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Treatment Options for Breast Cancer at Virginia Oncology Associates
Breast cancer treatment today is highly specific to the type of breast cancer, hormone and HER2 status, and level of lymph node involvement. The treatment approach for each patient is personalized based on these factors. In coordination with the breast cancer surgeon and radiation oncologist, your VOA breast cancer specialist will meet with you to discuss their recommendation.
Most patients receive at least one of the following treatments, although typically, several are required to ensure all of the cancer cells have been eliminated.
Most patients with breast cancer may need to have surgery at some point in their treatment process. Factors such as the tumor’s size, location, and a patient’s overall health status will determine the type of approach your surgical oncologist might recommend. The types of breast cancer surgery options are as follows:
Breast-Conserving Surgery (Lumpectomy)
Breast-conserving surgery, also called lumpectomy, is an operation to remove the cancer and some normal tissue around it, but not the breast itself. Your breast surgeon may also remove lymph nodes under the arm to check them for cancerous cells. Sometimes, part of the chest wall lining may be removed if the cancer is near it. Other names for this type of surgery may include partial mastectomy, segmental mastectomy, or quadrantectomy.
Breast Removal Surgery (Mastectomy)
A mastectomy is a surgical procedure that removes the whole breast that has cancer. This procedure is also called a simple mastectomy. Some of the lymph nodes under the arm may be removed and checked for cancer. Other mastectomy options may include:
Modified radical mastectomy is surgery to remove the whole breast that has cancer. This may include removal of the nipple, areola (the dark-colored skin around the nipple), and skin over the breast. Most of the lymph nodes under the arm are also removed.
Nipple-sparing and skin-sparing mastectomies are surgeries that preserve all or part of the original “breast envelope,” the skin overlying the breast mound.
Choosing the Right Breast Cancer Surgery for You
Talk to your surgeon about your personal preference for breast surgery. Whether you have a breast-conserving surgery or a mastectomy to remove the entire breast, some reconstruction may be possible to ensure both breasts are approximately the same size and shape.
You will typically meet with the plastic surgeon before your breast cancer surgery. They will discuss your needs with the breast cancer surgeon and then talk to you about your options for breast reconstruction.
Radiation Therapy for Breast Cancer
Radiation therapy (also called radiotherapy) uses high-energy rays to kill cancer cells. It affects cells only in the part of the body that is treated. Radiation therapy may be used after surgery to destroy breast cancer cells that remain in the area.
Oncologists use two types of radiation therapy to treat breast cancer. Some women receive both types.
External beam radiation therapy: The radiation comes from a large machine outside the body. You will go to a hospital or clinic for treatment. Treatments are usually five days a week for 4 to 6 weeks. Hypofractionated radiation therapy is a type of external beam radiation that divides the total radiation sessions into fewer, larger fractions. This highly-intense approach shortens weeks of treatment to about five days. External radiation is the most common type used for breast cancer.
Internal radiation therapy (implant radiation therapy or brachytherapy): The doctor places one or more thin tubes inside the breast through a tiny incision. A radioactive substance is loaded into the tube. The treatment session may last for a few minutes, and the substance is removed. When it’s removed, no radioactivity remains in your body. Internal radiation therapy may be repeated every day for a week.
Chemotherapy uses drugs to kill cancer cells. Before surgery, it may be given to shrink a large tumor, which makes surgery easier, and/or reduces the risk of recurrence (called neoadjuvant chemotherapy). Chemotherapy may also be given after surgery to reduce the risk of recurrence (called adjuvant chemotherapy).
Chemotherapy drugs are usually given through a vein (intravenous) or as a pill. If chemotherapy is part of your treatment plan, you will probably receive a combination of drugs.
Since chemotherapy drugs attack both healthy cells and cancerous cells, patients may experience side effects. Your oncology team will know how to manage these. We also have tips for managing side effects during cancer treatment. If you are diagnosed with breast cancer, have not gone through menopause, and would like to have children after treatment is complete, talk to your oncologist about possible impacts on fertility and how you can plan before treatment.
Hormone Therapy for Breast Cancer
If lab tests show the tumor in your breast is positive for hormone receptors, then hormone therapy will likely be a part of your treatment plan. Hormone therapy blocks the cancer cells from being able to use hormones to continue growing.
The right therapy will depend on several factors, including whether you’re still menstruating, in menopause, or are considered high-risk and in need of ovarian suppression.
Targeted therapy uses drugs that block the growth of breast cancer cells. Unlike chemotherapy, targeted therapies only kill cancer cells, leaving healthy cells alone. The most common use of targeted therapy in breast cancer is to slow the overgrowth of the HER2 protein found on the surface of breast cancer cells, which in turn slows the growth of breast cancer.
Immunotherapy, also called biological therapy, is designed to boost the body's natural defenses to fight cancer. It has shown benefits for patients with more aggressive subtypes of breast cancer, such as triple-negative breast cancer or metastatic breast cancer. Although it is not available for all types of breast cancer, clinical research is being conducted to see how it can be expanded for use with more patients. The primary breast cancer immunotherapy currently in use is called an immune checkpoint inhibitor.
One of the main jobs of the immune system is to keep the body from attacking itself. To do this, it uses “checkpoints.” These proteins on immune cells need to be turned on (or off) to start an immune response. Breast cancer cells can trick the body into thinking they are normal, allowing them to continue to reproduce. Drugs that target these checkpoint proteins help restore the immune response against breast cancer cells.
Pembrolizumab (Keytruda) is a type of immunotherapy checkpoint inhibitor used to treat high-risk, early-stage, triple-negative breast cancer in combination with chemotherapy before surgery. It could then continue to be given alone following surgery.
Clinical Trials Can Be Part of the Breast Cancer Treatment Plan
Cancer research played a vital role in making each of these breast cancer treatments available to patients everywhere. That’s why VOA participates in clinical trials. We want to offer our patients access to clinical trials that open new treatment options to eligible patients. If your VOA breast cancer specialist discusses a specific clinical trial with you, we hope you will consider it as a treatment option as it may benefit you and others as well. Learn more about clinical research trials for breast cancer.
Personalized Breast Cancer Treatment on the Peninsula, Southside, Western Tidewater, and Northeast North Carolina
