Breast Cancer

Breast Cancer Treatment

If you have been recently diagnosed with breast cancer, your cancer care team at Maryland Oncology Hematology will work with you to develop a treatment plan that best fits your cancer and overall needs. The treatment your physician recommends may depend on a variety of factors, including the type and stage of your breast cancer, any potential side effects, and your personal preferences. It’s important to speak to your physician about your needs, goals for your health and lifestyle, and any other concerns you may have about treatment.

Surgery

Many people with breast cancer will have surgery as a part of their cancer treatment plan. Sometimes, this is combined with other treatments before and/or after surgery. Surgery can be done to remove as much of the cancer as possible, discover whether the cancer has spread to the lymph nodes under the arm, restore the shape of the breast after treatment, or relieve cancer symptoms.

Two types of surgery are usually used to remove breast cancer:

A lumpectomy removes the tumor and some surrounding healthy tissue. Some lymph nodes may also be removed. This treatment is sometimes referred to as breast-conserving surgery because patients given a lumpectomy can usually keep most of their breast.
A mastectomy removes breast cancer by removing the entire breast. Sometimes, nearby tissues are also removed.

Sometimes surgery is done to remove nearby lymph nodes to determine how big the cancer is or how much it has spread. This can be done as a part of a cancer-removing surgery or on its own. If cancer has spread to the other parts of the body, surgery may be done to slow the spread or to prevent or relieve symptoms.

Some patients may have the option of breast reconstruction surgery following a surgery to remove their cancer. There are several types of reconstructive surgeries, depending on your medical needs and personal preferences. Discuss your options with your cancer care team before you have surgery to remove the cancer.

Radiation Therapy

Radiation therapy treats cancer by using high energy rays to target and eliminate cancer cells. Radiation therapy can be used as a part of treatment for almost every stage of breast cancer. Your physician may recommend radiation to treat cancer that cannot be removed with surgery, after surgery to treat any remaining cancer cells, or to target breast cancer that has spread to other parts of the body. It may also be used to reduce symptoms caused by breast cancer.

There are two main types of radiation therapy used to treat breast cancer:

External Beam Radiation Therapy: This form of radiation therapy uses a machine to deliver radiation to the area of the body affected by cancer. This procedure is painless and only lasts a few minutes, though set up for the treatment takes longer. This is the most common form of radiation therapy used to treat breast cancer.
Internal Radiation Therapy: Also called brachytherapy, this treatment is usually used after surgery. Radioactive substances are placed directly into the breast tissue in the area where the cancer was removed to destroy any remaining cancer cells.

Chemotherapy

Chemotherapy uses anti-cancer drugs that travel through the bloodstream to target cancer cells throughout the body. Chemotherapy can be given intravenously or taken by mouth. Not every patient with breast cancer will need chemotherapy, but it can be used:

After surgery: Also called adjuvant chemotherapy, this treatment can be used to eliminate cancer cells left behind after surgery or microscopic cancer cells that cannot be seen by the naked eye. Chemotherapy given after surgery can lower the risk of breast cancer recurrence.
Before surgery: Also called neoadjuvant chemotherapy, this treatment is sometimes given to shrink the tumor before surgery. Chemotherapy before surgery is often used for inflammatory breast cancers, cancers that are too big to be removed by surgery, or cancers with many affected lymph nodes. Some patients receiving chemotherapy before surgery may also need more chemotherapy after surgery.
To treat metastatic breast cancer: Chemotherapy is sometimes used as the main treatment for cancer that has spread to other parts of the body. It can also be used after a different initial treatment.

Hormone Therapy

Some breast cancer cells have proteins called receptors which help the cancer grow by attaching to hormones like estrogen and progesterone. These cancers are called hormone receptor-positive, and account for two out of three breast cancers. Hormone therapy treatments work by blocking your hormones from attaching to these receptors.

Hormone therapy is often used after surgery to reduce the risk of recurrence and is often taken for at least five years. It can also be started before surgery. Hormone therapy is sometimes used to treat cancer that has come back after treatment or spread to other parts of the body.

Targeted Drug Therapy

Targeted drug therapy uses medicine to target specific proteins on breast cancer cells to eliminate the cancer or slow its growth. These drugs travel through the bloodstream to reach cancer in all areas of the body. Different targeted therapy medications may be used to treat HER2-positive breast cancer, hormone receptor-positive breast cancer, cancer with a BRCA gene mutation, and triple-negative breast cancer.

Immunotherapy

Immunotherapy drugs treat breast cancer by restoring the immune system’s ability to recognize breast cancer cells and start an immune response. Pembrolizumab (Keytruda®) can be used with chemotherapy to treat triple-negative breast cancer before and after surgery for stage II or III cancers, cancer that has returned, or cancer that has spread to other parts of the body.