outside the uses it's licensed for if they're willing to take personal responsibility for this "off-licence" use of treatment.
The chest wall or lymph nodes under the arm or in the chest. This is called a regional recurrence. Another place, including distant organs such as the bones, lungs, liver, and brain. This is called a distant recurrence or a metastatic recurrence. For more information on a metastatic recurrence, see the Guide to Metastatic Breast Cancer. When breast cancer recurs, a new cycle of testing will begin again to learn as much as possible about the recurrence. Testing may include imaging tests, such as those discussed in the Diagnosis section. In addition, another biopsy may be needed to confirm the breast cancer recurrence and learn about the features of the cancer.
After this testing is done, you and your doctor will talk about the treatment options. The treatment plan may include the treatments described above such as surgery, radiation therapy, chemotherapy, targeted therapy, and hormonal therapy. They may be used in a different combination or given at a different pace. The treatment options for recurrent breast cancer depend on the following factors:. People with recurrent breast cancer often experience emotions such as disbelief or fear. You are encouraged to talk with the health care team about these feelings and ask about support services to help you cope.
Learn more about dealing with cancer recurrence.
A local or regional recurrence is often manageable and may be curable. The treatment options are explained below:. Whichever treatment plan you choose, palliative care will be important for relieving symptoms and side effects. Your doctor may suggest clinical trials that are studying new ways to treat this type of recurrent cancer.
The next section in this guide is About Clinical Trials. It offers more information about research studies that are focused on finding better ways to care for people with cancer. Use the menu to choose a different section to read in this guide. There may be several benefits to having other treatments before surgery: Women who may have needed a mastectomy could have breast-conserving surgery lumpectomy if the tumor shrinks before surgery. Surgery may be easier to perform because the tumor is smaller.
Your doctor may find out if certain treatments work well for the cancer. You may also be able to try a new treatment through a clinical trial. Learn more about making treatment decisions. Surgery Surgery is the removal of the tumor and some surrounding healthy tissue during an operation. The types of surgery include the following: Lumpectomy. This is the removal of the tumor and a small, cancer-free margin of healthy tissue around the tumor.
Most of the breast remains. For invasive cancer, radiation therapy to the remaining breast tissue is generally recommended after surgery. For DCIS, radiation therapy after surgery may be an option depending on the patient and the tumor. A lumpectomy may also be called breast-conserving surgery, a partial mastectomy, quadrantectomy, or a segmental mastectomy.
This is the surgical removal of the entire breast. There are several types of mastectomies. Talk with your doctor about whether the skin can be preserved, called a skin-sparing mastectomy, or the nipple, called a nipple-sparing mastectomy. Lymph node removal and analysis Cancer cells can be found in the axillary lymph nodes in some cancers. Sentinel lymph node biopsy. In a sentinel lymph node biopsy, the surgeon finds and removes a small number of lymph nodes from under the arm that receive lymph drainage from the breast.
This procedure helps avoid removing multiple lymph nodes with an axillary lymph node dissection see below for patients whose sentinel lymph nodes are mostly free of cancer. The smaller lymph node procedure helps lower the risk of several possible side effects. The pathologist then examines these lymph nodes for cancer cells. The injection, which can cause some discomfort, lasts about 15 seconds.
The dye or tracer travels to the lymph nodes, arriving at the sentinel node first. If dye is used, the surgeon can find the lymph node when it turns color. If a radioactive tracer is used, it will give off radiation which helps the surgeon find the lymph node. If the sentinel lymph node is cancer-free, research has shown that it is likely that the remaining lymph nodes will also be free of cancer. This means that no more lymph nodes need to be removed. If only 1 or 2 sentinel lymph nodes have cancer and you plan to have a lumpectomy and radiation therapy to the entire breast, an axillary lymph node dissection may not be needed.
Find out more about ASCO's recommendations for sentinel lymph node biopsy. Axillary lymph node dissection. In an axillary lymph node dissection, the surgeon removes many lymph nodes from under the arm. These are then examined for cancer cells by a pathologist. The actual number of lymph nodes removed varies from person to person. An axillary lymph node dissection may not be needed for all women with early-stage breast cancer with small amounts of cancer in the sentinel lymph nodes. Women having a lumpectomy and radiation therapy who have a smaller tumor and no more than 2 sentinel lymph nodes with cancer may avoid a full axillary lymph node dissection.
This helps reduce the risk of side effects and does not decrease survival. If cancer is found in the sentinel lymph node, whether more surgery is needed to remove more lymph nodes depends on the specific situation. Reconstructive plastic surgery Women who have a mastectomy may want to consider breast reconstruction. The techniques discussed below are typically used to shape a new breast.
Other important factors to consider when choosing implants include: Saline implants sometimes "ripple" at the top or shift with time, but many women do not find it bothersome enough to replace. This method, which can be done as a pedicle flap or free flap, uses muscle and tissue from the lower stomach wall.
Latissimus dorsi flap. This pedicle flap method uses muscle and tissue from the upper back. Deep inferior epigastric artery perforator DIEP flap. The DIEP free flap takes tissue from the abdomen and the surgeon attaches the blood vessels to the chest wall. Gluteal free flap. The gluteal free flap uses tissue and muscle from the buttocks to create the breast, and the surgeon also attaches the blood vessels.
External breast forms prostheses An external breast prosthesis or artificial breast form provides an option for women who plan to delay or not have reconstructive surgery. Summary of surgical options To summarize, surgical treatment options include the following: Removal of cancer in the breast: Lumpectomy or partial mastectomy, generally followed by radiation therapy if the cancer is invasive. Radiation therapy may or may not be used if it is DCIS.
A mastectomy may also be recommended, with or without immediate reconstruction. Radiation therapy Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. There are several different types of radiation therapy: External-beam radiation therapy. Radiation therapy may be given after or before surgery: Adjuvant radiation therapy is given after surgery. Most commonly, it is given after a lumpectomy, and sometimes, chemotherapy. Patients who have a mastectomy may not need radiation therapy, depending on the features of the tumor. The medical oncologists in the Breast Cancer Program have an in-depth understanding of current options in chemotherapy, hormonal therapy and advanced biological drugs.
Some women who receive treatment for breast cancer develop lymphedema, a swelling of the arm or hand caused by the accumulation of lymphatic fluid. Skip to main content. Breadcrumb Home Breast Cancer Treatments. Breast Cancer Treatment. Cancer Services. Tumor Boards Develop Individualized Treatment Our weekly "tumor board" meetings include surgeons, medical oncologists, radiation oncologists, pathologists, plastic and reconstructive surgeons and radiologists. Treatment Process Patients are given a tumor stage based on physical examination, radiology studies, and surgery results.
Radiation Oncology Radiation therapy plays a key role in helping many women with breast cancer preserve their breasts. The Breast Cancer Program includes radiation oncologists who focus their practice on treating breast disease. They are national leaders in developing new methods of delivering therapeutic radiation and shortening treatment courses.