Breast Cancer Treatment

Your doctor will think about a few things before they recommend a treatment for you:

• The type of breast cancer you have
• The size of your tumor and how far the cancer has spread in your body, called the stage of your disease
• Whether your tumor has things called receptors for HER2 protein, estrogen, and progesterone, or other specific features.

Your age, whether you’ve gone through menopause, other health conditions you have, and your personal preferences also play a role in this decision-making process.

Some treatments remove or destroy the disease within the breast and nearby tissues, such as lymph nodes. These include:

Surgery. For most people, the first step is to take out the tumor. An operation called lumpectomy removes only the part of your breast that has cancer. It’s sometimes called breast-conserving surgery. In a mastectomy, doctors remove the whole breast. There are different types of mastectomies and lumpectomies.

Radiation therapy. This treatment uses high-energy waves to kill cancer cells. Most women under age 70 who have a lumpectomy get radiation, too. Doctors also might recommend this method if the disease has spread. It helps destroy any cancer cells that the surgeon couldn’t remove. Radiation can come from a machine outside your body, or you might have tiny seeds that give off radiation placed inside your breast where the tumor was.

Chemotherapy uses drugs to kill cancer cells. You take the medicines as pills or through an IV. Most people get it after surgery to kill any cancer cells left behind. Doctors also prescribe it before surgery to make tumors smaller. Chemo works well against cancer, but it also can harm healthy cells.

Hormone therapy uses drugs to prevent hormones, especially estrogen, from fueling the growth of breast cancer cells. Medicines include tamoxifen (Nolvadex) for women before and after menopause and aromatase inhibitors including anastrozole (Arimidex), exemestane (Aromasin), and letrozole (Femara) for postmenopausal women. Some types of this therapy work by stopping the ovaries from making hormones, either through surgery or medication. Fulvestrant (Faslodex) is an injection that keeps estrogen from attaching to cancer cells.

Targeted therapy such as fam-trastuzumab-deruxtecan-nxki (Enhertu), lapatinib (Tykerb), pertuzumab (Perjeta), and trastuzumab (Herceptin) trigger your body’s immune system to help destroy cancer cells. These medicines target breast cancer cells that have high levels of a protein called HER2. T-DM1, or ado-trastuzumab emtansine (Kadcyla), is a medicine that combines Herceptin and the chemotherapy medicine emtansine to target HER2-positive cancer cells. Abemaciclib (Verzenio), palbociclib (Ibrance), and ribociclib (Kisqali) are often used with an aromatase inhibitor or fulvestrant (Faslodex), in women with certain types of advanced cancer. Abemaciclib (Verzenio) can be used alone in women who have already been treated with hormone therapy and chemotherapy. Alpelisib (Piqray) is a PI3K inhibitor that treats breast cancer in men and women who have a certain gene change resulting from treatment with hormonal therapy. Neratinib (Nerlynx) also works against HER2-positive breast cancer by blocking the cancer cells from getting growth signals. A new class of drugs called PARP (poly ADP ribose polymerase) inhibitors targets an enzyme that feeds cancer cells. PARP inhibitors include olaparib (Lynparza) and talazoparib (Talzenna).

Immunotherapy uses your own immune system to target cancer. The drugs atezolizumab (Tecentriq) and sacituzumab govitecan-hziy (Trodelvy) have been approved to treat triple-negative breast cancer that has spread.

You might get chemotherapy, hormone therapy, or targeted therapy along with surgery or radiation. They can kill any cancer cells that were left behind by other treatments.