Treatments

Breast cancer is treated using three different types of treatments: medications, surgery, and radiation. Some people with breast cancer will only use one of these treatment modalities. Others will use two or three.

Surgery

Surgery is an operation to remove a tumor, surrounding tissue, and possibly lymph nodes. You may have several options for breast cancer surgery that your care team will discuss with you. A surgical oncologist, often one who specializes in breast cancer, will usually perform this operation.

Breast-conserving surgery

This approach removes the cancer while leaving as much of your breast as possible. This includes:

  • Lumpectomy (removal of the lump with some surrounding tissue at the margin of the tumor),
  • Quadrantectomy (removal of one quarter, or quadrant, of your breast), and
  • Segmental mastectomy (removal of the cancer as well as some of your breast tissue around the tumor and the lining over the chest muscles below the tumor).

Nipple sparing mastectomy

In a nipple sparing mastectomy, the surgeon removes all the breast tissue, but leaves the skin and nipple. This allows the incisions to be nearly invisible.

Modified radical mastectomy

In this operation, the surgeon removes your breast, the lymph nodes under your arm, and the lining over the chest muscles. In some cases, part of your chest wall muscles will be removed as well. This may be followed by reconstructive surgery to reshape your breast.

Total or simple mastectomy

This surgery removes the entire breast.

Lymph node removal

After breast tissue is removed, your surgeon may remove some lymph nodes and take a tissue sample to find out if the cancer has spread.

  • In a sentinel lymph node biopsy, your surgeon will remove some lymph nodes in your tumor area.
  • In a radical lymph node dissection, all or most of your lymph nodes are removed (also called a lymphadenectomy).

A common side effect of breast cancer surgery is lymphedema, swelling in the arms, hands, fingers, shoulders or chest, caused by fluid retention in the body. Columbia surgeons have developed innovative ways to prevent lymphedema following surgery for breast cancer.

Oncoplastic or reconstructive breast surgery

Some people with breast cancer choose to have their breasts reconstructed after breast cancer surgery if they’re worried about how it will affect their appearance and to boost self esteem. Oncoplastic or reconstructive surgery uses techniques to give you excellent cosmetic results while following tried-and-true principles after major breast cancer surgery.

Learn More About Surgical Breast Care at Columbia

Medication Treatments

Chemotherapy

Chemotherapy uses medications (chemicals) to stop cancer growth and spread and to prevent cancer from recurring by causing rapidly dividing cancer cells to become damaged and die.

Chemotherapy is “systemic” medicine—it interferes with all fast-dividing cells in your body. This is why side effects, like hair loss, can happen with chemotherapy.

Chemotherapy is often given through an IV in our infusion center, but it can sometimes be given through a pill.

You may have chemotherapy before surgery (neoadjuvant) to shrink the tumor so it can be removed with less extensive surgery. Or, you may have chemotherapy after surgery (adjuvant) to address cancer cells that might have been left behind or may have spread but cannot be detected, even on imaging tests.

Hormonal therapy

If you have hormone receptor-positive breast cancer, your doctor may prescribe a medication to block the action of or decrease the level of estrogen and progesterone in your body. This hormonal therapy can stop cancer growth, prevent breast cancer from growing back, and even lower your risk of developing hormone-sensitive breast cancer if taken preventatively. Sometimes we recommend that you take hormone therapy after you’re finished with other cancer treatment.

Immunotherapy

Immunotherapy uses your immune system to fight certain types of breast cancer. Several immunotherapeutic medicines have received FDA approval, including adoptive cell therapies, vaccines, oncolytic viruses, and most notably, immune checkpoint blockade (ICB). Our clinical trials program actively studies new medications, such as immunotherapy, in the treatment of breast cancer.

Targeted therapy

Targeted therapy is medicine that takes advantage of molecular weaknesses in your particular kind of cancer. During diagnosis, a pathologist will look for tumor characteristics that indicate if these drugs can help kill cancer cells. Targeted therapy, which can include treatments that work with your immune system (immunotherapy), may have fewer side effects than traditional chemotherapy. It is sometimes paired with traditional chemotherapy.

Radiation Therapy

Radiation therapy causes cancer cells to break or die by targeting the DNA with high-energy particles, such as X-rays, gamma rays, electron beams, or protons. Radiation oncology specialists direct these particles to the tumor site from outside of your body to precisely target cancer cells, often sparing nearby tissue. You might hear this called external beam radiation therapy.

Our radiation oncologists ensure every patient receives the best and most appropriate radiation treatments based on their diagnosis. At Columbia Cancer we offer a full spectrum of radiation therapies, including:

Intraoperative radiation therapy (IORT)

Targeted radiation therapy delivered in the operating room at the time of surgery directly to the lumpectomy cavity. It adds about 30 minutes to the lumpectomy procedure. IORT is an excellent option for selected patients with early-stage breast cancer and is able to minimize radiation to the rest of the unaffected breast, as well as the underlying heart and lungs.

External beam radiation therapy (EBRT)

Daily treatments in prone or supine positions using 3D conformal or intensity-modulated radiation therapy. The course duration ranges between three and six weeks depending on stage and surgery performed.

Accelerated partial breast irradiation (APBI)

Radiation focused on the tumor cavity alone in appropriate patients. The entire course is completed in five sessions.

Hypofractionated EBRT

Standard treatment for locally advanced breast cancer is five to seven weeks of daily therapy, however shortening the standard course of radiation is an active area of clinical research. Our group has a number of clinical trials open allowing patients to either avoid radiation altogether or shorten the treatment time to 3-4 weeks. Additionally, for early stage breast cancer we have clinical studies investigating extremely short course of radiation (five fractions) in low risk patients.

Oligometastatic breast cancer

Oligometastasis describes patients who have limited metastatic disease (1-5 lesions) typically confined to one organ. We offer focal radiation delivered as stereotactic body radiotherapy (SBRT) as consolidative therapy to patients who have responded well to systemic therapy both on and off clinical trial with the hope to improve long term survival. 

Palliative radiation

Short treatments of one to five fractions are available to patients with focal areas of disease to help alleviate pain or other symptoms of disease without interruption of systemic therapy.

CNS radiation

For breast cancer patients who present with brain or spine metastasis we have radiation treatment options including Gamma Knife radiosurgery (GKRS), whole brain radiation with hippocampal sparing and standard whole brain irradiation for those who need it. In addition, we offer spine stereotactic body irradiation for focal spine metastasis or for re-irradiation for recurrent disease. We work closely with our neuro-oncology and neurosurgery colleagues to offer each patient the best treatment option.

Not all people with breast cancer need radiation treatments. If your personal care team recommends it for you, your radiation oncologist will create your course of treatment. You might have treatment daily, weekly, or every other day for a period of time, usually during an outpatient appointment.

Clinical Trials

You may qualify to participate in a clinical trial, which is a research study to learn more about promising new treatments or supportive care therapies. The goal of clinical trials is to improve the quality of life and survivorship of breast cancer patients. Clinical trials can give patients earlier access to new therapies that are not yet widely available. Columbia Cancer offers dozens of breast cancer clinical trials. You can talk to your care team about whether a clinical trial is an option for you.

Learn More About Clinical Trials