When people talk about cancer, they often discuss it in terms of stages. But what does that mean? When breast cancer is diagnosed, the medical team will categorize the extent of the growth. Generally, the more the cancer has spread, the higher the stage. The stage is an important factor in treatment decisions, and it is often determined through the same tests that led to the cancer diagnosis, including CT scans and PET scans. There are other important factors that could determine treatment course, such as the type of cancer, how fast it is spreading, if you’ve had cancer before, and your overall health.
Stages of breast cancer.
Breast cancer has five stages from 0 through IV, and some substages within them. At stage 0, the cancer is typically small and hasn’t spread; it is limited to the inside of the milk duct. Note that lobular carcinoma in situ (LCIS) (in situ is Latin for “in the original place”) — when abnormal cells appear in the lobes of the breast but nowhere else—is no longer categorized as stage 0 breast cancer. LCIS cases don’t necessarily require treatment, but they require a higher level of monitoring.
Ductal carcinoma in situ (DCIS) is when abnormal cells appear in the breast ducts. These cells may quickly spread into healthy tissues, so treatment is recommended immediately. Treatments typically include:
- Surgery, which can involve the removal of a piece of breast tissue (a lumpectomy) or even the removal of the breast (a mastectomy) or both breasts (double mastectomy).
- Radiation therapy, which uses powerful x-rays to kill cancer cells that may be lingering near the area of the surgery and is often used after a lumpectomy.
- Hormone therapy, which can be used after surgery may also help prevent more cancer from developing by blocking hormones that can promote cancer growth.
More about hormone therapy.
Hormone therapy, sometimes called endocrine therapy, is only used for certain types of cancer that are considered “hormone sensitive.” Hormones are the chemical messengers of the body, and they are heavily involved in cell growth in certain types of cancer. Hormone therapy seeks to block this growth. Today’s advanced, specialized therapies can do this in many different ways, such as blocking the ovaries from creating estrogen, one of the main hormones produced in the female body. Others work by keeping estrogen, but blocking its effects.
Adjuvant therapy versus neoadjuvant therapy.
You may also hear the terms adjuvant therapy and neoadjuvant therapy. Neoadjuvant therapy is treatment given prior to surgery to shrink a tumor. Examples of neoadjuvant therapy include chemotherapy, radiation therapy, and hormone therapy. Adjuvant therapy simply means additional cancer treatment given after the primary rounds of treatment to reduce the risk that the cancer will return. Adjuvant therapy may include chemotherapy, radiation therapy, hormone therapy, targeted therapy, or biological therapy.
Early stage treatment options.
What’s the difference between early stages of breast cancer? In stage 1, the cancer may have spread to the lymph nodes (organs throughout the body that support the immune system)which is why some combination of treatments is often recommended, as is close monitoring of the lymph nodes. In stage 2, the cancers tend to be larger and may have spread to nearby lymph nodes.
For both stages, surgery, sometimes a mastectomy, is the main treatment. Additional treatments may include:
- Radiation therapy to lower the chance of the cancer coming back.
- Hormone therapy for hormone-sensitive cancer types.
- Chemotherapy, which uses powerful medications to attack cancer cells.
- Combination therapy, which is when more than one treatment is used together. Combination therapy can be surgery, radiation therapy and chemotherapy, or it can simply be two chemotherapy drugs used together.
Treatment length and follow-up.
Your practitioners will closely monitor your treatment and conduct follow-up tests to see how the treatment regimen is working. Depending on the size, spread, and type of cancer, treatment can last from a few weeks to a few months. If chemotherapy is used, it may be delivered in cycles to allow healthy cells to re-form between treatments.
Just about all treatments for cancer cause some type of side effect. Surgery to remove tumors or cancerous cells can cause pain and swelling. Chemotherapy can cause fatigue, pain, hair loss, diarrhea, and mouth sores. Radiation therapy can cause itching, soreness, and peeling skin. Even targeted therapy, which is designed to go after cancer cells while leaving healthy cells alone, can cause side effects similar to chemotherapy, including vomiting, fatigue, and diarrhea. See the article on breast cancer side effects for more on these and possible long-term side effects.
But remember, side effects from breast cancer treatment vary widely from patient to patient, and many are treatable. Talk to your doctor or pharmacist about ways to lessen or treat side effects. And as always, our CareTeam is here to support you however you need us.