Categories: Breast Cancer

Stage-Wise Treatment of Breast Cancer

There are five stages of breast cancer. Every stage of breast cancer has a different treatment modality through which doctors provide relief to patients. The doctors perform various tests like blood tests, CT and PET scans, MRI’s, X-rays, including a mammogram, and ultrasounds to determine the stage based on which treatment is decided.

STAGE 0: In this stage, the tumor is very small and is only present in the glands where they have formed and have not yet grown into nearby tissues.

Surgery

Under the surgery for stage 0, a patient will be advised to either undergo lumpectomy or mastectomy based on their condition. Lumpectomy is a simple, one-day procedure that is performed when cancerous cells remain in one area. It involves removing these cells from the breast and a person is allowed to go back home after the surgery on the same day. A mastectomy is performed when the cells appear throughout the breast. Here, the procedure involves removing the entire breast. Post the procedure, plastic surgeon can rebuild the breast on the same day or at a later date.

Radiation therapy

The patient undergoes radiation therapy 4-6 weeks after the breast surgery site has healed. The therapy helps in killing cancer cells and prevent them from spreading.

Hormone treatment

Studies have shown that estrogen, produced by the body, helps in overcoming some types of breast cancer. That’s why in addition to surgery, hormone therapy is suggested to the person who is estrogen receptor-positive (ER+) or progesterone receptor-positive (PR+). To manage these hormone levels in the body, the patient may also be required to undergo radiation therapy.

STAGE I: In this stage, the tumor size is less than 2 cms and may spread to other tissues but in smaller areas.

Surgery

The surgical procedure for stage I breast cancer depends on various characteristics like genetics, personal preference, size of the tumor & breast, family history and location of the primary tumor. Based on these, the doctors may suggest lumpectomy or mastectomy as a suitable surgical option.

Radiation therapy

Radiation therapy is the norm for stage I breast cancer. Hormone therapy is recommended for patients over 70 years old as radiation therapy is not suitable for them at this age.

Hormone therapy

Estrogen is one of the catalysts that aids in the growth of cancer. Suppose the breast cancer is ER+/PR+, then hormone therapy is more effective as it averts the development of estrogen. It reaches the tiniest cancer cells developed in the breast & other areas and dwindles the risk of cancer relapse.

Chemotherapy

Triple-negative breast cancer (TNBC) is not receptive to estrogen, progesterone or human epidermal growth factor receptor 2 (HER2+). In such cases, doctors recommend chemotherapy, as hormone therapy is ineffective against this type of cancer. Regardless, in some cases, post running a couple of tests on the tumor, doctors do recommend chemotherapy to patients who are ER+/PR+. The doctors also recommend the usage of Herceptin – a targeted therapy, for HER2+ patients.

STAGE II: In this stage, the tumor grows to 20-50 mm in size and some lymph nodes get affected by cancer.

Surgery

For stage II breast cancer, the most common type of treatment is surgery. Through surgery, the doctors aim at removing cancer completely. Based on the size and the location of the tumor, patients with stage IIA/IIB breast cancer may have to undergo lumpectomy or mastectomy.

Combination therapy

In combination therapy, stage IIA/IIB breast cancer patients are recommended a mix of radiation therapy, chemotherapy and hormone therapy (for hormone receptive cancer) as a treatment option.

STAGE III: In this stage, the tumor is larger than 50 m with more lymph nodes involvement. Cancer may have spread to the skin or chest wall.

In stage III breast cancer, chemotherapy is administered even before the surgery, in an effort to dwindle the tumor. As stage III breast cancer is considered as advanced level, the doctors will administer radiation therapy to kill the remaining cancer cells along with hormone therapy and targeted therapy, if required.

STAGE IV: In this stage, cancer spreads out to other parts of the body.

Stage IV is the last stage of breast cancer. Chemotherapy, radiation therapy and hormone therapy (if required) are the treatment modality recommended for stage IV cancer patients. Targeted therapy may also be a treatment option as it attacks the proteins that allow the growth of the cancer cells. Stage IV denotes that cancer has spread to other important organs throughout the body, hence, the doctor’s advice the patients to undergo surgery to relieve the pain caused by the issues that develop in this type of cancer. Spinal cord compression, extracting single masses caused by metastasis and fixing broken bones are some of the issues faced by a stage IV breast cancer patient. The doctors may also recommend antidepressants to help with mood swings, anticonvulsants to manage neurologic conditions and local anesthetics to manage pain.

Before pursuing any type of treatment for breast cancer, the following things should be taken into considerations to determine if the treatment option will be effective:

Age: Breast cancers tend to be more aggressive in patients under 40.

Pregnancy: During pregnancy, the doctors may delay chemotherapy until the second or third trimester. They’ll also delay hormone and radiation therapy until after the baby is born.

How fast cancer grows and spreads: Aggressive cancers require aggressive treatments.

Family history: Patients with a past history of breast cancer in close relatives are more likely to experience it themselves.

Genetic mutation status: Patients testing positive for Breast cancer gene one (BRCA1) and Breast cancer gene two (BRCA2) are at the risk of developing breast cancer at a point in their life.

Dr. Aparna S, Medical Oncology – Consultant, Narayana Multispecialty Clinic, Shimoga

Narayana Health

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