Breast Cancer Treatment
Receiving a diagnosis of breast cancer is frightening, but you are not alone. At Houston Methodist we offer a complete range of the most advanced treatment options available, all provided in an atmosphere of warmth, compassion and caring to help you through this difficult time.
Receiving your diagnosis is the beginning of a new journey. You will meet with your doctors to discuss the details of your cancer and to develop a treatment plan that balances your condition with your lifestyle and your preferences. At every step in this process, you will be encouraged to ask questions — the doctors, nurses and staff at Houston Methodist are always available to help provide clarification, advice and a sympathetic ear.
The first step will be to determine what type of cancer you have (different cell types respond differently to treatment) and what stage your cancer is (how advanced and if or where it has spread). The stage and the type of cancer you have will determine your treatment plan. The breast care team works together to determine a treatment plan tailored to your individual needs. As you and the team make decisions about your treatment plan, your breast care navigator will be with you every step of the way to make sure you and your family fully understand each step of the process.
Once breast cancer has been diagnosed and staged, your oncologist at Houston Methodist may recommend one or more of the following treatments:
Types of Breast Cancer
Cancer can arise from many different types of cells and/or tissues within the breast, and the responses to treatment may be very different from one type to another.
- Ductal Carcinoma In Situ (DCIS) - DCIS is a common type of non-invasive breast cancer. Breast cancer cells are located in the lining of the milk ducts and have not yet invaded nearby tissue.
- Lobular Carcinoma In Situ (LCIS) - LCIS is not a true cancer but is sometimes classified as a non-invasive breast cancer. It is located in the lobules (milk producing organs) and has not invaded nearby tissue. Women who have had LCIS have a higher chance of developing an invasive breast cancer and need closer monitoring.
- Infiltrating Ductal Carcinoma (IDC) is also referred to as invasive ductal carcinoma and is the most common type of breast cancer. This type of cancer starts in the milk ducts and grows into the fatty tissue of the breast. This cancer has the potential to spread to other parts of the body through the lymphatic system or the bloodstream.
- Infiltrating Lobular Carcinoma (ILC) is also referred to as invasive lobular carcinoma. This type of cancer starts in the lobules (milk producing organs) and much like IDC, has the potential to spread to other parts of the body.
- Inflammatory Breast Cancer (IBC) is a less common type of invasive cancer that does not produce any lumps or tumors. Instead, it makes the skin of the breast look red and feel warm. The breast may become larger and more tender. Because of these changes, it is often initially treated as an infection. If antibiotics do not help, the skin may be biopsied to identify cancer cells. This type of cancer is hard to detect in its early stages because there are no lumps and mammograms may not show any abnormalities.
Other Characterization of Breast Cancer
- Hormone receptor-positive breast cancer — This type of cancer has receptors for estrogen or progesterone. In hormone receptor-positive breast cancer, the hormone estrogen causes the breast cancer cells to grow.
- HER2-positive breast cancer — HER2 (human epidermal growth factor receptor 2) refers to a protein that promotes cancer cell growth. In this type of cancer, a gene mutation causes an excess of the HER2 protein and the breast cancer cells grow faster.
- Hormone receptor-negative plus HER2-negative breast cancer — Also known as triple-negative breast cancer, the cancer cells lack estrogen receptors and progesterone receptors and do not have an excess of the HER2 protein on their surfaces. This type of cancer typically spreads faster than other invasive cancers and is more common in younger women and in African American women.
The treatment plan that you and your breast care team decide on will depend on the type of cancer you have.
Stages of Breast Cancer
The staging process is important in creating the best possible treatment plan for you. When staging breast cancer, your doctor will perform exams and tests to look at three primary factors — the size of the tumor, if cancer has spread to the lymph nodes and if the cancer has spread to other parts of the body.
There are three basic phases of breast cancer.
- Early breast cancer is typically stages 0 and 1. In early breast cancer, the tumor is fairly small and the cancer cells have not spread outside of the breast tissue.
- Locally advanced breast cancer is typically stages 2 and 3. At this point, the tumor may be a little larger and the cancer cells may have spread to the underarm lymph nodes.
- Metastatic breast cancer is typically stage 4. The cancer cells have spread to other organs and tissues in the body.
After determining the stage of your breast cancer, you and your breast care team will design a treatment plan that is tailored to fit your individual needs.
For more information about the stages of breast cancer, visit the National Cancer Institute.
The following tests and procedures may be used in the staging process:
- Chest X-ray
- Computed tomography (CT) scan
- Breast magnetic resonance imaging (MRI)
- Bone scan
Your breast care team will select the appropriate tests needed to determine the stage of your breast cancer. As part of your treatment, you and your breast surgeon will develop a surgical plan that may include both breast surgery and lymph node surgery.
The two surgeries will be completed at the same time; however, they are referred to as individual surgeries because there are several possible combinations of the two surgeries.
- Lymph Node Evaluation - Breast cancer tumors can shed cancerous cells into the nearby lymph nodes. Your breast surgeon may remove lymph nodes to be examined under the microscope. Identifying the presence or absence of cancer cells in the lymph nodes is an essential part of the staging process and aids in creating a treatment plan.
- Sentinel Lymph Node Biopsy - This is a diagnostic procedure to identify if there is cancer in the lymph nodes. Sentinel lymph nodes are closest to the tumor site. They drain lymphatic fluid from the area around the breast, which is the reason they are more likely to contain breast cancer cells. A patient will usually have one to four sentinel nodes removed for testing.
- Axillary Lymph Node Dissection - This procedure is performed to remove lymph nodes that are known to have cancer. Typically about 10 axillary (underarm) lymph nodes are removed for testing.
Breast Cancer Treatment - Surgery
A lumpectomy is an operation to remove only the lump and some surrounding tissue from the breast. A lumpectomy can be performed as either a diagnostic or treatment tool.
If the lumpectomy is being performed as a diagnostic tool, the surgeon will remove part of the tumor and some surrounding tissue. Sometimes, the surgeon will also remove lymph nodes from your axilla (underarm). The lump and the lymph nodes that have been removed will be sent off to the laboratory for testing to see what type of tumor it is and to stage the tumor.
For some types of cancer, a lumpectomy is a successful treatment option because it completely removes the tumor. The size of the lump will determine the amount of tissue surrounding the lump that needs to be removed.
For patients who have had a lumpectomy, depending on the location of the tumor and size of the breast, partial breast irradiation may be a treatment option. With this technology, breast cancer can be treated in five days instead of six to seven weeks. Candidates for this type of treatment require certain criteria, which can be identified by your doctor.
A mastectomy is the removal of the entire breast. One of the benefits of a mastectomy is that it decreases the risk of recurrent breast cancer. Patients typically stay in the hospital one or two nights following a mastectomy, with some additional recovery time once at home.
Different types of mastectomies include:
- Simple/total mastectomy - Often chosen for prevention, all of the breast tissue, areola and nipple are removed. This procedure is often combined with a sentinel lymph node biopsy.
- Modified radical mastectomy - All of the breast tissue and some of the skin of the breast, including the nipple and areola, as well as all of the axillary (underarm) lymph nodes are removed.
- Skin-sparing mastectomy - All of the breast tissue, areola and nipple are removed. However, nearly all of the breast skin is left in place, making simultaneous breast reconstruction ideal.
- Nipple-sparing mastectomy - The surgeon works through a small incision to remove the breast tissue, while leaving the nipple, areola, and all of the skin of the breast intact. The results of breast reconstruction are best with this type of mastectomy because the patient retains her nipple and areola.
It is possible for women to have breast reconstruction surgery at the same time as a mastectomy. This is called immediate reconstruction, but is not recommended for all women. Women who cannot have immediate breast reconstruction can have delayed reconstruction weeks to years after their mastectomy. Breast reconstruction can be done using your own natural tissue from your belly, buttocks or back, or with an implant.
Breast reconstruction surgery is not considered cosmetic surgery. Breast reconstruction is performed to restore a breast that has been removed by a mastectomy or distorted following lumpectomy and radiation. Studies have shown that breast reconstruction improves the well-being and self-esteem of women. Breast reconstruction is considered an integral part of breast cancer treatment. For this reason, federal law mandates insurance coverage of breast reconstruction following a mastectomy.
It is best for you to discuss your decisions for reconstruction with your surgeon and breast care team. Each procedure has advantages and the decision will depend on your body type and current treatment.
Radiation therapy may be used to destroy cancerous cells in specific areas. Radiation oncologists precisely calculate the amount of radiation used and the locations where it will be delivered, making sure patients are not exposed to any unnecessary or dangerous radiation levels.
Houston Methodist offers a variety of leading-edge radiation oncology options that mean we can deliver powerful cancer treatment with pinpoint accuracy and precision. Radiation is the best way to kill residual breast cancer cells after surgery, and the latest technologies reduce the side effects of radiation.
Intensity-Modulated Radiation Therapy (IMRT)
IMRT is considered the ideal form of treatment by many radiologists because of its accuracy and power. Advantages of IMRT include minimized side effects, minimized radiation to healthy tissue and higher radiation dosage to cancerous cells. Houston Methodist was the first in the nation to provide IMRT.
High-Dose Rate Brachytherapy
High-dose rate brachytherapy allows for shorter treatment time and less radiation exposure to healthy tissue by placing a temporary radioactive source in or near the area to be treated. This ensures that large doses of radiation are delivered to cancer tissue in short periods of time — five days compared with the traditional six weeks — while minimizing exposure to healthy tissue.
In general, radiation therapy side effects can include hair loss, skin pain, fatigue, changes in taste, loss of appetite and nausea. These side effects depend on the part of the body receiving radiation, the dose of radiation and the frequency of therapy. If radiation therapy is included in your treatment plan, your breast care team will discuss possible side effects with you.
Chemotherapy is a general term for the use of medications to treat cancer. The breast care team at Houston Methodist offers a complete spectrum of chemotherapy medications, including today's most advanced forms. Many forms of today’s chemotherapy have few troublesome side effects, helping to make the process of receiving chemotherapy easier than it once was.
If chemotherapy is part of your treatment plan, your breast care team will discuss the medications, any side effects and the way in which you will take the medication. Some chemotherapy is delivered in pill form; other chemotherapy drugs are administered intravenously.
Hormone therapy is most commonly used to help reduce the risk of cancer recurrence after surgery. It can also be used to treat cancer that has returned after treatment or for cancer that has spread. Most breast cancers are sensitive to the hormone estrogen (estrogen receptor-positive cancers) and the hormone progesterone (progesterone receptor-positive cancers). Blocking the effect of estrogen or lowering estrogen levels can be used to treat hormone receptor-positive breast cancers.
Targeted therapy uses drugs that have the ability to target certain genetic changes in cells that cause cancer. Most often, targeted therapy is used in treatment in conjunction with chemotherapy and is typically administered in your oncologist's office. Read more about breast cancer treatment.
Our physicians at Houston Methodist specialize in breast cancer treatment at the following convenient locations: