Breast Cancer Treatment Options

Disease Information

Virginia Cancer Specialists » Disease Types » Breast Cancer Treatment Options

Women with breast cancer have many treatment options. The treatment that’s best for one woman may not be best for another.

 

Options After a Mastectomy

The word mastectomy conjures up deformity and permanent disfigurement.  While it is true that a mastectomy removes the breast tissue, it is not true that an unsightly deformity is left behind.  The majority of women in our area choose to have immediate reconstruction after a mastectomy.  In most instances, we can save the nipple and skin and simply replace the inside contents. Part of the decision making process will include a consultation with a breast surgeon and a reconstructive surgeon.

There are a variety of techniques that we can use for reconstruction, but implant-based reconstruction is the most common.  In this setting, the breast surgeon performs that mastectomy, and the reconstruction/plastic surgeon will then step in and repair the breast either with a temporary implant (to be exchanged with a permanent implant at a later date) or a permanent implant.  Another method for reconstruction involves using your own (autologous) tissue.  This may come from the abdominal wall (like a tummy tuck), from the back, or from the thighs.

The discussion about which option is best for you will take into account other treatments that you may need to treat your breast cancer (such as chemotherapy or radiation) as well as your lifestyle and body composition.  This decision is made in conjunction with your team of physicians including your breast surgeon and reconstructive surgeon.  Additionally, breast reconstruction is covered by insurance. In most cases, procedures performed on the opposite breast for symmetry are also a covered benefit.

If you decide not to have immediate reconstruction, you may decide to wear a prosthesis (a breast form) or not.  There are special bras and fittings that can be done to achieve a natural appearance.  Bras and prostheses are also a covered insurance benefit.

All decisions regarding breast Surgery and reconstruction will take each individual into account.  We will work as a team to best meet your needs and the needs of your family.

Radiation Therapy

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.

Doctors use two types of radiation therapy to treat breast cancer. Some women receive both types:

  • External 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 5 days a week for 4 to 6 weeks. 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.

Hormone Therapy

Hormone therapy may also be called anti-hormone treatment. If lab tests show that the tumor in your breast has hormone receptors, then hormone therapy may be an option. (See Lab Tests with Breast Tissue.) Hormone therapy keeps cancer cells from getting or using the natural hormones (estrogen and progesterone) they need to grow.

Options before menopause

If you have not gone through menopause, the options include:

  • Tamoxifen: This drug can prevent the original breast cancer from returning and also helps prevent the development of new cancers in the other breast. As treatment for metastatic breast cancer, tamoxifen slows or stops the growth of cancer cells that are in the body. It’s a pill that you take every day for 5 years.

In general, the side effects of tamoxifen are similar to some of the symptoms of menopause. The most common are hot flashes and vaginal discharge. Others are irregular menstrual periods, thinning bones, headaches, fatigue, nausea, vomiting, vaginal dryness or itching, irritation of the skin around the vagina, and skin rash. Serious side effects are rare, but they include blood clots, strokes, uterine cancer, and cataracts. You may want to read the NCI fact sheet Tamoxifen.

  • LH-RH agonist: This type of drug can prevent the ovaries from making estrogen. The estrogen level falls slowly. Examples are leuprolide and goserelin. This type of drug may be given by injection under the skin in the stomach area. Side effects include hot flashes, headaches, weight gain, thinning bones, and bone pain.
  • Surgery to remove your ovaries: Until you go through menopause, your ovaries are your body’s main source of estrogen. When the surgeon removes your ovaries, this source of estrogen is also removed. (A woman who has gone through menopause wouldn’t benefit from this kind of surgery because her ovaries produce much less estrogen.) When the ovaries are removed, menopause occurs right away. The side effects are often more severe than those caused by natural menopause. Your health care team can suggest ways to cope with these side effects.

Options after menopause

If you have gone through menopause, the options include:

  • Aromatase inhibitor: This type of drug prevents the body from making a form of estrogen (estradiol). Examples are anastrazole, exemestane, and letrozole. Common side effects include hot flashes, nausea, vomiting, and painful bones or joints. Serious side effects include thinning bones and an increase in cholesterol.
  • Tamoxifen: Hormone therapy is given for at least 5 years. Women who have gone through menopause receive tamoxifen for 2 to 5 years. If tamoxifen is given for less than 5 years, then an aromatase inhibitor often is given to complete the 5 years. Some women have hormone therapy for more than 5 years. See above for more information about tamoxifen and its possible side effects.

Chemotherapy

Chemotherapy uses drugs to kill cancer cells. The drugs that treat breast cancer are usually given through a vein (intravenous) or as a pill. You’ll probably receive a combination of drugs.

You may receive chemotherapy in an outpatient part of the hospital, at the doctor’s office, or at home. Some women need to stay in the hospital during treatment.

Some anticancer drugs can damage the ovaries. If you have not gone through menopause yet, you may have hot flashes and vaginal dryness. Your menstrual periods may no longer be regular or may stop. You may become infertile (unable to become pregnant). For women over the age of 35, this damage to the ovaries is likely to be permanent.

On the other hand, you may remain able to become pregnant during chemotherapy. Before treatment begins, you should talk with your doctor about birth control because many drugs given during the first trimester are known to cause birth defects.

Targeted Therapy

Some women with breast cancer may receive drugs called targeted therapy. Targeted therapy uses drugs that block the growth of breast cancer cells. For example, targeted therapy may block the action of an abnormal protein (such as HER2) that stimulates the growth of breast cancer cells. (For information about HER2, see Lab Tests with Breast Tissue.)

Trastuzumab (Herceptin®) or lapatinib (TYKERB®) may be given to a woman whose lab tests show that her breast tumor has too much HER2:

  • Trastuzumab: This drug is given through a vein. It may be given alone or with chemotherapy. Side effects that most commonly occur during the first treatment include fever and chills. Other possible side effects include weakness, nausea, vomiting, diarrhea, headaches, difficulty breathing, and rashes. These side effects generally become less severe after the first treatment. Trastuzumab also may cause heart damage, heart failure, and serious breathing problems. Before and during treatment, your doctor will check your heart and lungs. The NCIfact sheet Herceptin® (Trastuzumab) has more information.
  • Lapatinib: The tablet is taken by mouth. Lapatinib is given with chemotherapy. Side effects include nausea, vomiting, diarrhea, tiredness, mouth sores, and rashes. It can also cause red, painful hands and feet. Before treatment, your doctor will check your heart and liver. During treatment, your doctor will watch for signs of heart, lung, or liver problems.
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                            [post_content] => Fairfax Office Brest Surgical Services

Address:
8503 Arlington Blvd., Suite 340
Fairfax, VA 22031

Dr. Stephanie Akbari received her medical degree from the University of Pennsylvania. She then went on to do her residency in surgery at Harvard’s New England Deaconess Hospital. She is certified by the American Board of Surgery. She is also a fellow of the American College of Surgeons and a member of the American Society of Breast Surgeons, and has previously served on committees of both of those organizations. Since 2005 she has been recognized as one of the region’s “Top Docs” in breast surgery by Washingtonian Magazine.

Dr. Akbari was the first dedicated breast surgeon in Northern Virginia and has been practicing in the area since 2002. She has been a pioneer in breast cancer surgery, continually integrating new technology into treatments she offers her patients. She was the first breast surgeon in the area to become certified in breast ultrasound, the first to incorporate partial breast irradiation into her practice, and the first to perform office based minimally invasive breast biopsies. In 2007, she established the first nationally accredited breast center in the Washington, DC region. She believes in personalized care and strives to put together the best treatment protocol individually tailored to meet the needs of each patient and their families.

In her leisure time, Dr. Akbari likes to spend time with her husband and two teenage boys. She also enjoys cooking, fitness, hiking, and traveling.


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                            [post_content] => Anne Favret, M.D. received her medical degree from Temple University and completed her internship and residency at Georgetown University Hospital. During her fellowship at Stanford University, she developed an interest in clinical research for breast cancer and has published several review articles, original research papers and a book chapter in the area of breast cancer management. Dr. Favret has also regularly spoken within the community and to news sources on the subject of breast cancer. In 2014, she was featured in Forbesmagazine for her expertise in breast cancer detection methods.

Dr. Favret is a member of the American Society of Clinical Oncology and stays active with tumor boards and local support groups. Having made patient care a top priority, she has received several awards throughout her career, including Top Doctor and Best Doctor honors in Washingtonian magazine, Virginia Living Magazine, and the Washington Post. Dr. Favret serves on the Executive Committee and is the Co-director of Breast Research for Virginia Cancer Specialists. She also serves on the Breast Committee for US Oncology.

Dr. Favret enjoys spending time with her family, including her three children. Her leisure time is spent cooking, running, entertaining, and going to the beach.



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[post_title] => Alina M. Huang, M.D. [post_excerpt] => [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => alina-m-huang-m-d [to_ping] => [pinged] => [post_modified] => 2019-03-11 19:05:15 [post_modified_gmt] => 2019-03-11 19:05:15 [post_content_filtered] => [post_parent] => 0 [guid] => http://vacs.wpengine.com/?post_type=physician&p=505 [menu_order] => 0 [post_type] => physician [post_mime_type] => [comment_count] => 0 [filter] => raw ) [3] => WP_Post Object ( [ID] => 508 [post_author] => 2 [post_date] => 2017-09-06 15:47:57 [post_date_gmt] => 2017-09-06 15:47:57 [post_content] => Dr. Irwin’s commitment to caring for and treating oncology and hematology patients led her to join the Loudoun Office of Virginia Cancer Specialists in 2008. She is a member of the American Society of Clinical Oncology and is a national clinical trials researcher. Dr. Irwin regularly lectures in the community for Life With Cancer, has educated the public on clinical trials for the Leukemia and Lymphoma Society, and has given multiple physician Grand Rounds at INOVA Loudoun Hospital to educate her peers on current oncology and hematology cases and developments. A recognized expert in the fight against breast cancer, Dr. Irwin is part of the national U.S. Oncology Breast Cancer Research Committee, has been interviewed as a breast cancer specialist on television and in magazines, and is repeatedly called on to speak at charity events for breast cancer awareness and prevention. Awarded multiple commendations for outstanding patient care, Dr. Irwin has a long-standing commitment to providing the best outcomes for her patients. She completed her Internal Medicine residency at the Hospital of the University of Pennsylvania in 2005, where she was awarded the University of Pennsylvania's Holmes Award in Patient Oriented Evaluative Research. Dr. Irwin went on to complete her Hematology/Oncology fellowship after returning to Georgetown University Hospital's Lombardi Cancer Center. Her research and clinical focus during fellowship was in breast cancer and she completed a Bone Marrow Transplant rotation at the National Cancer Institute in Bethesda, Maryland.  
[post_title] => Amy J. Irwin, M.D. [post_excerpt] => [post_status] => publish [comment_status] => closed [ping_status] => closed [post_password] => [post_name] => amy-j-irwin-m-d [to_ping] => [pinged] => [post_modified] => 2019-03-11 19:14:52 [post_modified_gmt] => 2019-03-11 19:14:52 [post_content_filtered] => [post_parent] => 0 [guid] => http://vacs.wpengine.com/?post_type=physician&p=508 [menu_order] => 0 [post_type] => physician [post_mime_type] => [comment_count] => 0 [filter] => raw ) [4] => WP_Post Object ( [ID] => 516 [post_author] => 2 [post_date] => 2017-09-07 16:48:14 [post_date_gmt] => 2017-09-07 16:48:14 [post_content] => Dr. Jey Maran joined Virginia Cancer Specialists in 2006. At VCS, he has built his interest in the fields of breast, prostate, and GI oncology; lymphomas; platelet and coagulation disorders; benign and malignant hematology conditions; and stem cell transplants. Dr. Maran is the Director of Medical Oncology for the Novant Health Breast Center. He works closely and collaborates with surgeons and radiation oncologists to provide multidisciplinary care for his patients. Dr. Maran has written several publications focusing on prostate cancer, and has reviewed articles in the field of molecular biology of red blood cell disorders. He is triple board certified in hematology, medical oncology, and internal medicine. Among his many academic honors, Dr. Maran served as Chief Fellow at Baylor College of Medicine, where he was also an NIH funded research fellow, working with an internationally renowned team in red blood cell disorders. He holds memberships with the American Society of Clinical Oncology and the American Society of Hematology.
 


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Breast Surgeon and Breast Cancer Team


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