You have several options for treating breast cancer, including chemo, radiation, hormone, and targeted therapies. Certain treatments may be more effective for specific types of breast cancer, and a doctor can advise you based on your case.
After diagnosis, knowing where to turn next with your breast cancer treatment can be a tough decision. Understanding the different types of therapies available and your stage of breast cancer can help ensure you know what’s best for you.
Surgery (tumor removal) is the primary treatment for localized and regional breast cancer. Usually, post-operative treatment is needed and includes one or a combination of the following therapies, depending on your needs:
Hormonal therapy
Hormone receptor-positive (estrogen receptor-positive or progesterone receptor-positive) breast cancer is usually managed with
The typical treatment uses an aromatase inhibitor (anastrozole, letrozole, or exemestane). These may be given in combination with a CDK 4/6 inhibitor (palbociclib, ribociclib, or abemaciclib), which are used in more advanced stages.
If this combination is given to a premenopausal person, an ovarian suppression (Zoladex, Lupron) medication must also be given. Ovarian suppression means the treatment stops the ovaries from producing hormones. The aromatase inhibitors only work when the ovaries no longer produce estrogen.
Other anti-estrogens include fulvestrant and tamoxifen, which could be combined with a targeted partner medication.
A particular line of anti-estrogen therapy is given as long as it’s working and the patient tolerates it.
The stage of breast cancer often influences the decision of whether you will receive one or more breast cancer therapies, and if this happens before or after surgery.
Side effects of hormone therapy vary with each drug but can include:
- hot flashes and night sweats
- vaginal dryness
- loss of sex drive
- changes in mood
- joint pain
Targeted therapies
Some hormonal and targeted therapies are available in pill form.
If side effects are difficult to tolerate or cancer continues to progress while taking hormonal or targeted therapy, a doctor may recommend changing drugs.
Depending on your needs, including cancer stage, some of these therapies may be more effective when used in combination with chemotherapy.
Chemotherapy
When breast cancer is estrogen receptor-negative, progesterone receptor-negative, and HER2-negative, it’s called triple-negative breast cancer. Unless it’s a small tumor, chemotherapy is the first line of treatment for this type of cancer.
Chemotherapy may also be used for other types of breast cancer when more targeted therapies may not be indicated. In this case, chemotherapy may be used upfront (before surgery) or as the last line of treatment. Each case is different.
Chemotherapy drugs are designed to
- hair follicles
- cells in your bone marrow that help form blood
- cells in your mouth, digestive tract, and reproductive system
- nerve cells
Chemotherapy has many potential side effects. Symptoms range from mild to severe and can include:
- hair loss
- loss of appetite
- nausea and vomiting
- diarrhea or constipation
- numbness and tingling
- changes to fingernails and toenails
- fatigue
- weight loss or gain
Medications, such as anti-nausea medications, can minimize some of these side effects. Immune boosters are also available to help your bone marrow make more healthy white blood cells to prevent infection.
The chemotherapy drugs are administered intravenously at certain intervals, which could be weekly, or every 2 or 3 weeks. Each chemotherapy session may last several hours. Side effects are usually most intense a few days after treatment.
Treatment for MBC depends on the biology of the tumor as well as the severity and type.
Surgery is rarely, if ever, used as first-line treatment for MBC. Severe symptoms and other therapies not working could lead a doctor to opt for palliative surgery. Palliative means its purpose is to relieve symptoms, but not address the cause.
Doctors may use surgery to remove tumors in affected organs when other methods don’t relieve symptoms. Surgery to relieve pressure around your spinal cord is one example.
Radiation is a targeted, first-line therapy for localized or regional cancers, since it destroys cancer cells in a specific area of the breast. Radiation therapy can’t be repeated if you have previously had radiation to the same area.
An oncologist can refer you to a palliative care specialist to help manage pain and other symptoms of breast cancer.
Other symptom management options may include drugs to treat:
- nausea and vomiting
- numbness and tingling (neuropathy)
- constipation or diarrhea
- insomnia
- mouth sensitivities and ulcers
- swelling
- menopausal symptoms
You can also look into some complementary therapies such as:
- massage
- meditation and other relaxation techniques
- physical therapy
- acupuncture
If you have stage 4 breast cancer, it means the cancer has spread beyond the breast and nearby lymph nodes.
When breast cancer metastasizes, it usually goes to your bones, liver, and lungs. It can sometimes spread to your brain.
If you were previously treated for breast cancer and it’s returned, it’s called recurrent breast cancer. When formulating a treatment plan, an oncologist will review your prior treatment history.
Stage 4 breast cancer cannot be cured, but it can be treated. Treatment is
- slow the spread of cancer
- shrink existing tumors
- lengthen your life
- maintain a good quality of life for as long as possible
Because the cancer is growing in several locations, you’ll need systemic drug therapy.
Targeted therapies depend on your hormone receptor and HER2 status. Chemotherapy, hormone therapy, and targeted drugs can be used alone or in combination.
You can continue these treatments as long as the cancer is not progressing and side effects are tolerable.
If your current treatment is no longer effective or the side effects become too much, you can try other therapies. Talk with your doctor to see if they recommend clinical trials for your condition.
It’s important to discuss the pros and cons of each breast cancer treatment with a doctor. You can be frank about how they fit into your lifestyle and treatment goals. Which treatment will work best depends on your staging, preferences, and biomarkers.
Your overall quality of life is important and something only you can assess. Even if you decide to stop treatment for cancer, you can still receive treatment for pain and other symptoms.