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Treatment by stage
Your doctor will recommend treatment based on the size and aggressiveness of your tumor and the extent to which it has spread. You can visit our pages on staging in the Tests section and breast cancer types in the About section for more information on the different stages and kinds of breast cancer.
Lesions (not "tumors" because usually they haven't developed into actual lumps) discovered at Stage 0, when they are noninvasive or precancerous, are almost always treated successfully. Many women with ductal carcinoma in situ (DCIS) opt for a lumpectomy followed by radiation treatment to kill lingering cells that could develop into invasive cancer. Others choose mastectomies and so are able to forgo radiation therapy. Many surgeons also recommend a sentinel node biopsy for women with DCIS, especially if there is reason to believe that DCIS is distributed throughout the breast or it is a high-grade lesion.
Most women with precancerous lobular carcinoma in situ (LCIS) don't undergo surgery, but tamoxifen or a similar hormonal treatment known to reduce the likelihood of future cancers may be prescribed.
At Stage I (early-stage invasive cancer), breast-conserving surgery such as lumpectomy, followed by radiation to kill any remaining cells, is often appropriate. If chemotherapy is recommended based on the patient's age or the aggressiveness of the tumor, it most often is given prior to radiation. Besides radiation or chemotherapy, lumpectomy patients may use tamoxifen or another hormonal medication to reduce the risk of recurrence if the tumor is hormone-receptor positive. Another approach involves a simple mastectomy to remove the entire breast. Women who opt for mastectomy generally do not undergo radiation therapy, though they still may receive chemotherapy or hormonal therapy after the surgery.
Breast cancer surgery generally also entails a procedure to check for the spread of cancer cells to the lymph nodes in the underarm. A technique known as sentinel node biopsy, which examines the first nodes to be affected by lymph draining from the breast, is increasingly used for this purpose.
At Stage II, when a tumor is fairly large or a small tumor is accompanied by lymph-node involvement, lumpectomy with subsequent radiation may be appropriate, as may be simple mastectomy. Chemotherapy and hormonal treatment are also commonly prescribed.
Stage III cancers often require more extensive surgery and more aggressive accompanying or "adjuvant" therapies, as the cancer has spread from the breast into the nearby lymph nodes or chest wall.
Stage IV cancers have metastasized to the lungs, liver, bones, or brain. Treatment of these advanced cancers is unlikely to result in a cure. The emphasis is on chemotherapy, radiation, and hormonal medications to slow the disease's progression.
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