Breast Cancer Treatment
Breast cancer is primarily treated with surgery and often combined with chemotherapy, radiation therapy or both. It may also include other treatment options like targeted therapy, proton therapy and angiogenesis inhibitors. We will develop a comprehensive treatment plan unique to you.
Surgery
Many patients undergo some form of surgery as part of their breast cancer treatment.
Some will receive chemotherapy or targeted therapy before surgery. The goal of these treatments is to shrink the tumor and affected lymph nodes to make the procedure and recovery easier on the patient. This also allows the treating team to assess how cancer has responded to treatment, which can be important for some breast cancer subtypes.
There are two categories of breast cancer surgery:
Lumpectomy
In a typical lumpectomy surgery, the tumor and a small amount of surrounding normal tissue are removed. This procedure may be appropriate for early breast cancer cases where the tumor is still small. Lumpectomies are generally outpatient procedures and have shorter recovery times. These procedures are usually followed by radiation therapy.
Mastectomy
In a typical mastectomy surgery, the tumor and the entire breast are removed. There are several different types of mastectomies, including procedures that spare the breast¡¯s skin and nipple/areola. Often a mastectomy and breast reconstruction can be performed in the same procedure.
In some cases, both breasts are removed (double mastectomy). This can help prevent the development of new breast cancer. It is typically done for patients who have an elevated risk of developing breast cancer due to family history or their own genetic profile, such as a BRCA mutation.
In both lumpectomies and mastectomies, surgeons may also remove nearby lymph nodes. Breast cancer can spread through nearby lymph nodes. Doctors will study the ones that are removed to determine if there are cancer cells within the nodes. This information can help determine the risk of the disease spreading to distant organs, as well as the need for chemotherapy and radiation therapy.
Like all surgeries, breast cancer surgery is most successful when performed by a specialist with a great deal of experience in a particular procedure. MD Anderson¡¯s breast cancer surgeons are among the most skilled and renowned in the world. They perform a large number of surgeries for breast cancer each year, using the least-invasive and most-effective techniques. At the start of treatment, care teams assess if the patient needs reconstructive surgery. If so, our breast cancer surgeons and reconstructive surgeons work together to plan procedures that minimize incision and possible scarring. Their goal is to achieve the most effective surgery and the best possible cosmetic outcome and symmetry.
Chemotherapy
Chemotherapy uses powerful drugs to directly kill cancer cells, control their growth or relieve pain. It is often given to patients before surgery to shrink the tumor and simplify the procedure. Breast cancer patients can receive chemotherapy either orally or intravenously.
Radiation therapy
Radiation therapy uses powerful beams of energy carefully designed to kill breast cancer cells.
For breast cancer patients, radiation therapy can be used before surgery to shrink large tumors and make the surgery easier on the patient. Radiation therapy can also be used after surgery to kill any remaining breast cancer cells that can¡¯t be seen by the naked eye. After a lumpectomy, patients often receive three to four weeks of daily radiation therapy. In some cases, one to two weeks may be appropriate. When the lymph nodes are involved or a mastectomy is performed, patients usually need six weeks of daily radiation therapy.
In metastatic breast cancer cases, radiation therapy can also be used as a palliative treatment to reduce symptoms caused by cancer spreading to other parts of the body and improve the patient¡¯s quality of life.
There are different techniques used in radiation therapy. Your doctors and radiation oncologist will collaborate to make sure you receive the most effective and precise dose of treatment. Radiation therapy treatments for breast cancer patients include:
3D conformal radiation therapy
This technique uses radiation beams that are shaped to the tumor¡¯s dimension.
Intensity-modulated radiation therapy
IMRT uses multiple beams of radiation with different intensities to deliver a precise, high dose of radiation to the tumor.
Volumetric arc therapy
VMAT is a special type of IMRT. In VMAT, the section of the machine that shoots out the beam of radiation rotates around the patient in an arc. This can irradiate the tumor more precisely and shorten procedure times.
Accelerated partial breast irradiation
A form of brachytherapy, APBI uses radioactive pellets or seeds to kill cancer cells that may remain after a lumpectomy.
Stereotactic body radiation therapy
Stereotactic body radiation therapy administers very high doses of radiation, using several beams of various intensities aimed at different angles to precisely target the tumor.
Stereotactic radiosurgery
Stereotactic radiosurgery is most commonly used to treat breast cancer that has spread to the brain. Stereotactic radiosurgery uses dozens of tiny radiation beams to target tumors with a precise, high dose of radiation.
At most hospitals, the radiation oncologist developing these treatments works on several different types of cancer. At MD Anderson's Breast Center, radiation oncologists are dedicated exclusively to caring for patients with breast cancer. This gives them the incredibly deep experience to draw from when designing treatment plans. Each breast cancer radiation treatment plan is also reviewed by every breast radiation oncology faculty member, ensuring that patients receive the best possible treatment.
Our physicians are recognized as world leaders in their field. MD Anderson radiation oncologists have developed radiation therapy treatments shown to deliver the most effective radiation courses in the shortest amount of time and with the fewest side effects.
Proton therapy
Proton therapy is similar to the radiation therapies described above, but it uses a different type of energy and is much more accurate at targeting tumors. It delivers high radiation doses directly into the tumor, sparing nearby healthy tissue and vital organs. For many patients, this results in better cancer control with fewer side effects.
Targeted therapy
Cancer cells rely on specific molecules (often in the form of proteins) to survive, multiply and spread. Targeted therapies stop or slow the growth of cancer by interfering with, or targeting, these molecules or the genes that produce them.
In recent years, targeted therapy has become a major weapon in the fight against breast cancer. Breast cancer subtypes that once had poor prognoses are now highly treatable.
One type of targeted therapy is endocrine therapy (also known as hormone therapy), which is given to patients with hormone receptor-positive breast cancer. This can be given before surgery to shrink the tumor. It is also given after surgery for five to 10 years to prevent a recurrence. Patients with the metastatic form of this disease are also given endocrine therapy to prevent disease progression.
Patients with HER2-positive breast cancer also receive targeted therapies. These patients may receive a different set of targeted therapy drugs both before and after surgery. Since about half of patients with HER2-positive breast cancer also have hormone receptor-positive tumors, they are also given endocrine therapy.
While there are no targeted therapies for triple-negative breast cancer, researchers are studying the disease to identify possible drug targets.
Angiogenesis inhibitors
Angiogenesis is the process of creating new blood vessels. Vascular endothelial growth factor (VEGF) is one of the main molecules that control the process. Some cancerous tumors are very efficient at using these molecules to create new blood vessels, which increases blood supply to the tumor and allows it to grow rapidly.
Researchers developed drugs called angiogenesis inhibitors, or anti-angiogenic therapy, to disrupt the growth process. These drugs search out and bind themselves to VEGF molecules, These drugs search out and bind themselves to VEGF molecules or receptor proteins, prohibiting them from activating angiogenesis.
Learn more about breast cancer:
Learn more about clinical trials for breast cancer.
Breast cancer diagnosis and treatment give employee new perspective
Crystal Futrell-Pratts has worked at MD Anderson for 23 years. While she's always felt connected to its mission, she never imagined she would have a new appreciation for MD Anderson as a patient.
Leading up to her annual mammogram in October 2020, Crystal noticed an unusual soreness and tenderness in her breasts. During her mammogram, her doctor ordered additional ultrasounds and decided to move forward with a biopsy. The biopsy results showed she had a type of breast cancer called invasive ductal carcinoma. Crystal was shocked by the news.
¡°I always have my annual mammogram, and I am diligent about reminding my friends not to miss their appointments,¡± she says. ¡°It¡¯s such a hard feeling to describe when you get a diagnosis. When you first hear the word ¡®cancer,¡¯ you want to faint, but I was ready to fight.¡±
As an MD Anderson employee, there was never a question about where she¡¯d seek treatment. She called and requested an appointment at MD Anderson.
Receiving breast cancer treatment as an MD Anderson employee
Because Crystal was undergoing treatment during the COVID-19 pandemic, she couldn¡¯t bring a caregiver with her to her appointments. She did her best to remember and process as much information as possible on her own. She also leaned on her work family within the Anesthesiology and Perioperative Medicine department.?
Breast medical oncologist Daniel Booser, M.D., now deceased, led her treatment plan, which included surgery led by , in December 2020. The following month, she started radiation therapy. Crystal has vitiligo, a chronic skin condition where patches of the skin lose color. She was concerned about how radiation therapy might impact her skin, but she was impressed with radiation oncologist , who researched how to best care for her condition. Crystal experienced minimal side effects or visible issues thanks to his expertise.
She also underwent testing to see whether chemotherapy was likely to reduce the risk of cancer returning. Her results were borderline, and after discussing her options with her care team, she decided to move forward with chemotherapy after completing radiation.
Finding neuropathy relief through scrambler therapy
Once she completed treatment in July 2021, Crystal noticed tingling in her fingers and toes, a common side effect of chemotherapy called chemotherapy-induced peripheral neuropathy. The tingling intensified to the point that her feet felt numb. She tried taking medication, but that made her feel like she was in a fog. She also tried hypnosis. Crystal started to feel hopeless because nothing seemed to relieve the neuropathy. She learned about scrambler therapy, a type of therapy , offers through MD Anderson¡¯s Pain Management Center.
Scrambler therapy mixes up (scrambles) a patient¡¯s pain signals to only permit non-pain signals to be transmitted to the brain. During the therapy, electrode patches were placed on Crystal¡¯s feet and hands, where she experiences pain. The patches are connected to a machine that sends electrode pulses to the area to interfere with the pain signal.?
Crystal¡¯s treatment required her to receive scrambler therapy for 30-45 minutes, five days in a row. Crystal¡¯s neuropathy isn¡¯t completely gone, but scrambler therapy has increased her quality of life. She experienced immediate relief once she started the treatment. While it made the most impact on her feet by removing the tingling sensation, she plans to continue to receive scrambler therapy for her hands.?
¡°Scrambler therapy is the only treatment option that has provided true relief for me,¡± she says. ¡°It is a game-changer. I want to spread the word about it because I think it could help others.¡±
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