The type of treatment you receive for IDC will depend on the size of your cancer; other biological features, such as hormone receptor status; and whether or not it has spread to lymph nodes or other organs. Many women will also sometimes opt for a combination of therapies.
Surgery
There are several types of surgical procedures for IDC, including:
- Lumpectomy or Partial Mastectomy Surgeons remove only the tumor and some of the tissue surrounding it. Underarm lymph nodes, known as axillary nodes, may also be taken out.
- Total or Simple Mastectomy The entire breast that contains the tumor is removed. Some lymph nodes may also be taken out, but the muscle beneath the breast is left alone.
- Modified Radical Mastectomy Surgeons remove the breast, the lining of the chest wall muscle, and (with exceptions in a few very well-defined cases) underarm lymph nodes, typically one to three nodes in what’s called a sentinel lymph node biopsy, or a full axillary lymph node dissection, in which all of the axillary lymph nodes are removed. This is necessary to determine staging and prognosis. For invasive cancer, lymph node removal is usually not up for discussion.
The type of surgery your doctor recommends will depend on where the cancer is located, the size of the tumor, and how much of the breast is affected by the cancer.
Radiation
Radiation therapy delivers either high-energy X-rays called photons or high energy particle beams to shrink tumors and kill cancer cells.
This treatment is usually given after a lumpectomy to decrease the chance of having cancer cells regrow in the breast, also known as a local recurrence. Women over age 65 may not always need radiation after a lumpectomy because they tend to have less aggressive disease than younger women.
The decision to recommend radiation therapy after a mastectomy depends on a number of factors, including the biology of the breast cancer type, the size of the tumor (usually if the tumor is larger than 5 centimeters), lymph node status, involvement of the pectoralis muscle, and whether the cancer has spread to the skin.
There are different ways of delivering radiation after breast surgery, including:
- External Whole Breast Radiation With or Without Lymph Node Treatment This type of radiation uses an external machine called an accelerator to deliver treatment. Historically, radiation therapy for breast cancer has been given daily for five to seven weeks. But an accelerated radiation schedule has been developed that involves fewer treatments at higher doses, so that the same total dose of radiation is administered within three to four weeks. A radiation oncologist can explain the different options and take the patient’s choices into consideration. The decision often also depends on the treatment preference of the radiation therapy center.
- External Partial-Breast Irradiation This technique involves delivering external beam radiation to the area of the breast tissue that’s at the highest risk of recurrence. Treatment usually lasts one to three weeks. There are quality, randomized clinical trials that show, in certain patients, partial breast irradiation is equivalent to full breast radiation in terms of outcomes.
- Brachytherapy With this treatment, radioactive materials like pellets or seeds are temporarily placed in or around the area where the tumor was located. The seeds emit radiation. This approach can be used in certain women after a lumpectomy.
The most important thing people should know is that doctors are evolving their use of radiation therapy to more closely match the biology of breast cancer a patient has, taking into consideration the type of cancer, whether it is receptor positive or negative, and also the patient’s age, says Michele Halyard, MD, a radiation oncologist at Mayo Clinic in Phoenix, Arizona, and co-founder of Coalition of Blacks Against Cancer. “Also, we have increasing data that patients may be treated with higher doses per day with overall less number of treatments with equivalent outcomes in appropriately selected patients,” she says.
Hormone Therapy
Side effects can be difficult for some people; they can include joint and bone pain, menopausal symptoms like hot flashes and vaginal dryness, fatigue, mood swings, and nausea.
Chemotherapy
Targeted Treatment
Targeted treatments home in on specific cancer cell traits to stop the cells from growing rapidly.
Generally, targeted approaches are less likely to kill healthy cells in your body compared with chemo and are often easier to tolerate. Still, a number of side effects are possible, depending on the drug you’re using.
Immunotherapy
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