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Treatment of Breast Cancer - Stages in Breast Cancer & Treatment Options
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Generally, there are five stages in the development of breast cancer. Stages of cancer tell how extensive the cancer is. The stages are numbered from 0 to IV.0 is the lest extensive stage and vice versa for IV. Mastectomy and lumpectomy surgeries are mostly used throughout the stages in order to control the spread of the cancer cells.
Breast cancer can be divided into:-
Stage 0
Stage 0: Lobular Carcinoma in situ(LCID)
LCID is the abnormal cells in the lobes(glands in which the milk is produced)of the breasts that are remained where it started. These abnormal cells indicate that one has a risk of developing breast cancer sometime in the future, but she does not have cancer right now.
Prophylactic mastectomy is conducted to provide the maximum reduction of risk. However, the disadvantage is this surgery is a major surgery which is more radical than the treatment of cancer for a disease one will never get .
Ductal Carcinoma in situ (DCIS), the other Stage 0 localized cancer of the breast is potentially more serious. It starts in the duct but has not spreaded. If it is left untreated, it will mostly progress to an invasive cancer in most women.
Treatment options:
| Lumpectomy alone |
Advantages:
- Least invasive and fewest side effects.
Disadvantages:
-High risk of recurrence in the breast and have to deal with cancer again.
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| Lumpectomy and Radiation Therapy |
Advantage :
-This combination reduces risk of cancer.
Disadvantages:
-A change in the size of a breast ( cosmetic changes) will occur as a result from the combination of lumpectomy and radiation therapy.
-6 weeks of treatment is required for radiation therapy.
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| Mastectomy
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Advantage:
-Lowest risk of recurrence.
Disadvantages :
-Major surgery for a disease which is not life-threatening
-Patient will lose their breasts.
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Stage I and II
In stage I, the tumour is 2 centimeters or less in diameter and has not spreaded beyond the breast. On the other hand, in stage II, the tumour is larger than 2 centimeters in diameter and may have spreaded to the lymph nodes under the arm on the same side of the tumour. The treatment of these two stages may include more than one treatment phase, be it the primary treatment, additional postsurgery treatment or another treatment before the primary treatment.
The first step of the primary treatment for Stage I and II is the local therapy. It is a treatment geared toward that particular area of the body. The patient will have one or more of the lymph glands under the arm removed ,regardless of whether she has a lumpectomy or mastectomy. Radiation will be required if the patient has a lumpectomy.
Treatment Options:
| Lumpectomy and Radiation Therapy |
Advantages:
-Allow patient to keep the breast.
-90% of women think it looks excellent.
-Small risk( less than 10%) of needing mastectomy in the future if the cancer returns.
Disadvantage:
-6 weeks of radiotherapy will be required. |
| Mastectomy Alone |
Advantages:
-Radiation therapy is usually not required.
-No more mammograms is required.
Disadvantages:
-The chest is numb.
-Need to wear external prosthesis (Breast form that has various shapes and colours, it looks just like women’s breast) if patient does not have reconstruction.
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| Mastectomy and Reconstruction |
Advantages:
-No need to wear external prosthesis.
-Radiation therapy is not usually needed
-No more mammograms on that side.
Disadvantages:
-Having reconstructive surgery means having more surgery.
-A reconstructed breast does not have normal sensation.
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Post Surgery Treatment:
| Factors |
Further Treatment |
| Factor 1: Lymph nodes did not contain cancer cells and the tumour is less than or equal to 1centimeter in diameter. |
No, but if tumour has hormone receptors, tamoxifen can be considered for prevention of new cancers in the opposite breast.
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| Factor 2: Lymph nodes contain cancer cells |
- With negative hormone-receptor results, patient will have to receive chemotherapy.
- With positive hormone-receptor results, patient will have to receive chemotherapy and endocrine therapy.
- If the patient is hormone-receptor-positive and older, she may receive endocrine therapy only.
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| Factor 3: Tumour measured is greater than 1 centimeter in diameter and the lymph nodes do not have cancer cells. |
-Hormone-receptor-negative and pre- or postmenopausal patient will receive chemotherapy.
-Hormone receptor-positive and premenopausal patient will receive combination of tamoxifen and chemotherapy.
-Hormone-receptor-positive and postmenopausal patient will receive anti-hormonal drugs or treatment that prevents the body from creating hormones (Aromatasei inhibitors) and possibly chemotherapy.
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| Will The Patients need Radiation after Surgery? |
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Stage
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After a Lumpectomy |
After a Mastectomy |
| Stage I |
Yes |
Never |
| Stage II |
Yes |
-Yes, if more than four nodes have cancer cells.
-May be, if 1-3 nodes have cancer cells
-Rarely, if no cancer cells are found in any of the nodes
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Stage III
In Stage III, different causes may contribute to this stage:
-The tumour is larger than 5 centimeters in diameter and has spreaded to the lymph nodes OR
-The tumour is of any size, it has spreaded to the lymph nodes and they are attached to one another or to surrounding tissue OR
-The cancer has spreaded to the skin or chest wall or the intestinal mammary nodes under the breastbone.
Treatment option:
Modified Radical Mastectomy with or without Radiation
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Advantages:
-Provide immediate pathology information to guide postoperative treatment.
Disadvantages:
- Patient lose their breasts.
- Patient has to wear prosthesis if they did not choose to have reconstructive surgery.
- The chest will be numb. |
| Chemotherapy before surgery and Try to have Lumpectomy |
Advantages:
-Allow the patient to keep the breast.
-Tell whether the patient is sensitive to the particular chemotherapy used.
Disadvantages:
-Patient does not have the complete pathology before treatment.
-It does not always result in being able to have a lumpectomy, but chemotherapy is a must. |
| Modified Radical Mastectomy and Reconstuction(With or without Radiation Therapy) |
Advantages:
-Patient will have a new breast.
Disadvantages:
-Having reconstructive surgery means having additional surgery.
-Reconstructed breast and nipple will not have the sense of feeling of the natural breast.
-If radiation therapy is required, it may alter the appearance of the reconstruction. |
Stage IV
Stage IV breast cancer has various conditions, as described bellow:
- Thecancer has metastasized to the bone and stayed there OR
- It has spread more widely throughout the body OR
- The cancer grows slowly in some women. However ,on the other hand, the cancer is very aggressive, spreading quickly and making the treatment more difficult.
Treatment option:
1.)Lymph Node Surgery
Axillary nodes(lymph nodes under the arm) are the major drainage sites for the lymphatic system in the breasts. They are divided into three levels based on their relationship to the minor pectoralis muscle on the chest wall.
During surgery for an invasive breast cancer, the surgeon usually removes one or more lymph nodes. A pathologist will firstly examine the lymph nodes under microscope to examine for the presence of cancer cells. Fewer positive nodes(nodes containing cancer) indicates the earlier the stage of the cancer. Negative nodes mean that metastases are less likely to happen.
Axillary Dissection is the removal of underarm lymph nodes. Traditional axillary dissection involves the removal of stage I and II lymph nodes along with the underarm fat pad to evaluate the extent of the disease.The information provided will help in planning the extent of afterward radiation required when a patient is having a lumpectomy or mastectomy.
 
Sentinel Node Biopsy After Sentinel Node Biopsy
2.)Sentinel Node Biopsy:
It is a less invasive procedure which is used to identify node-negative women.Only the first node to receive lymphatic drainage from sentinel node (the site of primary tumour) is removed and analyzed. The remaining node and lymph channels are remained intact thus minimizing the chance of lymphedema.
The surgeon locates the first node (sentinel node) into which the tumour drains by injecting the tumour with a radioisotope or blue dye, which will travel through lymph channels to sentinel node located in underarm. Then, he will examine it for the presence of cancer cells after removing it. Sometimes, there may be a false negative result in which the sentinel node is thought to be cancer-free but a cancerous node is left behind.
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