Breast Cancer

Breast Cancer Diagnosis and Treatment

The Saint Francis/Mount Sinai Regional Cancer Center works closely with the Hoffman Breast Health Center to provide breast cancer treatment targeting the best possible outcomes. Learn more... 

Your particular breast cancer treatment will depend on:

  • The stage of your cancer (whether it's confined to the breast or has spread to other places in your body)
  • The type of breast cancer you have
  • Characteristics of the cancer cells
  • Your menopausal status
  • The general state of your health

Stages of Breast Cancer 

Once a breast cancer diagnosis has been determined, more tests will be performed to learn whether the cancer has spread to other parts of the body. This is called staging. Your doctor needs to assess the stage of your disease in order to plan treatment. The following stages are used for breast cancer:

Breast cancer in situ (Stage 0)  

About 30 percent of breast cancers are identified very early. They are sometimes called
carcinoma in situ. There are two types of breast cancer in situ: ductal carcinoma in situ (also known as intraductal carcinoma), and lobular carcinoma in situ. Lobular carcinoma in situ is not cancer, but is a marker for patients at higher risk for developing breast cancer. For classification purposes it is also called breast cancer in situ, carcinoma in situ or stage 0 breast cancer.  

Stage I  

The cancer is no larger than 2 centimeters (a bit less than 1 inch) and has not spread outside the breast, or the cancer is no larger than 2 centimeters and there is lymph node involvement, with cells measuring less than 2 millimeters (micrometastasis).

Stage II  

 Stage II is divided into stages IIA and IIB.

Stage IIA is defined by one of the following:

  • The cancer is no bigger than 2 centimeters and has spread to the lymph nodes under the arm (the axillary lymph nodes).
  •  The cancer is between 2 and 5 centimeters (from 1 to 2 inches) and has not spread to the lymph nodes under the arm.
  •  There is cancer detected in the lymph nodes under the arm with no detectable cancer in the breast (unknown primary).

Stage IIB is defined by either of the following:

  •  The cancer is between 2 and 5 centimeters (from 1 to 2 inches) and has spread to the lymph nodes under the arm.
  • The cancer is bigger than 5 centimeters (larger than 2 inches) and has not spread to the lymph nodes under the arm.

Stage III  

Stage III is divided into stages IIIA, IIIB, and IIIC.

Stage IIIA is defined by either of the following:

  • The cancer is 5 centimeters or less in size and has spread to lymph nodes under the arm that have grown into each other or into other structures, or to lymph nodes near the breastbone.
  • The cancer is larger than 5 centimeters in size and has spread to the lymph nodes under the arm.

Stage IIIB is defined by the following:

  • The cancer has grown into the chest wall and/or the skin of the breast with or without evidence of spread to the lymph nodes.
  • The cancer may have spread to lymph nodes under the arm that have grown into each other or into other structures, or to lymph nodes near the breastbone.

Stage IIIC is defined by any tumor size with one of the following:

  • The cancer has spread to the lymph nodes above or below the collarbone.
  • There are more than 10 lymph nodes under the arm involved with cancer.
  • There is involvement of the lymph nodes near the breastbone.

Stage IV  

The cancer has spread to other body sites. Those where breast cancer is most likely to spread include the bones, lungs, liver, and brain.

Inflammatory Breast Cancer
Inflammatory breast cancer is a special class of breast cancer that is rare. The breast looks as if it is inflamed because of its swollen and red appearance. Sometimes it may feel warm. The skin may show signs of ridges and wheals (raised areas) or it may look pitted like the skin of an orange. This type of cancer tends to be more aggressive. Inflammatory breast cancer may be stage IIIB, IIIC, or stage IV.

Recurrence
Cancer is considered recurrent when it has returned following previous, apparently successful, treatment. Recurrence may take place in the breast, the lymph nodes, the soft tissues of the chest (the chest wall), or in another part of the body.

What kinds of breast cancer treatments are available?

Treatments are selected for each patient based on cancer stage and type. These may include:

  • Surgery to remove the cancerous tissue
  • Radiation therapy, using high-dose x-rays to kill cancer cells
  • Chemotherapy, in which drugs kill cancer cells
  • Hormone therapy, in which hormones stop cancer cells from growing
  • Targeted therapy, in which drugs are used which target a marker unique to breast cancer cells

In addition, new types of breast cancer treatment are continually under development and testing in clinical trials.

Breast Cancer Surgery

Surgery to remove cancerous tissue is a common part of breast cancer treatment for most patients. Lymph nodes lying beneath the arm are frequently removed as well, so that they may be analyzed for the presence of cancer cells.

Lumpectomy (sometimes called segmental mastectomy, partial mastectomy, or wide local excision) conserves the breast by removing only the lump and some of the surrounding tissue. It may be followed by radiation therapy applied to the part of the breast that remains, or to a portion of the breast that includes the surgical site. The surgeon may also remove some lymph nodes under the arm. Learn more... 

Total or simple mastectomy removes the entire breast. Sometimes lymph nodes under the arm are also removed. Learn more... 

Modified radical mastectomy removes the breast and some of the lymph nodes under the arm. Learn more... 

Sentinel Lymph Node Biopsy (SLNB) is the removal of the sentinel lymph node during surgery. The sentinel lymph node is the first to receive lymphatic drainage from a tumor; as such it is the first lymph node to which cancer from the tumor is likely to spread. If cancer is present in the sentinel node, the lymph nodes under the armpit are removed in a procedure called axillary lymph node dissection. SLNB is the preferred first step because it removes fewer lymph nodes than a formal axillary dissection, and SLNB produces fewer long-term side effects. It can also provide the physician with the necessary information needed for further treatment decisions.  Learn more... 

Breast Reconstruction
If your entire breast is to be removed, you may want to consider breast reconstruction. Plans for breast reconstruction are often part of the breast cancer treatment plan. Reconstruction can be done at the time of surgery, or at some time in the future. The breast may be reconstructed using your own tissue, or through implants filled with saline or silicone. Breast reconstruction is not considered cosmetic surgery, so it is typically covered by health insurance plans. In some cases, reconstructive surgery may also be performed for partial mastectomy patients.
Learn more about natural tissue reconstruction....
Learn more about implants... 

Radiation Therapy

This treatment uses high-energy X-rays to kill cancer cells and shrink tumors. Radiation may be introduced from a machine outside the body (external radiation therapy) or through radiation-producing substances transmitted through thin plastic tubes into the affected area (internal radiation therapy). Learn more... 

Chemotherapy

Chemotherapy is the use of special drugs to damage or kill cancer cells. Chemotherapy may be administered orally or through IV. Learn more... 

Hormone Therapy

If tests show that breast cancer cells contain estrogen or progesterone receptors, your doctor may choose hormone therapy. This treatment blocks hormones that can help cancers grow through either blocking the action of hormones, or through surgery to remove hormone-producing organs, such as the ovaries.
Hormone therapy with the medication tamoxifen can act on cells throughout the body and may increase your risk for cancer of the uterus. Patients undergoing this type of hormone therapy should be checked regularly for uterine cancer. Additionally, these patients should immediately report any non-menstrual uterine bleeding to their doctor. An aromatase inhibitor may be used instead of tamoxifen for women who have undergone menopause.

Targeted Therapy

Targeted therapy uses drugs to identify and attack specific markers on cancer cells. Some types of targeted therapy kill cancer cells directly by affecting how the cells grow and survive. Other targeted therapies help the body’s immune system, its natural defense, attack and fight the cancer. Monoclonal antibodies and tyrosine kinase inhibitors are two types of targeted therapies used in the treatment of breast cancer.

Treatment by Stage

Treatment for breast cancer depends on the type and stage of your disease, your menopausal status and your overall health. You may receive treatment that is considered standard based on its effectiveness in a number of patients in past studies, or you may choose to go into a clinical trial. Not all patients are cured with standard therapy, and some standard treatments may have more side effects than are desired. For these reasons, clinical trials are designed to find better ways to treat cancer patients and are based on the most up-to-date information.

Note: Therapy is considered adjuvant when it is given after surgery, when no cancer cells can be seen, to prevent cancer from recurring. Therapy is considered neoadjuvant when it is given before surgery to shrink the tumor and make it easier to remove, or to assess the response of the tumor to a specific type of treatment.

Breast Cancer In Situ

Your treatment depends on whether you have ductal carcinoma in situ or lobular carcinoma in situ. It is important to have your biopsy preparations (slides) observed through the microscope by a breast pathologist to be certain of the diagnosis. If you have ductal carcinoma in situ (DCIS), your treatment may be one of the following:

  • Breast conserving surgery and radiation therapy, with or without tamoxifen
  • Total mastectomy with or without tamoxifen
  • Breast conserving surgery without radiation therapy

If you have lobular carcinoma in situ (LCIS), you have a marker for a higher risk of developing cancer in either breast. This gives you about a 10-15 percent chance of developing breast cancer in either breast over the next 30 years. Many women with LCIS never develop an invasive breast cancer. The treatment options for LCIS are varied and quite controversial. Your treatment may include:

  • An excisional biopsy to diagnose the LCIS, followed by regular exams and mammograms to detect any abnormality
  • Tamoxifen to reduce the risk of developing breast cancer. A large clinical trial found that women at high risk for developing breast cancer who were treated with the hormonal therapy drug tamoxifen were almost 50 percent less likely to develop cancer than women at high risk who did not receive the drug.
  • Surgery to remove both breasts (prophylactic mastectomy)

Stage I, Stage II, Stage IIIA, Stage IIIB and Operable Stage IIIC Breast Cancer

Surgical options 

  • Surgery to remove the cancer and some surrounding breast tissue (lumpectomy or partial or segmental mastectomy). Some of the lymph nodes under the arm are also removed. This type of breast conserving surgery is followed by radiation therapy. This treatment provides identical long-term cure rates to those from a mastectomy. Your doctor's recommendation on which procedure to have is based on tumor size and location
  • Surgery to remove the whole breast (total mastectomy) or the whole breast and some of the lymph nodes under the arm (modified radical mastectomy)

Adjuvant therapy (following surgery) 

  • Radiation therapy
  • Chemotherapy, with or without hormone therapy
  • Hormone therapy
  • Targeted therapy combined with chemotherapy
  • Clinical trials

Stage III Inoperable Breast Cancer

Your treatment may include the following:

  • Chemotherapy
  • Chemotherapy, followed by surgery with lymph node removal, followed by radiation therapy
  • Additional chemotherapy or hormone therapy
  • Clinical trials testing new drugs or drug combinations

Stage IV Breast Cancer

Your treatment may include the following:

  • Hormonal therapy and/or chemotherapy
  • Targeted therapy
  • Radiation therapy and/or surgery to reduce your pain or symptoms
  • Clinical trials testing new drugs or drug combinations

Inflammatory Breast Cancer

Your treatment will probably be a combination of chemotherapy, followed by surgery to remove the breast, then radiation therapy. Hormonal therapy also may be used.

Recurrent Breast Cancer

Breast cancer that comes back (recurs) in the breast or lymph nodes can often be treated but is sometimes associated with disease in another part of the body. The treatment depends on hormone receptor levels, the kind of treatment you had before it recurred, where the cancer recurred, whether you still have menstrual periods, and other factors.
Your treatment may be one or more of the following:

  • Hormonal therapy
  • Chemotherapy
  • Surgery and/or radiation therapy for patients whose cancer has come back in only one place
  • Radiation therapy to help relieve pain caused by the spread of the cancer to the bones and other places
  • A clinical trial of new drugs or drug combinations.

 Adapted from NCI's Breast Cancer PDQ Breast Cancer Treatment by Stage © 1995, 2011 The University of Texas MD Anderson Cancer Center, Revised 02/07/11 Patient Education Office