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Stage and Treatment
 
  


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Stage and Treatment  

What treatments are usually associated with the different stages of breast cancer?

The stage of a breast cancer is probably the most important factor to be considered when determining treatment options. Stages and treatments options include:

  • Stage 0

    About 15% to 20% of all breast cancers are carcinomas in situ, meaning that the cancer is still contained in the site where it began. There are two types of Stage 0 cancer or breast cancer in situ:

    *Ductal carcinoma in situ (DCIS)
    *Lobular carcinoma in situ (LCIS)

    Treatment for DCIS may be one of the following:

    *Breast-conserving surgery with radiation therapy
    *Surgery to remove the whole breast (total mastectomy)

    The need for treatment and treatment options for lobular carcinoma in situ are varied and quite controversial. Lobular carcinoma in situ is not actually a cancer, but rather an overgrowth of abnormal cells that is viewed as a sign that a woman is at increased risk of developing cancer. Patients with LCIS have a 25% chance of developing breast cancer in either breast within the next 25 years. Nevertheless, lobular carcinoma in situ is classified as Stage 0 breast cancer.

    Treatment options for LCIS include:

    *More frequent clinical breast exams and mammograms to find any changes as early as possible
    *Tamoxifen therapy to reduce the risk of development of breast cancer in patients with estrogen-receptor positive cells in the abnormal area of the breast
    *If a patient has a strong family history of breast cancer, bilateral mastectomy (removal of both breasts) may be recommended.


  • Stage I

    Stage I breast cancers are no larger than 2 centimeters (less than 1 inch) and have not spread outside the breast.

    Treatment may be one of the following:

    *Breast-conserving surgery to remove only the cancer and some surrounding breast tissue (lumpectomy), or to remove part of the breast (partial or segmental mastectomy). The surgery is followed by radiation therapy. Some of the lymph nodes under the arm are also removed.
    *Surgery to remove the whole breast (total mastectomy), or the whole breast and the lining of tissue over the chest muscles (modified radical mastectomy). Some of the lymph nodes under the arm are also taken out.
    *In addition to surgery, patients may be treated with accompanying (adjuvant) therapies, such as the following:

  • Chemotherapy

  • Tamoxifen therapy in patients with estrogen receptor-positive cells in the tumor

  • A clinical trial of adjuvant chemotherapy in certain patients

  • A clinical trial of no adjuvant therapy for patients with a good chance of recovery

  • A clinical trial of treatment to keep the ovaries from working


  • Stage II

    Stage II cancers include cancers with the following characteristics:

    *The cancer is less than 2 centimeters in diameter, but it has spread to the lymph nodes under the arm
    *The cancer is between 2 and 5 centimeters (1 to 2 inches) in diameter, and it may or may not have spread to the lymph nodes under the arm
    *The cancer is larger than 5 centimeters (2 inches) in diameter and has not spread to the lymph nodes under the arm.

    Treatment for Stage II cancers is usually one of the following:

    *Breast-conserving surgery to remove only the cancer (lumpectomy), or partial or segmental mastectomy. The surgery is followed by radiation therapy. Some of the lymph nodes under the arm also are removed.
    *Total mastectomy or modified radical mastectomy. Some of the lymph nodes under
    the arm also are removed.
    *Adjuvant therapy may include the following options:

  • Chemotherapy

  • Tamoxifen therapy for patients with estrogen-positive cells in the tumor

  • A clinical trial of chemotherapy before surgery

  • A clinical trial of high-dose chemotherapy with bone marrow transplantation for patients with cancer in more than 3 lymph nodes


  • Stage IIIA

    Stage IIIA means either that:

    *The cancer is smaller than 5 centimeters and has spread to the lymph nodes under the arm, and the lymph nodes are attached to each other or to other structures
    *The cancer is larger than 5 centimeters and has spread to the lymph nodes under the arm.

    Treatment for Stage IIIA cancers may be one of the following:

    *Chemotherapy given prior to surgery, followed by adjuvant chemotherapy and radiation therapy, with or without hormone therapy. According to the National Cancer Institute, these options generally are the preferred treatment approach.
    *Modified radical mastectomy or radical mastectomy after chemotherapy
    *Radiation therapy given after surgery after chemotherapy
    *A clinical trial testing new chemotherapy with or without hormonal drugs, or a clinical trial testing chemotherapy before surgery (called neoadjuvant therapy)
    *A clinical trial of high-dose chemotherapy with either bone marrow or peripheral stem cell transplantation


  • Stage IIIB

    Stage IIIB means either that:

    *The cancer has spread to the tissues near the breast (the chest wall, including the ribs and the muscles in the chest)
    *The cancer has spread to the lymph nodes inside the chest along the breast bone.

    Treatment at Stage IIIB probably will include a biopsy and one of the following options:
    *Chemotherapy followed by surgery and radiation therapy, with or without hormone treatment to shrink the tumor
    *Tamoxifen therapy for patients with estrogen receptor-positive cells in the tumor, followed by additional therapy
    *A clinical trial testing new chemotherapy drugs and new biological therapies, new drug combinations, and new ways of giving chemotherapy
    *A clinical trial of high-dose chemotherapy with either bone marrow or peripheral stem cell transplantation


  • Stage IV

    Stage IV breast cancers have spread to other organs of the body, most often the bones, lungs, liver, or brain. Sometimes the tumor has spread locally to the skin and lymph nodes inside the neck, near the collarbone.

    Treatment at this stage probably will include a biopsy and one of the following:

    *Combination chemotherapy
    *Radiation therapy or, in some cases, a mastectomy to reduce the symptoms
    *Tamoxifen therapy or other anti-estrogen drugs for patients with estrogen receptor-positive cells in the tumor
    * Therapy with Herceptin (a monoclonal antibody) for patients whose tumor cells over-express the HER2 molecule on the surface of the tumor cells
    *A clinical trial testing new chemotherapy and hormonal drugs and new combinations of drugs and biological therapy
    *A clinical trial of high-dose chemotherapy with either bone marrow or peripheral stem cell transplantation


  • Inflammatory Breast Cancer

    Inflammatory Breast Cancer is a very aggressive type of cancer, which is categorized as a Stage IIIB. The unique quality of inflammatory breast cancer is that it makes the breast look red and inflamed. Due to the presence of inflammation, the breast may be warm to the touch. The skin of the breast often looks like the peel of an orange (called peau díorange) ó rough and dimply. Inflammatory breast cancer may be misdiagnosed as a simple infection.

    Treatment usually combines chemotherapy, hormonal therapy, radiation therapy, and sometimes surgery. The treatment approach usually is similar to treatment for Stage IIIB or IV breast cancer.


  • Recurrent Cancer

    Recurrent cancer is cancer that has come back (recurred) after it has been treated. Breast cancer may recur either in the breast, in the soft tissues of the chest (the chest wall), or in another part of the body. The choice of treatment depends on hormone receptor levels, the kind of treatment the patient had before, the length of time from the first treatment to when the cancer recurred, the location where the cancer recurred, whether the patient still has menstrual periods, and other factors.

    Treatment may be one of the following:

    *Tamoxifen therapy for patients with estrogen receptor-positive cells in the tumor
    *Other types of hormone therapy for patients with hormone receptors on the surface of the tumor cells
    *Surgery and/or radiation therapy (for the small group of patients whose cancer has come back only in one place in the body)
    *Combination chemotherapy
    *Treatment with the chemotherapeutic drug, Abraxane
    (albumin-bound paclitaxel)
    *Re-treatment with previously used therapies
    *A clinical trial of new chemotherapy or new biologic therapy


  • Questions Related to Stage and Treatment
    If my cancer does recur, how will I be treated?
    Iíve just been diagnosed with breast cancer. What should I do, including deciding on treatment?
    Should I get a second opinion from another doctor about my breast cancer?
    What are the treatment options for breast cancer?
    What things should I consider when deciding on a type of treatment for my breast cancer?
    What does a cancerís histological grade have to do with selecting a type of treatment?
    What is a bone scan? Why do I need one?
    What is the difference between breast cancer and recurrent breast cancer? How do the treatments differ?
    What are breast-conserving surgeries?
    Why do I need so many doctors involved in my treatment for breast cancer? What do all the doctors do?
    What is the difference between local and systemic treatment of breast cancer?
    How is hypercalcemia treated?
    What is the difference between a lumpectomy and a mastectomy?
    When would I choose a mastectomy over a lumpectomy?
    When is radiation added after a mastectomy?
    What is a lumpectomy?
    What is a partial mastectomy?
    What is a radical mastectomy?
    What is a modified radical mastectomy?
    What is a total mastectomy?
    What is a segmental mastectomy?
    What is a skin-sparing mastectomy?
    What is involved with a lumpectomy surgery? How long will it take?
    What is involved with a mastectomy surgery? How long will it take to recover?
    What is radiation therapy?
    When is radiation therapy appropriate for breast cancer?
    When is radiation therapy not an option for breast cancer?
    Does the procedure for external radiation therapy hurt?
    Will external radiation therapy make me radioactive?
    Does radiation therapy increase my risk of my breast cancer recurring?
    Does radiation therapy increase my risk of developing cancer in my other breast?
    Who is a dosimetrist?
    What happens during your radiation setup?
    What happens during the actual treatments with external radiation?
    What is brachytherapy?
    How long will my external radiation therapy take?
    What is a boost dose of radiation?
    What is intraoperative radiation therapy?
    What is hyperfractionated radiation therapy?
    What is radiosurgery ablation?
    Can I take vitamins during radiation treatment?
    What is chemotherapy? How does it work? How is the treatment taken?
    What are SERMs? How do they work?
    What are aromatase inhibitors? How do they work?
    What is tamoxifen? How does it work?
    What is Arimidex?
    What is Taxol?
    What are the different classes of chemotherapy (chemo) drugs used to treat breast cancer?
    What are adjuncts?
    What is bone marrow transplantation?

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