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Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising. This information represents the views of the doctors and nurses serving on the American Cancer Society's Cancer Information Database Editorial Board. There are two types of Stage 0 Breast Cancer: Lobular Carcinoma in Situ (LCIS) and Ductal Carcinoma in Situ (DCIS). The tumor is Stage I Breast Cancer is no larger than three-quarters of an inch (approximately 2cm) across. A Stage II tumor is typically between 2cm to 5cm (three-quarters of an inch to 2 inches) across. Various chemicals such as arsenic, aflatoxin, vinyle chloride, and benzene show definite evidence of causing human cancers. The Breast and Cervical Cancer Prevention and Treatment Act of 2000 gives states the option to provide treatment through Medicaid to eligible women who were screened for and found to have breast or cervical cancer, including precancerous conditions, through the National Breast and Cervical Cancer Early Detection Program (NBCCEDP).
For Californians diagnosed with breast cancer, free treatment is available to all who qualify through the Breast and Cervical Cancer Treatment Program. Five main types of therapies are available for the treatment of breast cancer: surgery, radiation therapy, chemotherapy, hormone therapy, and targeted therapy.
Most patients are treated with surgery as the main therapy in combination with one or more additional therapies for optimal cancer management. A Woman’s Guide to Breast Cancer Treatment, developed by the California Department of Public Health, Cancer Detection Section, is a valuable guide intended to help a woman become an informed partner in making choices with her health care team.
In March 2006, the state of California passed a law requiring physicians to provide this booklet to patients diagnosed with cancer. Breast conserving surgery (BCS) removes the cancer and a surrounding margin of normal breast tissue, while saving most of the breast.
The goal for all breast conserving procedures is to remove the entire breast cancer with a margin that is free of tumor invasion while saving as much of the breast as possible. For patients with invasive breast cancer, BCS is almost always followed with radiation therapy. For women with early-stage breast cancer, clinical studies have demonstrated similar survival rates with BCS plus radiation therapy as for mastectomy but with better cosmetic results.6 BCS is usually performed as an outpatient procedure under general or local anesthesia.
The most common type of mastectomy performed today is the total mastectomy. The skin-sparing mastectomy preserves most of the skin of the breast (not including the nipple and areola) and is used when the patient plans to have immediate breast reconstruction. The nipple-areolar sparing mastectomy preserves the skin of the nipple but removes the major ducts of the nipple lumen. All women undergoing a mastectomy should be informed of their options for breast reconstruction prior to surgery.
Lymph nodes are removed and analyzed, usually during the BCS or mastectomy, to help determine whether cancer has spread past the breast and to guide the course of therapy. The two primary methods of lymph node removal are axillary lymph node dissection (ALND) and sentinel lymph node dissection (SLND).
Axillary lymph node dissection (ALND) is a procedure in which multiple lymph nodes are surgically removed from under the arm and microscopically examined for evidence of cancer. If there is no cancer in the sentinel nodes, it is highly unlikely that the cancer has spread to other lymph nodes, so no further lymph node surgery is needed. Radiation therapy uses high-energy X-rays or other types of radiation to destroy cancer cells.
When used before surgery, radiation is referred to as neoadjuvant or preoperative radiation.
There are three main delivery methods with radiation therapy: external beam, brachytherapy, and intraoperative. Brachytherapy places a radioactive source inside the body close to the site of the surgical removal or into the tumor mass. Intraoperative radiation therapy delivers a single dose of radiation on the same day as a patient’s surgery with a goal of minimizing toxicity while maintaining effectiveness.
Whole breast radiation therapy (WBRT) targets the entire breast using external beam radiation.
Accelerated partial breast irradiation therapy (APBI) is a form of radiation therapy in which focused radiation is delivered only to the area immediately surrounding the tumor site instead of the whole breast. In contrast to radiation therapy and surgery, which are local therapies, chemotherapy is a systemic mode of treatment that affects tissues and organs throughout the entire body. The most common drugs used for breast cancer chemotherapy combination treatment include anthracyclines, such as doxorubicin (Adriamycin) and epirubicin (Ellence) and the taxanes such as paclitaxel (Taxol) and docetaxel (Taxotere).12 For a full listing of chemotherapy agents and their recommended use, see the National Comprehensive Cancer Network Guidelines for Breast Cancer. Chemotherapy is most often delivered intravenously through a catheter placed into a vein on the hand or lower arm. Chemotherapy is administered in cycles, with each cycle of treatment usually followed by a rest period. The side effects of chemotherapy depend on the types of drugs used, the dosages, and the duration of treatment.
Hormone therapy is a cancer treatment that either removes hormones or blocks their action in order to stop cancer cells from growing. Hormone therapy (also called endocrine therapy) is a cancer treatment that either removes hormones or blocks their action in order to stop cancer cells from growing.
Tamoxifen is a SERM used for treating breast cancer with both pre- and post-menopausal women, in early and advanced disease, and with invasive and noninvasive types of breast cancers. Tamoxifen is also used effectively for decreasing the likelihood of breast cancer in women at high risk. Raloxifene, also a SERM, is an effective alternative to tamoxifen for postmenopausal women at increased risk and has fewer side effects. Androgens are male hormones that are occasionally used for the treatment of advanced breast cancer after other hormone treatments have failed. Estrogens in high doses are another option sometimes considered for advanced breast cancer that is not responsive to other hormone therapies.
Targeted therapy is directed at specific targets in the body (cellular receptors, proteins, and enzyme systems) to help fight cancer. Trastuzumab (Herceptin), a monoclonal antibody, has been used since 1998 to treat certain cases of advanced breast cancer by targeting cancer cells that make excessive amounts of the protein HER2.
Ado-trastuzumab emtansine (TDM-1, Kadcyla) is made up of the same monoclonal antibody as trastuzumab and is attached to a chemotherapy drug known as DM-1.
Pertuzumab (Perjecta) is also a monoclonal antibody that attaches to the HER2 protein but seems to target a different part of the protein than trastuzumab. Each of these drugs has potentially serious side effects, including heart muscle damage and allergic reactions.
Many studies have found HER2 targeted therapies to be highly effective in the treatment of HER2-positive early stage and metastatic breast cancer.

Everolimus blocks mTOR, a protein in the cells that normally promotes cell growth, which can help stop cancer cells from growing. Bevacizumab is a monoclonal antibody that targets vascular endothelial growth factor, a protein that helps tumors form blood vessels. All aspects of breast cancer management - screening, prevention, diagnosis, and treatment - are researched in clinical trials. Clinical trials are research studies that test new medical approaches with volunteer patients. There are three phases of clinical trials in which a treatment or method is studied before it can be approved by the FDA for widespread use. Phase I trials test an experimental drug or treatment in a small group of people (15-30) for the first time to determine a safe dosage range, to decide how a new treatment should be given, and to see how the treatment affects the human body.
Phase II trials study the drug or treatment with a larger group of people (less than 100) to determine whether it is effective and to see how it affects the human body.
Many patients with breast cancer will learn about clinical trials from their oncologists, surgeons, radiologists, and other medical specialists on their cancer care team. NCI's Clinical Trials Registry contains abstracts of clinical trials that have been completed or closed. provides regularly updated information about federally and privately supported clinical trials.
The American Cancer Society Clinical Trial Matching Service is designed with a user-friendly question and answer format for patients and their caregivers.
The American Association for Cancer Research identifies clinical trials that match specific diagnosis, stage, and treatment history. Our medical and scientific professionals have devoted their lives to developing aggressive breast cancer treatment protocols that are both effective and noninvasive.
Stage I is considered an early stage invasive cancer, although cancer cells have not yet spread to other parts of the body. New Hope Unlimited’s treatment strategy for Stage IV cancer focuses on each cancer site individually in order to effectively reduce symptoms and improve the patient’s quality of life during recovery.
Complementary therapies are also available to help patients manage symptoms and side effects with treatments (See Complementary Therapies).
The guide can be dowloaded or ordered in English, Chinese, Japanese, Korean, Russian, Spanish, Tagalog, and Vietnamese through the Medical Board of California. The type of surgical procedure depends upon a number of factors, including the size and location of the tumor, the type and stage of the breast cancer, the size of the breast, and a woman's personal preference.
The lumpectomy, including any possible re-excisions, must be able to remove all of the cancer. It is usually recommended for women with more advanced breast cancer or for women who otherwise do not meet criteria for breast conserving surgery.
Also called the Halsted mastectomy, this procedure involved the removal of the breast, all surrounding lymph nodes, and the underlying chest muscles.
The procedure involves the removal of the breast, nipple, areola, and a variable amount of the skin of the breast.
The American Cancer Society (ACS) offers a Reach to Recovery program that relies on carefully selected, trained survivors to help women cope with treatment-related issues. The initial method used depends upon whether spread to the lymph nodes is suspected prior to surgery.
These nodes, called the sentinel lymph nodes (usually two or three), are then removed and checked for cancer. If the sentinel nodes are positive for cancer, some patients will require a complete ALND. It may be used before surgery, after surgery (breast conserving surgery or mastectomy), and as palliative care. Neoadjuvant radiation aims to reduce the size or extent of a tumor prior to surgery in order to make complete removal more likely.
This type of radiation therapy reduces the risk of recurrence and increases survival and is recommended for most women who have undergone breast conserving surgery.
APBI delivers a higher dose of radiation over a shorter period of time and can be delivered via external beam radiation, brachytherapy, or intraoperative radiation. Other temporary side effects include swelling or heaviness in the breast, sunburn-like changes in the skin, and loss of appetite. It is the role of the medical oncologist to determine which combination of drugs will be used and their order, dose, and frequency. Another resource is the National Cancer Institute’s Cancer Drug Information page, which lists drugs approved by the FDA for breast cancer.
It can also be delivered by IV through ports and pumps or injected into the muscle (intramuscularly) or under the skin (subcutaneously).
Cycles are usually 2 or 3 weeks long but vary according to the drug or combination of drugs. This form of therapy is based upon the recognition that estrogen and progesterone stimulate the growth of breast cancer cells.
It is approved for the prevention of breast cancer in postmenopausal women with osteoporosis at high risk for invasive breast cancer, but is not currently utilized as a breast cancer treatment. Also called ovarian suppression, this form of therapy is used with premenopausal women, in whom ovaries are the main source of the body's estrogen. The primary side effects are the development of masculine characteristics such as body hair and a deeper voice.
Other terms used for this type of therapy are biological response modifier therapy and biological therapy. This drug has been widely used for treatment of metastatic triple negative breast cancer, but has serious side effects including high blood pressure and blood clots. A number of organizations offer detailed treatment guidelines for practitioners and patients according to the stage of the breast cancer. When talking with patients about the potential benefits and risks of participation, health providers should thoroughly explain the purpose of the trial, the type of tests and treatments involved, and how these compare with the standard approaches. Primary care providers can also help connect the patient with appropriate clinical trial information by knowing about several key registries available online.
Most studies within the database are sponsored by NCI but the registry also includes trials sponsored by pharmaceutical companies, medical centers, and other groups from around the world. Cancer trials registered with NCI will automatically be registered in and vice versa, but users may prefer the unique search features of one source over the other. Registration is required; however, all information is held confidential and the matching service is free of charge.
If a match is found, the AACR will assign the patient a Clinical Trials Navigator to connect the patient with the trials and locations that are most appropriate and convenient. Even though a diagnosis of LCIS in one breast increases the risk of cancer for both breasts, the cancer is usually noninvasive.

The modified radical mastectomy includes complete removal of the breast and the underlying fascia of the chest muscles, along with the removal of the level I and II axillary lymph nodes.
Total mastectomy preserves the pectoral muscles and the axillary contents with the use of a sentinel lymph node dissection. If the nodes are clinically suspicious, then a needle biopsy of the nodes may be performed. This is now the preferred procedure for patients without suspected lymph node involvement because it poses a lower risk of side effects than ALND. This method targets a precise beam of radiation to the area of the body affected by cancer with minimal impact on adjacent tissues. Interstitial brachytherapy delivers radiation through small, hollow catheters inserted directly into the tissue in the area where the cancer was removed.
Chemotherapy may also be used as the primary treatment for managing metastatic or recurrent breast cancer. Adjuvant and neoadjuvant chemotherapy is generally given for a total time period of 3 to 6 months, depending on which drugs are used.
Common side effects are nausea and vomiting, hair loss (alopecia), and fatigue (sometimes due to low red blood cell counts).
When this action is interrupted, the cancer cells that depend upon these hormones stop growing and die.
In addition, women at high risk of developing breast cancer may be offered hormone therapy as an effective method of risk reduction.
In premenopausal women, this group of drugs is ineffective since most of their estrogen is produced from the ovaries. Traditionally, ovarian ablation involves surgery (oophrectomy) or radiation, but ovarian produced estrogen can now be suppressed by drugs called luteinizing hormone-releasing hormone (LHRH) agonists, such as goserelin. This drug seems to help hormone therapy drugs work better and is approved for hormone receptor-positive, HER2- negative, breast cancer in postmenopausal women whose cancers have grown while being treated with letrozole or anastrazole.
They are also helping others by contributing to research that may lead to significant medical advances. Patients considering participation will also need to know how long the trial will last, how often and where treatments will be administered, who will be in charge of their care during the trial, and what the long-term follow-up will be.
This tool can be used to find individually tailored information on clinically appropriate, open and enrolling trials.
At the patient's request, an ACS Information Specialist will contact the patient by phone or by email with additional information about one or more trials. Breast cancer can negatively affect not only your physical health, but also your emotional and spiritual well-being. Some females may have a history of pain with no mass; however, this presentation is less common. Biopsy: the removal and examination of a small piece of tissue from the living body to determine if cancer cells are present. For patients with invasive breast cancer, surgery is usually paired with an axillary lymph node or sentinel lymph node dissection for pathological staging and to help guide additional treatment decisions. The total mastectomy has been proven equally effective for treating breast cancer and is less disfiguring. Intracavitary brachytherapy uses a small catheter which is inserted into the space left after breast conserving surgery.
It is frequently used to treat postmenopausal women with advanced cancer who no longer respond to tamoxifen. Hormone agonists work by inhibiting the signaling of LHRH, so that the body's production of estrogen is reduced. If financial costs are involved, patients need to know whether or not such costs are covered by insurance, and if not, whether financial aid is available. Trastuzumab in the adjuvant treatment of early-stage breast cancer: a systematic review and meta-analysis of randomized controlled trials. We are dedicated to standing with you in the fight against breast cancer, but we are also here to support you in any other way we can.
Although the abnormal cells found in DCIS have not yet moved to the other breast tissue, the cancer can become invasive if left untreated. The following are possible breast cancer symptoms, breast enlargement, a thickening in the breast tissue, or nipple dimpling, nipple discharge, nipple erosion or ulceration, lymph node enlargement around the breast area or under the arms. It is generally administered five times per week for five to seven weeks, and treatments usually last less than 30 minutes. For both methods, the catheters are left in place for several days and radioactive pellets are inserted for short periods of time each day and then removed.
Treatment approach to metastatic hormone receptor-positive breast cancer: endocrine therapy. New Hope Unlimited offers individualized treatment programs that focus on eliminating the tumor, rebuilding the immune system, and promoting overall wellness throughout the recovery process.
Extended radical mastectomy: radical mastectomy with removal of the ipsilateral half of the sternum, a portion of the ribs, and the internal mammary lymph nodes.
A woman's characteristics, including age, menopausal status, and overall health are also key considerations.
The most effective orthodox or alternative treatment for cancer is early treatment.Possible Risk Factors of Breast CancerThe risk for breast cancer increases with age.
Finally, appropriate treatment will take into account the personal preferences of a patient who has been fully informed of all her options.
Worldwide breast cancer tendency rates appear to correspond with variations in diet, especially a high fat intake diet and high alcohol intake. Lumpectomy: a surgical excision or removal of only the palpable lesion or mass in the breast. The BRCA 1 and BRCA 2 genes are inherited genes and account for only about 3% of breast cancers. If a woman has already had cancer in one breast, she should be aware that she has an increased risk for getting cancer in the other breast. Women with early periods (menarche), late menopause, and late first pregnancy are at increased risk.
Modified radical mastectomy: a total mastectomy with axillary node removal but leaving the pectoral muscle.

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