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Breast Cancer Treatment by Stage

Treating breast cancer is a well-collaborated effort that involves accuracy and patience in every step. As there are five stages of breast cancer, the treatment for each of the stages is different. In some stages, a simple lumpectomy can remove the cancerous tissue, while in some cases, a patient needs chemotherapy. 

Doctors use different methods like mammograms, MRI, USG etc., to identify the stage of breast cancer. Doctors then decide and choose the best cancer treatment based on the stage. Some patients go for breast-conserving techniques, while some go for surgery. It is the oncologist who will determine the cancer stage and the best treatment option.

The stage of breast cancer depends on the size of the tumour, whether it has spread to other body parts and the number of lymph nodes it has affected. 

The stages of breast cancer and their respective treatments are given below:

The first stage is called the DCIS stage, where the cancer is non-invasive, and the cancer cells are confined only to the milk ducts. Immediate treatment in this stage prevents cancer from spreading.

• Lumpectomy is done to remove the cancerous cells. 
• Mastectomy can be done to remove the breasts.
• Radiation therapy after the lumpectomy lowers the risk of the spread, and it is done five days per week for 5-7 weeks.
• Targeted hormone treatment or oral hormone-like tamoxifen, trastuzumab etc., is considered.

Stage 1A and 1B are the early stages of invasive cancers where the tumour is about 2cm, and axillary lymph nodes are not affected. To treat this cancer following treatments can be done:

• Lumpectomy and Mastectomy.
• Radiation/ hormone therapy.
• Chemotherapy for hormone-positive breast cancer and even for Triple Negative Breast cancer (no presence of estrogen, progesterone and HER2)

In stages 2A and 2B, the tumour is 2-5 cm and has spread to nearby lymph nodes or 5 cm and hasn’t spread to lymph nodes. This stage requires a combined treatment of two or more therapies.

• Lumpectomy and mastectomy along with the removal of a certain part of the chest muscle, if required
• Radiation therapy followed by the previous method. 
• Chemotherapy using a variety of drugs like docetaxel, doxorubicin, cyclophosphamide etc.
• Herceptin, along with other targeted therapies like Perjeta and Nerlynx.

Stage 3 consists of three stages of breast cancer, namely 3A, 3B and 3C. In this stage, the tumours are large and have started growing into the internal mammary lymph nodes, and in some cases, cancer has even spread across the chest bone, collar bone and internal mammary nodes. Some treatments options might include:

• Mastectomy
• Effective and prolonged chemotherapy and hormone therapy.

It is by far the last stage of recognising breast cancer. If breast cancer has reached stage 4, cancer has already spread to several parts of the body- Metastasized.

• A systematic drug therapy involving chemotherapy, radiation therapy and hormone therapy.
• Immunotherapy
• Patients with HER2 positive cancers who no longer respond to traditional drugs might certain drugs live with Pertuzumab, Ado-trastuzumab etc. along with chemotherapy.

Have queries or concern ?

The survival rates for breast cancer depends on the patient, genetics and its stage. White women are more likely to develop breast cancer, but even black women can develop dangerous breast cancers in their lifetime. Surveillance research of the American Cancer Society in 2019 gives key deductions of the survival rate as:

In stages 1 and 2, 49% of women undergo BCS (lumpectomy and partial mastectomy) with RT. Also, about 12% of the women undergo BCS with no RT, 18% undergo mastectomy with no chemotherapy, and 16% undergo mastectomy with chemotherapy. 

Stage 3 is crucial, where 56% of women undergo mastectomy with chemo and radiation therapy. Around 16% undergo BCS+RT, 12% undergo mastectomy with no chemotherapy, and 6% undergo only RT.

In stage 4, 56% of the women undergo chemotherapy, and RT and 26% do not respond to either RT or chemo. Only 2-3% of cases of BCS are successful.

Immunotherapy is one of the emerging treatments for breast cancer. Although it hasn’t been approved by the FDA, it is still thought to be promising. Several independent clinical and preclinical studies suggest that it has fewer side effects as compared to chemotherapy and works by raising the body’s natural immune level to fight breast cancer.

It is the oncologist who will first determine the stage of breast cancer and then suggest treatments. Patients must not lose hope and fight till the end. Starting to have a healthy diet, reducing alcohol and switching to natural foods can work a long way in preventing breast cancer.