Ask the Doctor: Louis Vandermolen, M.D.

Q. How do you treat early stage breast cancer?

A. There are several types of breast cancer therapies and surgeries available to treat early stage breast cancer.

Surgery is the main form of treatment for breast cancer at any stage. Most patients need to have breast cancer surgically removed at some point during treatment. Usually, surgery comes first and is followed by chemotherapy and radiation therapy, if necessary. However, more recently, some patients who require chemotherapy may receive it prior to surgery. There are several types of surgeries available including lumpectomy (breast-conserving surgery), mastectomy (removal of the entire breast) and oncoplastic surgery. If surgery is needed, your physician will discuss what option is best for you based on the details of your diagnosis.

Once a breast cancer has been removed by lumpectomy, radiation therapy is commonly used afterwards on the surrounding remaining breast tissue to target leftover tumor cells. Radiation therapy uses high-energy radiation to shrink tumors and destroy cancer cells. It is delivered by an external beam outside of the body or some patients qualify for a one-time intraoperative dose. The details of your diagnosis, including stage, location and size will help determine the radiation type you receive.

Another common treatment is chemotherapy, which utilizes medicines or drugs to treat cancer by killing cancer cells, stopping the spread and growth, and helping to relieve symptoms. It can be given prior to or after surgery. Chemotherapy drugs are commonly administered intravenously (through the veins), although some may be injected into the muscle or under the skin, as well as taken orally in pill, tablet or liquid form. Sometimes your physician may choose to administer more than one chemotherapy drug since they do not all act in the same way. Chemotherapy is traditionally an outpatient procedure, and is given in cycles over weeks or months. Though chemotherapy is an effective way to treat many types of cancer, it also carries a risk of side effects. Some chemotherapy side effects are mild and treatable, while others can cause significant complications.

Some types of breast cancer are affected by hormones in the blood. For example, estrogen-positive and progesterone-positive breast cancer cells have receptors (proteins) that attach to estrogen, which help them grow. In cases like these, anti-hormone therapy, which is a systemic therapy that reaches cancer cells nearly anywhere in the body including outside of the breast, may be used. Anti-hormone therapy is often used after surgery as adjuvant therapy to help reduce the risk of the cancer coming back. It is usually taken for at least five years and sometimes longer. Women with these types of breast cancer may also benefit from targeted therapy, which can make anti-hormone therapy even more effective in some cases. Anti-hormone therapy can also be used to treat cancer that has come back after treatment or has spread to other parts of the body.

While there are many options available to treat early breast cancer, it is important for you and your physician to work together to determine the best treatment plan for your needs.

Louis Vandermolen, M.D., is medical oncologist/hematologist who specializes in breast cancer treatment.