What is your breast cancer treatment plan? The key factor used by the doctor to decide

The diagnosis of breast cancer carries many questions and fear. One of the first is, “What treatment will I need?”

The short answer is: usually the + operation depends. Your treatment must be personalized for you and your specific cancer.

Read on to review the factors that your team might consider when they build your treatment plan, plus what they mean.

Note that this is a general review and does not cover every nuance involved in treatment. Your treatment plan can end differently from what you read here. Your personal preference also affects your plan.

Do I need surgery for breast cancer?

Most breast cancer is treated with surgery, namely: good:

• Lumpctomy: Only eliminate cancer and small edges healthy tissue around it, leaving most of the breasts in its place; usually followed by radiation to kill the cancer that is left behind
• Mastectomy: Remove all breasts; Other treatments may also be needed

Your team may not recommend surgery If you have:

• Stage 4 Metastatic cancer: Your cancer has spread to distant organs, such as the lungs or brain; Main breast tumors are usually only removed with surgery if it causes pain, bleeding, or infection
• Inflammatory breast cancer: Chemotherapy is used first; Surgery can be passed if the tumor does not respond to chemotherapy
• Serious health condition: You may not be healthy enough for surgery
• Broad local diseases: The tumor is too large or has invaded the nearby structure; Chemo or other therapies can be used first to shrink the tumor; Surgery may be passed if the tumor does not shrink
• Lobular carcinoma in situ: Not true cancer – more than risk markers; often managed by monitoring and/or oral drugs rather than surgery

Personal factors in breast cancer treatment

Your oncologist will consider these personal factors:

• Your age and overall health: Helps determine which treatment you can tolerate
• Menopause Status: Whether you are close or have gone through menopause to influence decisions about hormone therapy
• Genetic Mutations: Including BRCA1, BRCA2, and other mutations that can affect treatment
• Personal preferences: Some patients prioritize more aggressive treatment, while others focus on minimizing side effects

How your specific cancer affects treatment

These factors about your specific cancer also determine your treatment.

Type of breast cancer

Invasive (infiltration)

Breast cancer has spread from the original channel or lobules to the surrounding breast tissue. There are 2 types:

• Invasive Ductal Carcinoma (IDC): The most common type of invasive (around 80% of cases); Starting in the milk channel and growing into the surrounding breast tissue
  What does it mean: Surgery + Possible radiation, chemo, hormone therapy, and/or targeted therapy
• Invasive lobular carcinoma (ILC): Starting in the milk -producing glands (lobules)
  What does it mean: Similar to IDC; Hormone therapy often occurs because most ILC is a positive hormone receptor

Non-invasive (in situ)

Breast cancer has not spread outside the channel or lobules. There are 2 types:

• Ductal Carcinoma in Situ (DCIS): Cancer is in the milk channel but has not yet invaded the surrounding tissue
  What does it mean: Surgery + radiation + possible hormone therapy; often considered very treated
• Lobular carcinoma in situ (LCIS): Abnormal cells in lobules; not considered true cancer but increases the risk of invasive breast cancer in both breasts
  What does it mean: Cover monitoring + possible prevention drugs, or surgery

Less common type

• Inflammatory breast cancer (IBC): Rare and aggressive types in which cancer blocks lymphatic vessels in the skin of the breast, causing redness, swelling, and warmth
  What does it mean: Treatment usually starts with chemotherapy, then surgery + radiation (the opposite of the first normal operating approach)
• Paget’s disease from the nipple: Rare cancer involving the skin of the nipple and areola, is often associated with the underlying DCIS or IDC
  What does it mean: Surgery + Possible Radiation + Other Treatment
• Triple-negative breast cancer (TNBC): Has no estrogen, progesterone, or her2 receptors
  What does it mean: Surgery + chemo is the main treatment; Chemotherapy can be given before surgery if the tumor is greater than 2 cm or lymph nodes are involved; Hormones and therapy targeted HER2 will not be effective

Cancer stage

• Stage 0 (in situ): Only in channels or lobules; does not attack the surrounding tissue
  What does it mean: Usually surgery + possible chemo and/or hormone therapy
• Stage I: Small invasive cancer (2 cm or smaller); No or minimal lymph node involvement
  What does it mean: Surgery + Possible radiation, chemo, hormone therapy, and/or targeted therapy HER2
• Stage II: Larger tumors (2-5 cm) and/or spread to several lymph nodes nearby
  What does it mean: Surgery + radiation + chemo + possible hormone therapy and/or possible target therapy Her2
• Phase III: Larger tumors (more than 5 cm), extensive lymph nodes, or cancer in the skin/chest wall
  What does it mean: Often chemotherapy first, then surgery + radiation + possibly chemo after + possible hormone therapy, and/or therapy targeted HER2
• Stage IV (Metastatic): The cancer has spread (metastasis) to distant organs, such as bones, brain, or lungs
  What does it mean: The main treatment is hormone therapy; chemo + immunotherapy if the triple is negative; or target chemo therapy + her2; Surgery only if breast tumors cause pain, bleeding, or infection

Cancer level

• Grade 1 (low level/well differentiation): The cell looks quite normal, growing slowly; less aggressive
  What does it mean: May not require chemo if other risk factors are low
• Grade 2 (medium/moderate medium): Cells look more abnormal, grow faster; Middle risk
  What does it mean: Treatment depends on the stages and receptors status
• Class 3 (high side/bad): The cell looks very abnormal, growing quickly; more aggressive
  What does it mean: Kemo is more likely to be recommended, even in the previous stage

Hormone receptor status

Your cancer is possible Estrogen receptor (are+) and/or Progesterone Receptor (PR+). ER+ or PR+ means estrogen can cause cancer to grow.

What does it mean: If your cancer positive receptor hormone (IS/PER+), You might need Hormone therapy (endocrine)which blocks hormones or decreases their levels to slow down or stop the growth of cancer and can reduce the risk of cancer again; Negative hormone receptors (IS/PR-) Cancer does not respond to hormone therapy

Status of human epidermal growth factors (HER2) status

Her2 is a protein in breast cells that helps them grow and divide. Your cancer can:

• Positive her2: Cancer cells make too much HER2, which makes them grow faster; This cancer tends to be more aggressive
• Negative Her2: Normal level her2

What does it mean: Her2+ cancer can be treated with Targeted therapy her2 which blocks this protein; usually given in a combination with chemotherapy

Genomic testing

Genomic testing see the activity of specific genes in your cancer. General tests include Oncotype Dx or Mammaprint.