Breast cancer treatment guide
Get the facts on risk, prevention, symptoms and treatment of breast cancer.
What is breast cancer?
Breast cancer develops when cells in the breast grow abnormally and form a tumor. Benign (noncancerous) tumors stay confined to the breast while malignant (cancerous) tumors grow into surrounding tissue or metastasize (spread) to other parts of the body.
Risk factors
Factors that can increase your risk for developing breast cancer include:
Treatment options
At each of our four breast centers, you have the focused attention of an experienced breast care team, including specialists in breast surgery, plastic and reconstructive surgery, medical and radiation oncology, radiology, pathology, cancer genetics, oncology nursing and oncology social work. You will have a nurse navigator to guide you through every aspect of your care, and all decisions are made with full support of all members of the team.
Treatment options for breast cancer include:
Surgery
- Breast cancer is often treated with surgery, either alone or in combination with other treatments. Our goal for surgery is to remove all cancerous cells while leaving as much breast tissue and skin as possible. Our experienced breast surgeons are skilled in the latest minimally invasive techniques, including sentinel node biopsy, Hidden Scar surgery and skin- and nipple-sparing mastectomies.
- There are different types of breast cancer surgery and the type you have depends on factors such as the size of your breast, the size and location of the tumor and whether the cancer has spread to the under-arm lymph nodes. The type of surgery may also depend on your personal preference. Breast reconstruction is an option following lumpectomy or mastectomy.
Medical therapies
- These treatments destroy or control cancer cells throughout your body.
- Chemotherapy uses drugs to kill cancer cells. It may be recommended before or after surgery.
- Hormone therapies are medications that prevent hormones, especially estrogen, from fueling the growth of breast cancer cells.
- Targeted therapies are medicines that target breast cancer cells that have high levels of a protein called HER-2/neu. They are given with chemotherapy or hormone therapy.
- Immunotherapy uses your own immune system to target cancer.
Radiation therapy
- Many breast cancer patients receive radiation therapy, a type of cancer treatment that uses high-energy particles and beams to destroy cancer cells. You may have radiation therapy in conjunction with other treatments such as surgery or chemotherapy. During external radiation therapy, our radiation oncologists aim high-powered X-ray beams at precise places in your body to eradicate any potential remaining cancer cells while protecting your normal surrounding healthy tissues.
- Intensity-modulated radiation therapy, or IMRT, uses sophisticated imaging and software to identify the exact size, shape and location of a tumor and to deliver a precise dose of radiation that conforms to the tumor area while protecting the normal surrounding tissue.
- The TrueBeam® linear accelerator combines imaging, beam delivery and sophisticated motion management to accurately and precisely target tumors more efficiently.
- Stereotactic body radiation therapy (SBRT) is designed to deliver radiation therapy with extreme precision to tumors anywhere in the body in five or fewer treatments.
- Internal radiation therapy, called brachytherapy, involves placement of radiation "seeds" inside the breast to eradicate any potential remaining cancer cells from within.
Diagnosing breast cancer
Screenings for breast cancer can include:
- Mammogram—The most common method of testing for breast cancer, which is a low-dose X-ray of the breast tissue.
- Breast exam—Your doctor will check for lumps or other abnormalities in your breasts and lymph nodes.
- Ultrasound—An ultrasound uses sound waves to produce a computer image of areas inside the body. It can be used to look at breast changes that may not have appeared on a mammogram. It may also be used to look at breast changes in women with dense breasts, since dense breast tissue and cancer masses can both appear white on a mammogram.
- MRI—Magnetic resonance imaging uses radio waves and magnets to produce detailed images of areas inside the body. An MRI may find cancer masses that a mammogram missed.
- Biopsy—Small tissue samples are removed from suspicious areas of the breast and examined under a microscope. After a biopsy is performed, the sample is sent to a lab where a pathologist will view it under a microscope and look for cancer cells. The pathologist will be able to identify whether cancer is present and what type of cancer it is. If your doctor determines the cancer is likely to have spread, they may order additional tests.
While an abnormal test result can bring up feelings of fear and concern, in many cases the outcome is not breast cancer. If you are diagnosed with breast cancer, however, there are many treatment approaches and therapies available to you.
Stages of cancer
A breast cancer diagnosis brings a mountain of information, which can be overwhelming. Breast cancer nurse navigators are here to provide individualized guidance and support to patients, families and caregivers throughout your treatment, from screening through survivorship. A nurse navigator is a registered nurse who acts as a liaison between you and your health care providers.
Diagnosing breast cancer includes examination of cancer cells to learn how quickly the cancer may grow, how likely it is to spread, how well certain treatments may work and how likely the cancer is to come back.
Based on these tests, breast cancer is graded as one of the following types:
- Hormone receptor positive (estrogen and/or progesterone receptor positive) or hormone receptor negative (estrogen and/or progesterone receptor negative)
- HER2/neu positive or HER2/neu negative
- Triple negative (estrogen receptor, progesterone receptor, and HER2/neu negative)
Staging, used to determine whether breast cancer has spread, is based on the size and location of the primary tumor, the spread of cancer to nearby lymph nodes or other parts of the body, tumor grade and whether certain biomarkers are present. This information helps your doctor decide which treatments will work best for your cancer.
While breast cancer staging is complex and includes many factors, it is generally grouped into the following stages:
Stage 0 – The cancer is noninvasive and there is no evidence that it has spread beyond the original site.
Stage I – Invasive cancer is broken into categories IA and IB.
- In IA, the cancer has not spread outside the breast or to the lymph nodes and the tumor is less than 2 centimeters. In IB, the cancer may be found only in the lymph nodes or in both the lymph nodes and the breast (at a size less than 2 cm).
Stage II – Stage II is invasive cancer and is broken into categories IIA and IIB. These follow the same criteria as Stages IA and IB, except that the cancers are between 2 cm and 5 cm in size.
Stage III – Stage III is invasive cancer that is broken into the following categories:
- IIIA: Cancer is found in four to nine lymph nodes under the arm or lymph nodes near the breastbone; or the tumor is larger than 5 cm and cancer is found in one to three lymph nodes under the arm or lymph nodes near the breastbone.
- IIIB: The tumor is any size and is growing into the chest wall or skin; cancer may have spread to up to nine lymph nodes under the arm; or cancer may have spread to lymph nodes near the breastbone.
- IIIC: The tumor is any size and may have grown into the chest wall or skin; cancer has spread to 10 or more lymph nodes under the arm; or cancer has spread to lymph nodes near the breastbone or collarbone.
Stage IV – Stage IV is invasive cancer that has spread to other areas of the body such as other organs, distant lymph nodes, skin or bones. This stage is also known as metastatic or advanced stage breast cancer.
These stages are general and oftentimes cancer may exhibit characteristics of multiple stages. Once a stage has been determined, your doctor can formulate the right treatment plan.
- Being female—Women have a significantly higher risk, but men can also develop breast cancer.
- Age—Breast cancer is more likely to occur in women aged 55 and older. Your chance of developing breast cancer increases as you age.
- Genetics—If you have inherited a BRCA1 or BRCA2 gene mutation, you’re at higher risk for developing breast cancer. BRCA1 and BRCA2 mutations also signal a greater chance of developing breast cancer at a younger age and in both breasts. Other gene defects also can increase your risk.
- Family history—Having a mother, sister or daughter who has had breast cancer (especially if they were diagnosed at a young age) almost doubles your risk of developing the disease. Having an additional family member or a father or brother with breast cancer also increases risk.
- Personal history—If you have previously been diagnosed with breast cancer, you have a higher risk of developing it again (either in the same or opposite breast). If you had radiation therapy to the chest for another cancer, especially as a teen or young adult, you are at higher risk for breast cancer.
- Menstrual history—If you started menstruating early (before age 12) or stopped menstruating (menopause) after age 55, the extra exposure to estrogen and progesterone hormones can lead to an increased risk of developing breast cancer. There may also be a link between hormone replacement therapy and breast cancer.
- Pregnancy history—Women who have never had a full-term pregnancy or gave birth to their first child after age 30 may have an increased risk for breast cancer.
- Dense breasts—Women with dense breasts have a higher risk of breast cancer. Higher breast density may also make it more difficult for a mammogram to detect cancer. Additional screening may be recommended for women with dense breasts.
- Lifestyle—Drinking alcohol is linked to an increased risk of breast cancer. Being overweight or obese after menopause also increases risk.
Types of breast cancer
Common types of breast cancer include:
- Invasive ductal carcinoma (IDC) begins in the breast ducts and can spread to nearby breast tissues or lymph nodes in the armpit.
- Invasive lobular carcinoma (ILC) begins in the milk-producing lobules of the breast and spreads to nearby breast tissues.
- Ductal carcinoma in situ (DCIS) is noninvasive cancer that begins in the milk ducts of the breast.
Rare types of breast cancer include:
- Sarcomas, which include phyllodes tumors and angiosarcomas, develop in the connective tissue of the breast.
- Inflammatory breast cancer begins with reddening or swelling of the breast rather than a lump and spreads very rapidly.
- Paget disease begins in the breast ducts and spreads to the skin of the nipple followed by the areola.
- Male breast cancer— Breast cancer in men accounts for less than 1% of breast cancers, but most cases will be IDC.
Symptoms
Symptoms of breast cancer can include:
- A lump in the breast or underarm
- Swelling or change in size/shape of the breast
- Dimpled, irritated or scaly appearance of skin on the breast
- Breast or nipple pain
- Nipple retraction (turning inward)
- Bloody or clear nipple discharge
- Swollen lymph nodes under the arm or near the collarbone
It’s important to discuss any physical changes you notice with your doctor as soon as possible in order to find the right diagnosis and treatment.
Why choose Main Line Health
Breast cancer is the most common cancer in women and the most frequent cancer diagnosed and treated at Main Line Health. Fortunately, advances in prevention, early detection and treatment mean that more women diagnosed with breast cancer are living longer and with better quality of life than ever before.
Main Line Health patients receive comprehensive, highly coordinated clinical and supportive services—from state-of-the-art screening and genetics and risk assessment through prompt biopsy, precise diagnosis and staging, personalized treatment and survivorship care. Our multidisciplinary team includes breast surgeons who are skilled in oncoplastic minimally invasive surgery along with specialists in reconstructive surgery, medical oncology, radiation oncology and immunotherapy. You'll have access to breakthrough treatments through breast cancer clinical trials. Integrative therapies, educational programs and the lymphedema management program are examples of supportive survivorship programs. Our nurse navigators guide you through every step, from diagnosis through treatment and survivorship.
At each of our hospitals, we offer a complete range of health services complemented by education and research activities to meet your individual needs. Lankenau Medical Center, Bryn Mawr Hospital and Paoli Hospital are fully accredited by the National Accreditation Program for Breast Centers (NAPBC).
Survivorship care
Survivorship focuses on the health and well-being of a person with cancer during and after treatment from the time of diagnosis. Supporting mental, physical, social and emotional health is an integral part of overall wellness.
Our Survivorship Program offers:
- Support groups for patients and caregivers
- Nutrition seminars
- Thriving During and After Cancer Treatment webinar series
- Cardio-Oncology Program
- Lymphedema Management Program
- Integrative services such as art and music therapy, nutrition consultation, therapeutic massage, acupuncture, reiki, aromatherapy and mindfulness-based stress reduction
- Hair loss support including the Paxman Scalp Cooling System and free wig program
- Senior Oncology Program for patients age 70 and older
Clinical trials
Main Line Health is actively involved in clinical research for cancer prevention, diagnosis, treatment and survivorship through Lankenau Institute for Medical Research.
Our Center for Clinical Cancer Research gives patients and participants access to state-of-the-art clinical trials and new cancer treatments before they become available to the general public.
