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 d’orange) — 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
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