Treatment Options for Breast Cancer
At Rocky Mountain Cancer Centers (RMCC) there are many breast cancer treatment options that allow us to customize the best cancer care plan for you depending on your personal situation and cancer diagnosis.
Breast Cancer Surgery
Out of all the treatment options for breast cancer, surgery is the most common. To ensure you know what to expect, we will explain each type, discuss and compare the benefits and risks, and describe how each will change the way you look.
There are two main types of breast cancer surgery, which include:
Breast-sparing surgery: Also called breast-conserving surgery, this operation removes the cancer rather than the breast. It can be done as a lumpectomy or segmental mastectomy (also called a partial mastectomy). Sometimes an excisional biopsy is the only surgery a woman needs because the surgeon was able to remove the whole lump.
Mastectomy: This operation removes the entire breast (or as much of the breast tissue as possible). In some cases, a skin-sparing mastectomy may be an option. For this approach, your surgeon removes as little skin as possible.
During either of these procedures, your surgeon will likely remove one or more lymph nodes from under the arm to check for cancer cells. This is called your lymph node status.
After surgery for breast cancer, some women may choose breast reconstruction. It may be done at the same time as the cancer removal surgery or later.
To learn more about Breast Reconstruction Surgery visit our webpage.
Radiation Therapy For Breast Cancer
To destroy breast cancer cells that remain in the area after surgery, your oncologist may recommend radiation therapy in your breast cancer treatment plan. Radiation therapy (also called radiotherapy) uses high-energy rays to kill cancer cells and only affects the cells in the part of the body that is being treated.
There are two types of radiation therapy that oncologists use to treat breast cancer. Depending on your situation, you may receive both types, which include:
- External radiation therapy, in which the radiation comes from a large machine outside the body. Treatments are usually 5 days a week for 4 to 6 weeks and take place in a hospital or clinic. External radiation is the most common type used for breast cancer.
- Internal radiation therapy (implant radiation therapy or brachytherapy), in which the doctor places one or more thin tubes inside the breast through a tiny incision.
Hormone Therapy For Breast Cancer
If lab tests show that the tumor in your breast has hormone receptors, meaning that it is fueled by natural hormones (estrogen and progesterone), then hormone therapy may be an option. Hormone therapy, also sometimes called anti-hormone treatment, keeps cancer cells from getting or using the natural hormones they need to grow.
Options Before Menopause
If you have not gone through menopause, your options include:
- Tamoxifen: This drug can prevent the original breast cancer from returning and also helps prevent the development of new cancers in the other breast. As treatment for metastatic breast cancer, tamoxifen slows or stops the growth of cancer cells that are in the body. It’s a pill that you take every day for five years.In general, the side effects of tamoxifen are similar to some of the symptoms of menopause. The most common are hot flashes and vaginal discharge. Others are irregular menstrual periods, thinning bones, headaches, fatigue, nausea, vomiting, vaginal dryness or itching, irritation of the skin around the vagina, and skin rash. Serious side effects are rare, but they include blood clots, strokes, uterine cancer, and cataracts.You may want to read the NCI fact sheet on Tamoxifen.
- LH-RH agonist: This type of drug can prevent the ovaries from making estrogen. It may be given by injection under the skin in the stomach area. Side effects include hot flashes, headaches, weight gain, thinning bones, and bone pain. Examples are leuprolide and goserelin.
- Surgery to remove your ovaries: Until you go through menopause, your ovaries are your body’s main source of estrogen. When the surgeon removes your ovaries, this source of estrogen is also removed. (A woman who has gone through menopause wouldn’t benefit from this kind of surgery because her ovaries produce much less estrogen.) When the ovaries are removed, menopause occurs right away. The side effects are often more severe than those caused by natural menopause. Your health care team can suggest ways to cope with these side effects.
Options After Menopause
If you have gone through menopause, your options include:
- Aromatase inhibitor: This type of drug prevents the body from making a form of estrogen (estradiol). Common side effects include hot flashes, nausea, vomiting, and painful bones or joints. Serious side effects include thinning bones and an increase in cholesterol. Examples of aromatase inhibitors include anastrozole, exemestane, and letrozole.
- Tamoxifen: Hormone therapy is given for at least 5 years. Therefore, if you have gone through menopause, you can expect to receive tamoxifen for 2 to 5 years. If tamoxifen is given for less than 5 years, then an aromatase inhibitor often is given to complete the 5 years. Some women have hormone therapy for more than 5 years. See above for more information about tamoxifen and its possible side effects.
While chemotherapy is very effective in treating breast cancer, it might not be necessary for you. Chemotherapy uses drugs to kill cancer cells. These drugs are usually given through a vein (intravenous) or as a pill. If chemotherapy is part of your treatment plan, you will probably receive a combination of drugs.
Chemotherapy can be administered in an outpatient part of the hospital, at the doctor’s office, or at home. Some women, however, need to stay in the hospital during treatment. At RMCC, chemotherapy is normally delivered at each of our clinics, at the same location as your oncologist and the rest of the breast cancer care team.
Unfortunately, there are times when certain anticancer drugs can damage the ovaries. If you have not gone through menopause yet, you may experience various symptoms and side effects such as hot flashes and vaginal dryness, irregular menstrual periods (or periods that stop altogether), and infertility (inability to become pregnant). For women over the age of 35, this damage to the ovaries is likely to be permanent.
On the other hand, you may remain able to become pregnant during chemotherapy. Before treatment begins, you should talk with your doctor about birth control because many drugs given during the first trimester are known to cause birth defects.
Another breast cancer treatment approach your RMCC oncologist might recommend is targeted therapy. Unlike chemotherapy, targeted therapies only kill cancer cells, leaving healthy cells alone. Instead of targeting the hormone receptors estrogen and progesterone, they target other parts of the cancer cell. This often reduces the number of side effects you may experience. With that said, there are unique side effects with targeted therapy that can be explained by your RMCC oncologist.
Because breast cancer can have many different attributes, it’s important to understand that, depending on your situation, targeted therapy may not be the best option for you. Additionally, The American Society of Clinical Oncology (ASCO) states that studies show that not all tumors have the same targets, therefore, the same targeted treatment does not work for everyone. If you are a good candidate for targeted therapies, however, you may receive them in addition to another form of cancer treatment such as chemotherapy, radiation therapy, or hormone therapy.
Types of Targeted Therapy Used for Breast Cancer
There are two main types of targeted therapy:
- Monoclonal antibodies, which block a specific target on the outside of cancer cells
- Small-molecule drugs, which can block the process that helps cancer cells multiply and spread
Drugs used in targeted therapy have been developed to target specific cell changes. Therefore, the drugs given to patients are usually based on their specific hormone status and the type of their breast cancer. If your RMCC oncologist feels like you would benefit from targeted therapy, your options could include any of the following types:
Targeted Therapy for HER2-Positive Breast Cancer
If your cancer has tested positive for a protein called human epidermal growth factor receptor 2 (HER2), it is likely that your breast cancer will grow and spread more aggressively. To target this type of breast cancer, a variety of drugs have been developed, which include:
- Nerlynx: Nerlynx (chemical name: neratinib) is an irreversible pan-HER inhibitor. Nerlynx works against HER2-positive breast cancer by blocking the cancer cells’ ability to receive growth signals.
- Herceptin: Herceptin (chemical name: trastuzumab) works against HER2-positive breast cancers by blocking the ability of the cancer cells to receive chemical signals that tell the cells to grow.
- Perjeta: Like Herceptin, Perjeta (chemical name: pertuzumab) works against HER2-positive breast cancers by blocking the cancer cells’ ability to receive growth signals.
- Kadcyla: Kadcyla (chemical name: T-DM1 or ado-trastuzumab emtansine) is a combination of Herceptin and the chemotherapy medicine emtansine. Kadcyla was designed to deliver emtansine to cancer cells in a targeted way by attaching emtansine to Herceptin. Herceptin then carries emtansine to the HER2-positive cancer cells.
- Tykerb: Tykerb (chemical name: lapatinib) works against HER2-positive breast cancers by blocking certain proteins that can cause uncontrolled cell growth.
Targeted Therapy for Hormone Receptor-Positive Breast Cancer
If your breast cancer is hormone receptor-positive, your treatment will typically begin with hormone therapy. To help make hormone therapy even more effective, certain targeted therapy drugs have been developed. These include:
- Afinitor: Afinitor (chemical name: everolimus) is an mTOR (mammalian target of rapamycin) inhibitor. Afinitor works against hormone-receptor-positive breast cancers that have stopped responding to aromatase inhibitors by stopping the cancer cells from getting the energy they need.
- Avastin: Avastin (chemical name: bevacizumab) works by blocking the growth of new blood vessels that cancer cells depend on to grow and function.
- Ibrance: Ibrance (chemical name: palbociclib) is a cyclin-dependent kinase 4/6 inhibitor. A kinase is a type of protein in the body that helps control cell division. Ibrance works by stopping cancer cells from dividing and growing.
- Kisqali: Kisqali (chemical name: ribociclib, formerly called LEE011) is also a cyclin-dependent kinase 4/6 inhibitor like Ibrance. A kinase is a type of protein in the body that helps control cell division. Kisqali works by stopping cancer cells from dividing and growing.
- Verzenio: Verzenio (chemical name: abemaciclib) is cyclin-dependent kinase 4/6 inhibitor, like Ibrance and Kisqali. A kinase is a type of protein in the body that helps control cell division. Verzenio works by stopping cancer cells from dividing and growing.
Targeted Therapy for Women with BRCA Gene Mutations
If you have hereditary breast cancer syndrome caused by inherited gene changes in BRCA1 and BRCA2, your cancer will be targeted with a type of drug known as a PARP inhibitor. The primary drug used is:
- Lynparza: Lynparza (chemical name: olaparib) is a PARP inhibitor. The PARP enzyme fixes DNA damage in both healthy and cancer cells. Lynparza works against metastatic HER2-negative breast cancer with a BRCA1 or BRCA2 mutation by making it very difficult for these cancer cells to fix DNA damage.
Rest assured, you are in good hands with Rocky Mountain Cancer Centers. We believe in treating the whole person, not just the disease, which is why we will work hard to create the best cancer treatment plan for you.