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Table of Contents
General Information About Breast Cancer
Stages of Breast Cancer
Inflammatory Breast Cancer
Recurrent Breast Cancer
Treatment Option Overview
Treatment Options by Stage
Treatment Options for Inflammatory Breast Cancer
Treatment Options for Recurrent Breast Cancer
General Information About Breast Cancer
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Breast cancer is a disease in which malignant (cancer) cells form in the tissues of the breast.
The breast is made up of lobes and ducts. Each breast has 15 to 20 sections called lobes, which have many smaller sections called lobules. Lobules end in dozens of tiny bulbs that can produce milk. The lobes, lobules, and bulbs are linked by thin tubes called ducts.
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| Anatomy of the breast, showing lymph nodes and lymph vessels. |
Each breast also has blood vessels and lymph vessels. The lymph vessels carry an almost colorless fluid called lymph. Lymph vessels lead to organs called lymph nodes. Lymph nodes are small bean-shaped structures that are found throughout the body. They filter substances in a fluid called lymph and help fight infection and disease. Clusters of lymph nodes are found near the breast in the axilla (under the arm), above the collarbone, and in the chest.
The most common type of breast cancer is ductal carcinoma, which begins in the cells of the ducts. Cancer that begins in the lobes or lobules is called lobular carcinoma and is more often found in both breasts than are other types of breast cancer. Inflammatory breast cancer is an uncommon type of breast cancer in which the breast is warm, red, and swollen.
Age and health history can affect the risk of developing breast cancer.
Anything that increases your chance of getting a disease is called a risk factor. Risk factors for breast cancer include the following:
- Older age.
- Menstruating at an early age.
- Older age at first birth or never having given birth.
- A personal history of breast cancer or benign (noncancer) breast disease.
- A mother or sister with breast cancer.
- Treatment with radiation therapy to the breast/chest.
- Breast tissue that is dense on a mammogram.
- Taking hormones such as estrogen and progesterone.
- Drinking alcoholic beverages.
- Being white.
Breast cancer is sometimes caused by inherited gene mutations (changes).
The genes in cells carry the hereditary information that is received from a person’s parents. Hereditary breast cancer makes up approximately 5% to 10% of all breast cancer. Some altered genes related to breast cancer are more common in certain ethnic groups.
Women who have an altered gene related to breast cancer and who have had breast cancer in one breast have an increased risk of developing breast cancer in the other breast. These women also have an increased risk of developing ovarian cancer, and may have an increased risk of developing other cancers. Men who have an altered gene related to breast cancer also have an increased risk of developing this disease. (For more information, refer to the PDQ summary on Male Breast Cancer Treatment.)
Tests have been developed that can detect altered genes. These genetic tests are sometimes done for members of families with a high risk of cancer. (Refer to the PDQ summaries on Screening for Breast Cancer, Prevention of Breast Cancer, and Genetics of Breast and Ovarian Cancer for more information.)
Tests that examine the breasts are used to detect (find) and diagnose breast cancer.
A doctor should be seen if changes in the breast are noticed. The following tests and procedures may be used:
- Mammogram: An x-ray of the breast.
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| Mammography of the right breast. |
- Biopsy: The removal of cells or tissues so they can be viewed under a microscope by a pathologist to check for signs of cancer. If a lump in the breast is found, the doctor may need to cut out a small piece of the lump. Four types of biopsies are as follows:
- Excisional biopsy: The removal of an entire lump or suspicious tissue.
- Incisional biopsy: The removal of part of a lump or suspicious tissue.
- Core biopsy: The removal of part of a lump or suspicious tissue using a wide needle.
- Needle biopsy: The removal of part of a lump, suspicious tissue, or fluid, using a thin needle. This procedure is also called a fine-needle biopsy.
- Estrogen and progesterone receptor test: A test to measure the amount of estrogen and progesterone (hormones) receptors in cancer tissue. If cancer is found in the breast, tissue from the tumor is checked in the laboratory to find out whether estrogen and progesterone could affect the way cancer grows. The test results show whether hormone therapy may stop the cancer from growing.
- MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body. This procedure is also called nuclear magnetic resonance imaging (NMRI).
Certain factors affect prognosis (chance of recovery) and treatment options.
The prognosis (chance of recovery) and treatment options depend on the following:
- The stage of the cancer (whether it is in the breast only or has spread to lymph nodes or other places in the body).
- The type of breast cancer.
- Estrogen-receptor and progesterone-receptor levels in the tumor tissue.
- A woman’s age, general health, and menopausal status (whether a woman is still having menstrual periods).
- Whether the cancer has just been diagnosed or has recurred (come back).
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Stages of Breast Cancer
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After breast cancer has been diagnosed, tests are done to find out if cancer cells have spread within the breast or to other parts of the body.
The process used to find out whether the cancer has spread within the breast or to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment.
The following stages are used for breast cancer:
Stage 0 (carcinoma in situ)
There are 2 types of breast carcinoma in situ:
- Ductal carcinoma in situ (DCIS) is a noninvasive, precancerous condition in which abnormal cells are found in the lining of a breast duct. The abnormal cells have not spread outside the duct to other tissues in the breast. In some cases, DCIS may become invasive cancer and spread to other tissues, although it is not known at this time how to predict which lesions will become invasive.
- Lobular carcinoma in situ (LCIS) is a condition in which abnormal cells are found in the lobules of the breast. This condition seldom becomes invasive cancer; however, having lobular carcinoma in situ in one breast increases the risk of developing breast cancer in either breast.
Stage I
In stage I, the tumor is 2 centimeters or smaller and has not spread outside the breast.
Stage IIA
In stage IIA:
- no tumor is found in the breast, but cancer is found in the axillary lymph nodes (the lymph nodes under the arm); or
- the tumor is 2 centimeters or smaller and has spread to the axillary lymph nodes; or
- the tumor is larger than 2 centimeters but not larger than 5 centimeters and has not spread to the axillary lymph nodes.
Stage IIB
In stage IIB, the tumor is either:
- larger than 2 centimeters but not larger than 5 centimeters and has spread to the axillary lymph nodes; or
- larger than 5 centimeters but has not spread to the axillary lymph nodes.
Stage IIIA
In stage IIIA:
- no tumor is found in the breast, but cancer is found in axillary lymph nodes that are attached to each other or to other structures; or
- the tumor is 5 centimeters or smaller and has spread to axillary lymph nodes that are attached to each other or to other structures; or
- the tumor is larger than 5 centimeters and has spread to axillary lymph nodes that may be attached to each other or to other structures.
Stage IIIB
In stage IIIB, the cancer may be any size and:
- has spread to tissues near the breast (the skin or chest wall, including the ribs and muscles in the chest); and
- may have spread to lymph nodes within the breast or under the arm.
Stage IIIC
In stage IIIC, the cancer:
- has spread to lymph nodes beneath the collarbone and near the neck; and
- may have spread to lymph nodes within the breast or under the arm and to tissues near the breast.
Stage IIIC breast cancer is divided into operable and inoperable stage IIIC.
In operable stage IIIC, the cancer:
- is found in 10 or more of the lymph nodes under the arm; or
- is found in the lymph nodes beneath the collarbone and near the neck on the same side of the body as the breast with cancer; or
- is found in lymph nodes within the breast itself and in lymph nodes under the arm.
In inoperable stage IIIC breast cancer, the cancer has spread to the lymph nodes above the collarbone and near the neck on the same side of the body as the breast with cancer.
Stage IV
In stage IV, the cancer has spread to other organs of the body, most often the bones, lungs, liver, or brain.
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Inflammatory Breast Cancer
In inflammatory breast cancer, the breast looks red and swollen and feels warm. The redness and warmth occur because the cancer cells block the lymph vessels in the skin. The skin of the breast may also show the pitted appearance called peau d’orange (like the skin of an orange). Inflammatory breast cancer may be stage IIIB, stage IIIC, or stage IV.
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| Inflammatory breast cancer of the left breast showing peau d’orange and inverted nipple. |
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Recurrent Breast Cancer
Recurrent breast cancer is cancer that has recurred (come back) after it has been treated. The cancer may come back in the breast, in the chest wall, or in other parts of the body.
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Treatment Option Overview
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There are different types of treatment for patients with breast cancer.
Different types of treatment are available for patients with breast cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. Before starting treatment, patients may want to think about taking part in a clinical trial. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment.
Clinical trials are taking place in many parts of the country. Information about ongoing clinical trials is available from the NCI Web site. Choosing the most appropriate cancer treatment is a decision that ideally involves the patient, family, and health care team.
Four types of standard treatment are used:
Surgery
Most patients with breast cancer have surgery to remove the cancer from the breast. Some of the lymph nodes under the arm are usually taken out and looked at under a microscope to see if they contain cancer cells.
Breast-conserving surgery, an operation to remove the cancer but not the breast itself, includes the following:
- Lumpectomy: Surgery to remove a tumor (lump) and a small amount of normal tissue around it.
- Partial mastectomy: Surgery to remove the part of the breast that has cancer and some normal tissue around it. This procedure is also called a segmental mastectomy.
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| Breast-conserving surgery. Dotted lines show area containing the tumor that is removed and some of the lymph nodes that may be removed. |
Patients who are treated with breast-conserving surgery may also have some of the lymph nodes under the arm removed for biopsy. This procedure is called lymph node dissection. It may be done at the same time as the breast-conserving surgery or after. Lymph node dissection is done through a separate incision.
Other types of surgery include the following:
- Total mastectomy: Surgery to remove 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 for biopsy at the same time as the breast surgery or after. This is done through a separate incision.
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| Total mastectomy. Dotted line shows entire breast is removed. Some lymph nodes under the arm may also be removed. |
- Modified radical mastectomy: Surgery to remove the whole breast that has cancer, many of the lymph nodes under the arm, the lining over the chest muscles, and sometimes, part of the chest wall muscles.
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| Modified radical mastectomy. Dotted line shows entire breast and some lymph nodes are removed. Part of the chest wall muscle may also be removed. |
- Radical mastectomy: Surgery to remove the breast that has cancer, chest wall muscles under the breast, and all of the lymph nodes under the arm. This procedure is sometimes called a Halsted radical mastectomy.
Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given radiation therapy, chemotherapy, or hormone therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to increase the chances of a cure, is called adjuvant therapy.
If a patient is going to have a mastectomy, breast reconstruction (surgery to rebuild a breast’s shape after a mastectomy) may be considered. Breast reconstruction may be done at the time of the mastectomy or at a future time. The reconstructed breast may be made with the patient’s own (nonbreast) tissue or by using implants filled with saline or silicone gel. Before the decision to get an implant is made, patients can call the Food and Drug Administration's (FDA) Center for Devices and Radiologic Health at 1-888-INFO-FDA (1-888-463-6332) or visit the FDA's Web site for more information on breast implants.
Radiation therapy
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.
Chemotherapy
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.
Hormone therapy
Hormone therapy is a cancer treatment that removes hormones or blocks their action and stops cancer cells from growing. Hormones are substances produced by glands in the body and circulated in the bloodstream. Some hormones can cause certain cancers to grow. If tests show that the cancer cells have places where hormones can attach (receptors), drugs, surgery, or radiation therapy are used to reduce the production of hormones or block them from working.
Hormone therapy with tamoxifen is often given to patients with early stages of breast cancer and those with metastatic breast cancer (cancer that has spread to other parts of the body). Hormone therapy with tamoxifen or estrogens can act on cells all over the body and may increase the chance of developing endometrial cancer. Women taking tamoxifen should have a pelvic exam every year to look for any signs of cancer. Any vaginal bleeding, other than menstrual bleeding, should be reported to a doctor as soon as possible.
Hormone therapy with an aromatase inhibitor is given to some postmenopausal women who have hormone-dependent breast cancer. Hormone-dependent breast cancer needs the hormone estrogen to grow. Aromatase inhibitors decrease the body's estrogen by blocking an enzyme called aromatase from turning androgen into estrogen.
For the treatment of early stage breast cancer, certain aromatase inhibitors may be used as adjuvant therapy instead of tamoxifen or after 2 or more years of tamoxifen. For the treatment of metastatic breast cancer, aromatase inhibitors are being tested in clinical trials to compare them to hormone therapy with tamoxifen.
New types of treatment are being tested in clinical trials. These include the following:
Sentinel lymph node biopsy followed by surgery
Sentinel lymph node biopsy is the removal of the sentinel lymph node during surgery. The sentinel lymph node is the first lymph node to receive lymphatic drainage from a tumor. It is the first lymph node the cancer is likely to spread to from the tumor. A radioactive substance and/or blue dye is injected near the tumor. The substance or dye flows through the lymph ducts to the lymph nodes. The first lymph node to receive the substance or dye is removed. A pathologist views the tissue under a microscope to look for cancer cells. If cancer cells are not found, it may not be necessary to remove more lymph nodes. After the sentinel lymph node biopsy, the surgeon removes the tumor (breast-conserving surgery or mastectomy).
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