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SEER Training Modules

Breast Cancer Treatment

Treatment of breast cancer is among the most widely studied of all cancer therapies. New approaches to therapy and refinements in accepted regimens are constantly being evaluated and may rapidly become part of standard treatment protocols. Geographic practices also influence what is considered standard. Users should continually update their knowledge of cutting edge and standard treatment patterns.

Local control of the cancer occur more often when the tumor is small and can be completely removed by surgery. In the most advanced stages, breast cancer treatment begins with excision of the tumor or destruction of the tumor by radiation therapy. Surgery is frequently accompanied by some type of adjuvant treatment—radiotherapy, chemotherapy, hormonal therapy, immunotherapy, and other therapies.

Below is the information about treatment options by stage. The following sections will provide you with more detailed discussions about different therapies for breast cancer treatment.

Treatment Options by Stage

Intraductal Carcinoma

Total mastectomy; excisional biopsy with radiation therapy

Lobular Carcinoma in situ

Unilateral or bilateral total mastectomies with or without low axillary dissection

Stage I (negative nodes)

Excisional biopsy/lumpectomy or segmental/wedge/partial breast resection with separate axillary node dissection and radiation to breast; modified radical or total mastectomy with axillary dissection. Adjuvant chemotherapy for estrogen receptor negative patients; adjuvant tamoxifen for estrogen receptor positive patients.

Stage II

Excisional biopsy/lumpectomy or segmental/wedge/partial breast resection with separate axillary node dissection and radiation to breast; modified radical or total mastectomy with axillary dissection; radical mastecomy (if needed to accomplish complete resection of tumor). Adjuvant chemotherapy (CMF, CAF, CA+/-tamoxifen, L-PAM + 5-FU, L-PAM, 5-FU + tamoxifen, PAF, CMFVP, tamoxifen alone)

Stage IIIA (operable)

Modified radical mastectomy or radical mastectomy with either radiation or chemotherapy. Radiation could be preoperative external beam radiation or postoperative external beam radiation with a booster dose to primary site. Chemotherapy could be CMF, CA, CAF, CMFP, CMFVP, L-PAM and 5-FU with or without tamoxifen

Stage IIIB (inoperable, including inflammatory)

Incisional biopsy plus external beam radiation to primary and regional nodes, followed by boost to local area plus interstitial implants to primary. Mastectomy thereafter if technically feasible, followed by chemotherapy or endocrine manipulation. Chemotherapy could be CMF, CAF, CMFP, CA, CMFVP. Endocrine therapy could include oophorectomy, tamoxifen, progesterone or androgens.

Stage IV

Biopsy followed by external beam radiotherapy to primary or mastectomy to control local disease. Hormonal therapy if estrogen receptor positive (oophorectomy, tamoxifen or progestational agent). Chemotherapy (CMF, CAF, CMFP, CMFVP, CA)