Treatment by Type of Breast Cancer
Type | Possible Treatments |
|---|---|
DCIS | Mastectomy Breast-conserving surgery in some patients (with lesions confined to one quadrant) with or without* radiation therapy Endocrine therapy for some patients |
LCIS, classic | Surgical excision to exclude cancer in certain cases If negative, observation with regular examinations and mammograms Bilateral prophylactic mastectomy (rarely) |
LCIS, pleomorphic | Surgical excision to negative margins |
Stages I and II (early-stage) cancer | Preoperative chemotherapy to optimize chances for breast-conserving surgery (in patients with T2 or higher-grade breast cancer) Breast-conserving surgery, followed by radiation therapy Mastectomy with or without breast reconstruction Systemic therapy (eg, postoperative chemotherapy, endocrine therapy, anti-HER2 medications, or a combination) based on results of tumor tests (eg, analysis for hormone receptors and HER2 protein), except possibly in some postmenopausal women with hormone receptor-positive tumors with low to intermediate Oncotype Dx scores |
Stage III (locally advanced) cancer, including inflammatory breast cancer | Preoperative systemic therapy, usually chemotherapy Breast-conserving surgery or mastectomy if tumor is resectable after preoperative therapy Mastectomy for inflammatory breast cancer Usually, postoperative radiation therapy Postoperative chemotherapy, endocrine therapy, or both |
Stage IV (metastatic) cancer | If cancer is symptomatic and multifocal, endocrine therapy, ovarian ablation therapy, or chemotherapy For brain metastases, local skin recurrences, or isolated symptomatic bone metastases, radiation therapy For bone metastases, IV bisphosphonates to reduce bone loss and bone pain |
Paget disease of the nipple | Usually, based on type of underlying breast cancer if any Occasionally, local excision only |
Locally recurrent breast cancer | Mastectomy or surgical resection (if mastectomy has already been done), sometimes preceded by chemotherapy or endocrine therapy Radiation therapy for some patients Chemotherapy or endocrine therapy |
Phyllodes tumors | Wide excision Sometimes radiation therapy (if borderline or malignant) Mastectomy if the mass is large |
* Wide excision or breast-conserving surgery may be used alone, especially if the lesion is < 2.5 cm and histologic characteristics are favorable, or with radiation therapy if size and histologic characteristics are less favorable. | |
DCIS = ductal carcinoma in situ; HER2 = human epidermal growth factor receptor 2; LCIS = lobular carcinoma in situ. | |