They are also the best way for doctors to learn better methods to treat cancer. Still, they're not right for everyone. If you would like to learn more about clinical trials that might be right for you, start by asking your doctor if your clinic or hospital conducts clinical trials. These methods can include vitamins, herbs, and special diets, or other methods such as acupuncture or massage, to name a few.
Complementary methods refer to treatments that are used along with your regular medical care. Although some of these methods might be helpful in relieving symptoms or helping you feel better, many have not been proven to work. Some might even be harmful.
Be sure to talk to your cancer care team about any method you are thinking about using. They can help you learn what is known or not known about the method, which can help you make an informed decision. People with cancer need support and information, no matter what stage of illness they may be in. Knowing all of your options and finding the resources you need will help you make informed decisions about your care.
Whether you are thinking about treatment, getting treatment, or not being treated at all, you can still get supportive care to help with pain or other symptoms.
Communicating with your cancer care team is important so you understand your diagnosis, what treatment is recommended, and ways to maintain or improve your quality of life. Different types of programs and support services may be helpful, and can be an important part of your care.
These might include nursing or social work services, financial aid, nutritional advice, rehab, or spiritual help. The American Cancer Society also has programs and services — including rides to treatment, lodging, and more — to help you get through treatment.
Call our National Cancer Information Center at and speak with one of our trained specialists. All IBC cases are classified as at least stage 3 breast cancer.
It has fewer side effects than chemotherapy and is less likely to cause resistance. Pembrolizumab is an immune checkpoint inhibitor. It works by blocking specific antibodies that make it harder for the immune system to fight the cancer. This allows the body to fight back more efficiently. A study found Some people with breast cancer might be interested in exploring complementary or alternative treatments like vitamins, herbs, acupuncture, and massage.
These treatments are used alongside traditional breast cancer therapies to treat cancer or relieve cancer symptoms and uncomfortable side effects of treatments like chemotherapy. You can explore these treatments at any stage of breast cancer. Breast cancer that spreads to other parts of the body can cause pain, such as bone pain, muscle pain, headaches, and discomfort around the liver.
Talk with your doctor about pain management. Options for mild to moderate pain include acetaminophen and nonsteroidal anti-inflammatory drugs NSAIDs , such as ibuprofen. For severe pain in a later stage, your doctor may recommend an opioid such as morphine , oxycodone , hydromorphone , or fentanyl.
These opioids have the potential for addiction, so they are only recommended in certain cases. In recent years, a growing number of people with cancer are using cannabis to manage cancer symptoms and pain.
A large observational study of cancer patients using cannabis over 6 months showed a decreased number of patients with severe pain, as well as decreased opioid use. While breast cancer stage has a lot to do with treatment options, other factors can impact your treatment options as well.
The prognosis for breast cancer is usually worse in people younger than 40 because breast cancer tends to be more aggressive in younger people. Balancing body image with perceived risk reduction may play a role in the decision between lumpectomy and mastectomy. In addition to surgery, chemotherapy, and radiation, several years of hormonal therapy for hormone-positive breast cancers is often recommended for young people. This can help prevent a recurrence or spread of breast cancer.
Being pregnant also impacts breast cancer treatment. Breast cancer surgery is usually safe for people who are pregnant, but doctors may discourage chemotherapy until the second or third trimester. If you have an aggressive form of breast cancer, your doctor may recommend a more aggressive approach, such as surgery and a combination of other therapies.
Treatment for breast cancer may depend partly on having a close relative with a history of breast cancer or testing positive for a gene that increases the risk of developing breast cancer. Patients with these factors may choose a preventive surgical option, such as a bilateral mastectomy. Clinical trials are studies in which patients volunteer to try new drugs, combinations of drugs, and methods of treatment under the careful supervision of doctors and researchers.
Clinical trials are a crucial step in discovering new breast cancer treatment methods. There is currently no cure for metastatic breast cancer, or breast cancer that has spread to distant parts of the body.
However, early stages of breast cancer that remain localized are highly treatable — 99 percent of people who receive treatment in the earliest stages of breast cancer live for 5 years or longer after diagnosis, according to the American Cancer Society. The outlook for breast cancer depends, in large part, on the stage at the time of diagnosis.
Talk with your doctor about which screening schedule is right for you. Learn about screening schedules and more in this comprehensive guide to breast cancer.
There are standard treatments for the different types and stages of breast cancer, but your treatment will be tailored to your individual needs. In addition to the stage at diagnosis, your doctors will consider the type of breast cancer you have and other health factors.
They will adjust your treatment plan according to how well you respond to it. Find support from others who are living with breast cancer. Hormone therapy for breast cancer works to stop or slow the production of hormones that fuel tumors. Read more on the pros and cons of this treatment. Here are seven things you need to know about targeted treatment for advanced breast cancer. There's no cure for breast cancer that has spread to distant parts of the body, but new treatments are helping prolong life and improve quality of….
Neoadjuvant radiation therapy is radiation therapy given before surgery to shrink a large tumor, which makes it easier to remove. This approach is uncommon and is usually only considered when a tumor cannot be removed with surgery.
Women with a TP53 mutation are at higher risk of complications from radiation therapy, and therefore should undergo mastectomy instead of lumpectomy and radiation. Those with an ATM mutation or other related mutations should talk with their doctor about whether adjuvant radiation therapy is right for them.
Currently, there is not enough data to recommend avoiding radiation therapy in all women with ATM mutations. Your doctor can recommend topical medication to apply to the skin to treat some of these side effects. Very rarely, a small amount of the lung can be affected by the radiation therapy, causing pneumonitis, a radiation-related swelling of the lung tissue. This risk depends on the size of the area that received radiation therapy, and it tends to heal with time. In the past, with older equipment and radiation therapy techniques, women who received treatment for breast cancer on the left side of the body had a small increase in the long-term risk of heart disease.
Modern techniques, such as respiratory gating, which uses technology to guide the delivery of radiation while a patient breathes, are now able to spare the vast majority of the heart from the effects of radiation therapy. Many types of radiation therapy may be available to you with different schedules see below. Talk with your doctor about the advantages and disadvantages of each option.
After a lumpectomy. Radiation therapy after a lumpectomy is external-beam radiation therapy given Monday through Friday for 3 to 4 weeks if the cancer is not in the lymph nodes. If the cancer is in the lymph nodes, radiation therapy is given for 5 to 6 weeks. However, this duration is changing, as there is a preference for a shorter duration to be given in women who meet the criteria for shorter treatment.
This often starts with radiation therapy to the whole breast, followed by a more focused treatment to where the tumor was located in the breast for the remaining treatments. This focused part of the treatment, called a boost, is standard for women with invasive breast cancer to reduce the risk of a recurrence in the breast. Women with DCIS may also receive the boost. For women with a low risk of recurrence, the boost may be optional.
It is important to discuss this treatment approach with your doctor. After a mastectomy. For those who need radiation therapy after a mastectomy, it is usually given 5 days a week for 5 to 6 weeks. Radiation therapy can be given before or after reconstructive surgery. As is the case following lumpectomy, some women may be recommended to have less than 5 weeks of radiation therapy after mastectomy.
Even shorter schedules have been studied and are in use in some centers, including accelerated partial breast radiation therapy see below for 5 days. These shorter schedules may not be options for women who need radiation therapy after a mastectomy or radiation therapy to their lymph nodes. Also, longer schedules of radiation therapy may be needed for some women with very large breasts. Partial breast irradiation. Partial breast irradiation PBI is radiation therapy that is given directly to the tumor area instead of the entire breast.
It is more common after a lumpectomy. Targeting radiation directly to the tumor area usually shortens the amount of time that patients need to receive radiation therapy. However, only some patients may be able to have PBI. Although early results have been promising, PBI is still being studied. However, it is already part of routine care in certain circumstances, including for specific people with early-stage breast cancer. You may want to discuss with your radiation oncologist the pros and cons of PBI compared to whole breast radiation therapy.
PBI can be done with standard external-beam radiation therapy that is focused on the area where the tumor was removed and not on the entire breast. PBI may also be done with brachytherapy by using plastic catheters or a metal wand placed temporarily in the breast.
Breast brachytherapy can involve short treatment times, ranging from 1 dose to 1 week. It can also be given as 1 dose in the operating room immediately after the tumor is removed.
These forms of focused radiation therapy are currently used only for patients with a smaller, less aggressive, and lymph node-negative tumor. Intensity-modulated radiation therapy. Intensity-modulated radiation therapy IMRT is a more advanced way to give external-beam radiation therapy to the breast. The intensity of the radiation directed at the breast is varied to better target the tumor, spreading the radiation more evenly throughout the breast. The use of IMRT lessens the radiation dose and may decrease possible damage to nearby organs, such as the heart and lung, as well as lessen the risks of some immediate side effects, such as peeling of the skin during treatment.
This can be especially important for women with medium to large breasts who have a higher risk of side effects, such as peeling and burns, compared with women with smaller breasts. IMRT may also help to lessen the long-term effects on the breast tissue, such as hardness, swelling, or discoloration, that were common with older radiation techniques.
IMRT is not recommended for everyone. Talk with your radiation oncologist to learn more. Special insurance approval may also be needed for coverage for IMRT. It is important to check with your health insurance company before any treatment begins to make sure it is covered.
Proton therapy. Standard radiation therapy for breast cancer uses x-rays, also called photon therapy, to kill cancer cells. Proton therapy is a type of external-beam radiation therapy that uses protons rather than x-rays.
At high energy, protons can destroy cancer cells. Protons have different physical properties that may allow the radiation therapy to be more targeted than photon therapy and potentially reduce the radiation dose. The therapy may also reduce the amount of radiation that goes near the heart. Researchers are studying the benefits of proton therapy versus photon therapy in a national clinical trial.
Currently, proton therapy is an experimental treatment and may not be widely available or covered by health insurance. Recent research studies have looked at the possibility of avoiding radiation therapy for women age 65 or older with an ER-positive, lymph node-negative, early-stage tumor see Introduction , or for women with a small tumor.
Importantly, these studies show that for women with small, less aggressive breast tumors that are removed with lumpectomy, the likelihood of cancer returning in the same breast is very low. Treatment with radiation therapy reduces the risk of breast cancer recurrence in the same breast even further compared with surgery alone. However, they note that women with special situations or a low-risk tumor could reasonably choose not to have radiation therapy and use only systemic therapy see below after lumpectomy.
This includes women age 70 or older, as well as those with medical conditions that could limit life expectancy within 5 years. People who choose this option will have a modest increase in the risk of the cancer coming back in the breast.
It is important for these women to discuss the pros and cons of omitting radiation therapy with their doctor. Systemic therapy is the use of medication to destroy cancer cells.
Medications circulate through the body and therefore can reach cancer cells throughout the body. Systemic therapies are generally prescribed by a medical oncologist, a doctor who specializes in treating cancer with medication.
Common ways to give systemic therapies include an intravenous IV tube placed into a vein using a needle, an injection into a muscle or under the skin, or in a pill or capsule that is swallowed orally.
Each of these therapies is discussed below in more detail. A person may receive 1 type of systemic therapy at a time or a combination of systemic therapies given at the same time. The medications used to treat cancer are continually being evaluated.
Your doctor may suggest that you consider participating in clinical trials that are studying new ways to treat breast cancer. Talking with your doctor is often the best way to learn about the medications that can be prescribed for you, their purposes, and their potential side effects. It is also important to let your doctor know if you are taking any other prescription or over-the-counter medications or supplements.
Herbs, supplements, and other drugs can interact with cancer medications. Learn more about your prescriptions by using searchable drug databases. Chemotherapy is the use of drugs to destroy cancer cells, usually by keeping the cancer cells from growing, dividing, and making more cells. It may also be given after surgery to reduce the risk of recurrence, called adjuvant chemotherapy. A chemotherapy regimen, or schedule, usually consists of a combination of drugs given in a specific number of cycles over a set period of time.
Chemotherapy may be given on many different schedules depending on what worked best in clinical trials for that specific type of regimen. It may be given once a week, once every 2 weeks, once every 3 weeks, or even once every 4 weeks. There are many types of chemotherapy used to treat breast cancer. Common drugs include:. A patient may receive 1 drug at a time or a combination of different drugs given at the same time.
Research has shown that combinations of certain drugs are sometimes more effective than single drugs for adjuvant treatment. ASCO does not recommend routinely adding platinum chemotherapy cisplatin or carboplatin to anthracycline doxorubicin or epiribicin or taxane paclitaxel or docetaxel chemotherapy to treat people with inherited BRCA mutations before or after surgery.
The following drugs or combinations of drugs may be used as adjuvant therapy for early-stage and locally advanced breast cancer:.
An example is the antibody trastuzumab. Combination regimens for early-stage HER2-positive breast cancer may include:. The side effects of chemotherapy depend on the individual, the drug s used, whether the chemotherapy has been combined with other drugs, and the schedule and dose used.
These side effects can include fatigue, risk of infection, nausea and vomiting, hair loss, loss of appetite, diarrhea, constipation, numbness and tingling, pain, early menopause, weight gain, and chemo-brain or cognitive dysfunction. These side effects can often be very successfully prevented or managed during treatment with supportive medications, and they usually go away after treatment is finished. For hair loss reduction, talk with your doctor about whether they do cold cap techniques.
Rarely, long-term side effects may occur, such as heart damage, permanent nerve damage, or secondary cancers such as leukemia or lymphoma. Talk with your health care team about the possible side effects of your specific chemotherapy plan, and seek medical attention immediately if you experience a fever during chemotherapy. Hormonal therapy, also called endocrine therapy, is an effective treatment for most tumors that test positive for either estrogen or progesterone receptors called ER positive or PR positive; see Introduction.
This type of tumor uses hormones to fuel its growth. Blocking the hormones can help prevent a cancer recurrence and death from breast cancer when hormonal therapy is used either by itself or after chemotherapy.
Hormonal therapy for breast cancer treatment is different than menopausal hormone therapy MHT. They block hormone actions or lower hormone levels in the body.
Hormonal therapy may also be called endocrine therapy. The endocrine system in the body makes hormones. This is called neoadjuvant hormonal therapy.
When given before surgery, it is typically given for at least 3 to 6 months before surgery and continued after surgery. It may also be given solely after surgery to reduce the risk of recurrence. This is called adjuvant hormonal therapy. Tamoxifen is a drug that blocks estrogen from binding to breast cancer cells. It is effective for lowering the risk of recurrence in the breast that had cancer, the risk of developing cancer in the other breast, and the risk of distant recurrence.
Tamoxifen works in women who have been through menopause as well as those who have not. Tamoxifen is a pill that is taken daily by mouth every day for 5 to 10 years. For premenopausal women, it may be combined with medication to stop the ovaries from producing estrogen.
It is important to discuss any other medications or supplements you take with your doctor, particularly any anti-depression medications, as there are some that may interfere with tamoxifen. Common side effects of tamoxifen include hot flashes and vaginal dryness, discharge, or bleeding.
Very rare risks include a cancer of the lining of the uterus, cataracts, and blood clots. However, tamoxifen may improve bone health and cholesterol levels. Aromatase inhibitors AIs.
AIs decrease the amount of estrogen made in tissues other than the ovaries in post-menopausal women by blocking the aromatase enzyme. This enzyme changes weak male hormones called androgens into estrogen when the ovaries have stopped making estrogen during menopause. These drugs include anastrozole Arimidex , exemestane Aromasin , and letrozole Femara.
All of the AIs are pills taken daily by mouth. Only women who have gone through menopause or who take medicines to stop the ovaries from making estrogen see "Ovarian suppression," below can take AIs. Treatment with AIs, either as the first hormonal therapy taken or after treatment with tamoxifen, may be more effective than taking only tamoxifen to reduce the risk of recurrence in post-menopausal women.
Post-menopausal women with hormone receptor-positive breast cancer can:. Begin hormone therapy with an AI. Begin hormone therapy with tamoxifen and then after a few years, switch to an AI. When an AI is taken after tamoxifen, the drugs are taken for a combined total of 5 to 10 years. The side effects of AIs may include muscle and joint pain, hot flashes, vaginal dryness, an increased risk of osteoporosis and broken bones, and rarely, increased cholesterol levels and thinning of hair.
Research shows that all AIs work equally well and have similar side effects. However, women who have undesirable side effects while taking one AI medication may have fewer side effects with a different AI for unclear reasons.
Women who have not gone through menopause and who are not getting shots to stop the ovaries from working see below should not take AIs, as they do not block the effects of estrogen made by the ovaries. Often, doctors will monitor blood estrogen levels in women whose menstrual cycles have recently stopped, those whose periods stopped with chemotherapy, or those who have had a hysterectomy but their ovaries are still in place, to be sure that the ovaries are no longer producing estrogen.
Ovarian suppression or ablation. Ovarian suppression is the use of drugs to stop the ovaries from producing estrogen. Ovarian ablation is the use of surgery to remove the ovaries.
These options may be used in addition to another type of hormonal therapy for women who have not been through menopause. For ovarian suppression, gonadotropin or luteinizing releasing hormone GnRH or LHRH agonist drugs are used to stop the ovaries from making estrogen, causing temporary menopause.
Goserelin Zoladex and leuprolide Eligard, Lupron are types of these drugs. Since they are not very effective for treating breast cancer on their own, they are typically given in combination with other hormonal therapy.
They are given by injection every 4 weeks and stop the ovaries from making estrogen. The effects of GnRH drugs go away if treatment is stopped. For ovarian ablation, surgery to remove the ovaries is used to stop estrogen production.
While this is permanent, it can be a good option for women who no longer want to become pregnant, especially since the cost is typically lower over the long term. Tamoxifen for 5 years, followed by an AI for up to 5 years. This would be a total of 10 years of hormonal therapy. Tamoxifen for 2 to 3 years, followed by 2 to 8 years of an AI for a total of 5 to 10 years of hormonal therapy. In general, women should expect 5 to 10 years of hormonal therapy.
The tumor biomarkers and other features of the cancer may also impact who is recommended to take a longer course of hormonal therapy. As noted above, premenopausal women should not take AI medications without ovarian suppression, as they will not lower estrogen levels.
Options for adjuvant hormonal therapy for premenopausal women include the following:. Tamoxifen for 5 years. Then, treatment is based on their risk of cancer recurrence as well as whether or not they have gone through menopause in those 5 years.
If a woman has not gone through menopause after the first 5 years of treatment and is recommended to continue treatment, they can continue tamoxifen for another 5 years, for a total of 10 years of tamoxifen. Alternatively, a woman could start ovarian suppression and switch to taking an AI for another 5 years. If a woman goes through menopause during the first 5 years of treatment and is recommended to continue treatment, they can continue tamoxifen for an additional 5 years or switch to an AI for 5 more years.
Only women who are clearly post-menopausal should consider taking an AI. However, evidence now suggests benefits independent of the use of chemotherapy as well. For women with stage I or stage II cancer with a higher risk of recurrence who may consider also having chemotherapy. For women who cannot take tamoxifen for other health reasons, such as having a history of blood clots, so they can take an AI medication.
Ovarian suppression is not recommended in addition to another type of hormonal therapy in the following situations:. This information is based on ASCO recommendations for adjuvant endocrine therapy for women with hormone receptor-positive breast cancer. Please note this link takes you to another ASCO website. These treatments are very focused and work differently than chemotherapy. This type of treatment blocks the growth and spread of cancer cells and limits damage to healthy cells.
Not all tumors have the same targets. To find the most effective treatment, your doctor may run tests to identify the genes, proteins, and other factors in your tumor. In addition, research studies continue to find out more about specific molecular targets and new treatments directed at them. Learn more about the basics of targeted treatments. The first approved targeted therapies for breast cancer were hormonal therapies. Trastuzumab FDA-approved biosimilar forms are available. This drug is approved as a therapy for non-metastatic HER2-positive breast cancer.
It is given either as an infusion into a vein every 1 to 3 weeks or as an injection into the skin every 3 weeks. Currently, patients with stage I to stage III breast cancer see Stages should receive a trastuzumab-based regimen, often including a combination of trastuzumab with chemotherapy, followed by a total of 1 year of adjuvant trastuzumab.
This risk is increased if a patient has other risk factors for heart disease or receives chemotherapy that also increases the risk of heart problems at the same time.
These heart problems may go away and can be treated with medication. Pertuzumab Perjeta. This drug is approved for stage II and stage III breast cancer in combination with trastuzumab and chemotherapy. It is given as an infusion into a vein every 3 weeks. Pertuzumab, trastuzumab, and hyaluronidase—zzxf Phesgo. This combination drug, which contains pertuzumab, trastuzumab, and hyaluronidase-zzxf in a single dose, is approved for people with early-stage HER2-positive breast cancer.
It may be given in combination with chemotherapy. It is given by injection under the skin and can be administered either at a treatment center or at home by a health care professional.
Neratinib Nerlynx. This oral drug is approved as a treatment for higher-risk HER2-positive, early-stage breast cancer. It is taken for a year, starting after patients have finished 1 year of trastuzumab. Ado-trastuzumab emtansine or T-DM1 Kadcyla. This is approved for patients with early-stage breast cancer who have had treatment with trastuzumab and chemotherapy with either paclitaxel or docetaxel followed by surgery, and who had cancer remaining or present at the time of surgery.
T-DM1 is a combination of trastuzumab linked to a very small amount of a strong chemotherapy. This allows the drug to deliver chemotherapy into the cancer cell while lessening the chemotherapy received by healthy cells, which usually means that it causes fewer side effects than standard chemotherapy. T-DM1 is given by vein every 3 weeks. Talk with your doctor about possible side effects of specific medications and how they can be managed.
Bone modifying drugs block bone destruction and help strengthen the bone. They may be used to prevent cancer from recurring in the bone or to treat cancer that has spread to the bone. Certain types are also used in low doses to prevent and treat osteoporosis. Osteoporosis is the thinning of the bones.
Denosumab Prolia, Xgeva. An osteoclast-targeted therapy called a RANK ligand inhibitor. The use of denosumab to lower the risk of breast cancer recurrence is under study. For people with breast cancer that has not spread, receiving bisphosphonates after breast cancer treatment may help to prevent a recurrence. ASCO recommends zoledronic acid Reclast, Zometa or clodronate multiple brand names as options to help prevent a bone recurrence for women who have been through menopause.
Clodronate is only available outside of the United States. You may have other targeted therapy options for breast cancer treatment, depending on several factors. The following drug is used for the treatment of non-metastatic breast cancer.
0コメント