The Huntington Cancer Center, an affiliate of Cedars-Sinai Cancer, has one of the area’s premiere breast cancer facilities. Our specialists are highly experienced in the most advanced breast cancer treatments, and we are constantly seeking out treatment innovations to improve outcomes and decrease comfort for our patients, from shorter courses of radiation therapy, to incorporating proven supplemental therapies through our integrative oncology program. Your care team will help you craft a custom treatment plan that’s right for you.
Treatment Options for Breast Cancer
Among the many decisions you will be making regarding your cancer treatment, is your choice regarding the best surgical treatment option. The role of surgery in breast cancer treatment is to treat the tumor in the breast, as well as determine if the cancer has spread to the nodes under the arm (axilla). Together, you and your physicians will decide what is best for your individual circumstances.
Breast Conserving Surgery (Lumpectomy)
Often referred to as a lumpectomy, breast conserving surgery removes only the tumor and a small margin of the normal tissue around it.
This surgery involves total removal of the breast tissue. When your doctor recommends that a significant amount of breast tissue must be removed to get rid of the tumor(s), a mastectomy may be the right choice for you.
Choosing the Right Surgery for You
Your doctor determines your breast cancer treatment options based on a number of factors including:
- The type of tumor(s)
- The size of the tumor as determined by physical exam and imaging (mammogram, ultrasound, MRI)
- The molecular features of the tumor (estrogen receptor, progesterone receptor, HER2/neu status)
- Your overall health
- Your own personal preferences
Breast cancer surgery does not have to be disfiguring or deforming. Advances in surgical techniques for breast cancer have allowed women to complete their cancer treatment without sacrificing their body image or self-esteem. Balancing your cancer treatment with the cosmetic outcome can be an important consideration when determining the best choice for you.
For patients who undergo Breast Surgery to remove all or part of their breast, Breast Reconstruction surgery may be the right choice. This surgery is performed by a plastic reconstructive surgeon.
Radiation Therapy is a form of local treatment for breast cancer. Radiation is almost always required after lumpectomy and sometimes is recommended after mastectomy. Studies have shown that radiation therapy markedly improves local control of breast cancer and also improves survival rates.
Radiation Therapy Options
- Linear Accelerators
- 3-D Conformal Radiation Therapy: Whole Breast or Partial Breast
- Hypofractionated Radiation Therapy: Whole Breast or Partial Breast
- Breast Brachytherapy
Your surgeon and radiation oncologist will help you chose the radiation option that is best suited for you.
Radiation Oncology Expertise
Our Radiation Oncology department is committed to provide the newest state-of-the-art radiation therapy treatment options in a caring and compassionate environment. Our radiation oncology program is unique in that each radiation oncologist specializes in treating a specific tumor site.
We have radiation oncologists who specialize in breast cancer treatment and the most advanced treatment equipment available. Our department is experienced in external beam radiation as well as breast brachytherapy.
Chemotherapy, hormone therapy and targeted therapy are “systemic treatments” that aim to kill any cancer cells that may have spread into the bloodstream. While surgery and radiation provide local treatment to the cancer in the breast, cancers that have spread (or that your doctor is concerned may have spread) can benefit from system treatments that kill those cancer cells to prevent them from metastasizing (spreading) to other organs.
Systemic Therapy Treatments
Chemotherapy (chemo) uses medications to destroy cancer cells in the body, including cells at the original cancer site and any that may have spread.
Hormonal therapy medicines are systemic treatment for hormone-receptor-positive (HR+) breast cancers.
Targeted HER2 Therapy
Targeted HER2 therapies are treatments that target a specific protein called HER2/neu that allows the cancer cells to grow in a rapid or abnormal way. Targeted therapies are generally less likely than chemotherapy to harm normal, healthy cells. However, they are more effective when given in combination with chemotherapy.
How does it work?
There are currently four HER2 targeted therapy drugs that doctors use to treat breast cancer:
- Herceptin (trastuzumab) works against HER2-positive breast cancers by blocking the ability of the cancer cells to receive chemical signals that tell the cells to grow.
- Tykerb (lapatinib) works against HER2-positive breast cancers by blocking certain proteins that can cause uncontrolled cell growth.
- Perjeta (pertuzumab), similar to Herceptin, works against HER2-positive breast cancers by blocking the cancer cells’ ability to receive growth signals.
- Kadcyla (T-DM1 or ado-trastuzumab emtansine) is a combination of Herceptin and the chemotherapy medicine emtansine. Kadcyla was designed to deliver emtansine to cancer cells in a targeted way by attaching emtansine to Herceptin. Herceptin then carries emtansine to the HER2-positive cancer cells, thus potentially making the chemotherapy more effective while being less toxic to normal cells.
Who needs targeted HER2 therapy?
- Invasive breast cancer – approximately 20% of invasive breast cancers are HER2 positive, meaning they have too many copies of the HER2 gene. This results in HER2 overexpression, or too much HER2 protein on the cell’s surface. This leads to a cancer cell receiving lots of signals to grow, thus resulting in a cancer cell which can grow or spread more quickly.
- Ductal carcinoma in situ (DCIS) – studies show up to 60% of DCIS are HER2 positive, but the clinical significance of this is unknown. In the NSABP B-43, doctors are currently studying whether adding a targeted drug (Herceptin) during radiation therapy after lumpectomy may help reduce the risk of a local recurrence.
When is targeted therapy given?
Like chemotherapy, targeted HER2 therapy can be given either after surgery or before and after. Your doctors will help you decide which timing is best for you.
What are the side effects of targeted HER2 therapy?
Targeted therapies are generally given with chemotherapy, so patients still experience side effects of chemo. Rare side effects which are specifically associated with targeted therapies include damage to the heart muscle and swelling of lung tissue. Report any symptoms of shortness of breath, difficulty breathing, a fast or irregular heartbeat, increased cough, and swelling of the feet or lower legs to your doctor as soon as possible.
Who Needs Systemic Treatment?
Systemic treatment should be considered in every woman with invasive breast cancer. Based on information obtained from your physical exam, breast imaging, and tumor pathology report, your doctors decide whether systemic therapy is necessary by assessing the risk and benefit of treatment. Depending on your cancer, you may get no systemic treatment, chemotherapy alone, hormonal therapy alone or a combination of chemotherapy and hormone therapy.
Clinical trials may also be available as you and your doctor explore treatment options.
Genetic testing involves testing for two known breast cancer genes. Identification of a breast cancer gene can have significant implications on your future risk of a new breast cancer or ovarian cancer, and may be helpful in helping you and your doctors determine the best treatment option and follow-up/surveillance plan for you.