Treatment for Invasive Breast Cancer

Having invasive breast cancer means cancer that started in the milk glands or ducts has spread to other areas of the breast. It can also spread (metastasize) beyond the breast. There are many treatment options for this type of cancer. Treatment varies by how advanced the cancer is, which includes its stage and subtype. Your age and general health make a difference, too.

Stage I

Stage I cancer usually means a small tumor that hasn't spread beyond the nearest lymph node. Treatment options include: 

• Surgery. Your doctor might remove the tumor only (lumpectomy), the tumor and some of the breast (breast-conserving surgery), or the whole breast (mastectomy). The doctor will also check nearby lymph nodes for cancer cells.

• Radiation therapy. You may get X-ray treatments to kill any cancer cells that remain after surgery. This is most common with a lumpectomy or breast-conserving surgery.

• Hormone therapy. You may have this treatment if you have hormone receptor-positive cancer. That's a subtype of breast cancer in which the cells have receptors for estrogen or progesterone. Treatment involves taking pills to block female hormones. When to take it, for how long, and which type you get depends on whether you're through menopause. The aim is to slow down cancer growth and prevent the cancer from coming back. You may take hormone therapy for about five years.

• Targeted therapy. Women with a subtype of cancer called HER2-positive have too much of a protein that causes breast cancer cell to grow. Targeted therapies are drugs that block this protein. You may take targeted therapy for about a year.

• Chemotherapy. This treatment uses drugs to kill cancer cells. You might have chemotherapy after surgery for stage I cancer if the tumor is high risk, meaning the cancer cells are more likely to grow quickly and spread. Some people take chemotherapy as pills. Others have the drugs put directly into a vein (infusion). There are many choices, from just one drug to a combination of drugs.

Stage II

This stage includes tumors that are larger than stage I and have spread to more than one lymph node near your breast. Treatment options include: 

• Surgery, with options like those for stage I treatment

• Chemotherapy before or after surgery. Chemotherapy before surgery is called neoadjuvant therapy; after surgery it’s called adjuvant therapy.

• Radiation therapy after chemotherapy and surgery

• Hormone therapy if your cancer is hormone receptor-positive, starting before surgery and continuing for about five years

• Targeted therapy, along with chemotherapy, that continues for about one year if the cancer is HER2-positve

Stage III

This stage includes tumors that are larger than stage II and have spread to skin, muscle or many lymph nodes near your breast. Treatment options include: 

• Chemotherapy, likely before surgery to shrink the size of your cancer. It may also be given after surgery.

• Targeted therapy combined with chemotherapy to shrink your cancer if it is HER2-positive. Targeted therapy continues after surgery.

• Breast-conserving surgery. This may be an option if your cancer shrinks enough. If not, you may need a mastectomy. You will almost always have lymph node dissection, which means the surgeon removes several lymph nodes.

• Radiation therapy after surgery

• Hormone therapy, if your cancer is hormone receptor-positive.

Stage IV

This stage includes cancers that have spread to other parts of your body. Although this is advanced breast cancer, there are several treatment options to keep the cancer from growing and spreading further and to prolong life. Treatment options include: 

• Chemotherapy. This is usually the first treatment for stage IV cancer.

• Hormone therapy, if your cancer is hormone receptor-positive.

• Targeted therapy, if your cancer is HER2-positive.

• Surgery and radiation therapy. These are not a major part of treatment for stage IV cancer. Some people have them to control symptoms from cancer that has spread to other areas of the body, such as the lungs or bones.

Every breast cancer is different. Your doctor will help you make the best choices for your unique situation. You have lots of treatment options to consider. If your treatment includes surgery, also talk with your doctor about your options for reconstructive breast surgery. Above all, learn as much as you can about your cancer.