Also known as breast-sparing surgery or breast-conserving surgery, this procedure involves the removal of only the cancerous mass along with some surrounding healthy tissue. The surgeon typically also removes one or more lymph nodes from under your arm to test for the spread of cancer to your lymphatic system.
Breast Cancer Treatment Options in Central New York
Most patients undergoing breast cancer treatment receive a combination of therapies as part of their overall treatment plan. The order and timing of these therapies are tailored to the individual based on the stage of the cancer. Treatment options for breast cancer may include:
Breast Cancer Surgery
Surgery is almost always part of the breast cancer treatment plan. Your care team, which includes a breast surgeon, will work together to determine the most appropriate procedure and timing for your specific case. Depending on your diagnosis, you may undergo one of the following surgical procedures:
Lumpectomy
Mastectomy
This procedure involves the removal of the entire breast containing the cancer. There are two main types of mastectomy:
- Total (simple) mastectomy: The surgeon removes the entire breast.
- Modified radical mastectomy: The surgeon removes the entire breast along with a significant number of lymph nodes under your arm and the lining over your chest muscles.
Advanced surgical options are also available that preserve all or part of the original “breast envelope,” which is the skin covering the breast mound. These options, called nipple-sparing and skin-sparing mastectomies, allow for the reconstructive process to begin at the time of the mastectomy, resulting in excellent cosmetic outcomes.
Breast Reconstruction
Some women opt for breast reconstruction after undergoing surgery to remove breast cancer to restore the shape of the breast. Reconstruction can be performed at the same time as the cancer surgery or at a later date. If you are considering breast reconstruction, be sure to discuss your options with your oncologist. They may recommend consulting with a plastic surgeon before undergoing any initial breast cancer surgeries.
Radiation Therapy for Breast Cancer
Radiation therapy, also known as radiotherapy, uses high-energy radiation to kill breast cancer cells. This treatment specifically affects only the part of the body being treated.
Patients may receive radiation therapy in the following situations:
- Before surgery to help shrink a tumor
- After breast-conserving surgery(BCS) to reduce the chance of breast cancer recurrence
- After amastectomy, particularly when the cancer is larger than 5 cm, multiple lymph nodes are involved, or if cancer cells are found at the surgical margin
- If the cancer has metastasized to distant sites, such as the bones, spinal cord, or brain
Your cancer care team at HOA will include a radiation oncologist, who specializes in determining the right type and dosage of radiation therapy that may be needed based on the stage and location of the cancer.
There are two types of radiation therapy used for breast cancer treatment: external beam radiation therapy (EBRT) and brachytherapy.
External beam radiation therapy (EBRT)
This type of radiation is the most common form of radiation therapy for breast cancer. It is delivered from a machine called a linear accelerator.
External beam radiation therapy typically does not begin until the surgical site has healed. It is also delayed until chemotherapy treatment has finished. Certain treatments after surgery, such as hormone therapy or HER2 targeted therapy, can be given at the same time as radiation.
Various approaches are used when administering EBRT, including:
- Whole breast radiation: Radiation is delivered to the entire breast. Patients typically visit the HOA cancer center for treatment, usually five days a week over several weeks. In some cases, hypofractionated radiation therapy may be an option, which delivers higher doses of radiation in fewer treatments (usually 3-4 weeks).
- Accelerated partial breast irradiation (APBI): This method involves delivering larger doses of radiation over a shorter time period to a specific part of the breast (the tumor bed), rather than the whole breast.
- Chest wall radiation: Women who have undergone a mastectomy with no affected lymph nodes may receive radiation to the entire chest wall, the mastectomy scar, and any areas where surgical drains were placed.
- Lymph node radiation: If cancer was found in the axillary lymph nodes (under the arm), this area may also receive radiation.
Internal radiation (implant radiation therapy or HDR brachytherapy)
Brachytherapy involves placing a radiation source directly into the breast tissue, rather than targeting the tumor with external beams. The most common type of brachytherapy for women with breast cancer is intracavitary brachytherapy.
This method requires the placement of radioactive material into a catheter (tube) that is surgically implanted in the breast. Due to the high doses of radiation, the radioactive seeds are only inserted for a few minutes at a time before being removed. No radioactivity remains in your body afterwards. Internal radiation therapy is typically given twice a day for 5 days in an outpatient setting.
Hematology-Oncology Associates of Central New York has provided advanced breast cancer treatments for several decades, enabling patients to conveniently access the latest medical and supportive care they need.
Chemotherapy for Breast Cancer
Chemotherapy uses drugs to destroy cancer cells. These drugs circulate in the bloodstream, allowing them to reach cancer cells throughout the body. Breast cancer chemotherapy is typically given through a vein (intravenous) or in pill form. Treatment may take place in an outpatient clinic, at a doctor's office, or at home.
Chemotherapy may be recommended:
- Before surgery (neoadjuvant chemotherapy) to help shrink the tumor, making it easier to remove
- After surgery (adjuvant chemotherapy) to help kill any cancer cells that remain after the tumor is removed
Typically, a combination of drugs is used to treat breast cancer more effectively. However, some women with advanced breast cancer may only receive a single chemotherapy drug. There are several chemotherapy drugs available for breast cancer.
The highly skilled team at HOA will help you understand your specific chemotherapy regimen and the potential side effects you might experience during treatment.
Hormone Therapy for Breast Cancer
Hormone therapy may be an option if tests indicate that your breast tumor has hormone receptors. This type of therapy helps prevent cancer cells from getting or using the natural hormones—estrogen and progesterone—that they need to grow. It may also be used in combination with other treatments.
The specific hormone therapy you receive will depend on whether or not you have gone through menopause.
Hormone therapy options before menopause
If you have not yet gone through menopause, your options may include:
- Tamoxifen: This medication can help prevent the original breast cancer from returning and also reduce the risk of developing new cancers in the other breast. When treating metastatic breast cancer, tamoxifen slows or stops the growth of cancer cells in the body. It is taken as a pill every day for up to five years.
- LH-RH agonist: These drugs can prevent the ovaries from producing estrogen, which eventually decreases estrogen levels. Examples include leuprolide and goserelin, which are typically given by injection under the skin in the abdominal area. Side effects may include hot flashes, headaches, weight gain, thinning bones, and bone pain.
- Surgery to remove your ovaries: Since your ovaries are the main source of estrogen before menopause, removing them eliminates this source. This surgery causes immediate menopause, which can result in more severe side effects than natural menopause. Your cancer care team can advise you on how to manage the side effects.
Hormone therapy options after menopause
If you have already gone through menopause, your options may include:
- Aromatase inhibitor: These drugs, such as anastrozole, exemestane, and letrozole, block an enzyme called aromatase, which the body uses to produce estrogen in the ovaries and other tissues. Aromatase inhibitors are primarily used in postmenopausal women because the ovaries in premenopausal women produce too much estrogen to be blocked effectively.
- Tamoxifen: Hormone therapy is often given for at least five years to prevent recurrence of breast cancer. Some women may continue hormone therapy for a longer time. Refer to the previous section for more information about tamoxifen.
Breast Cancer Targeted Therapy
Targeted therapy for breast cancer focuses on targeting specific proteins and genes known to promote breast cancer growth. This precise approach blocks the cancer while minimizing the effect on normal, healthy cells.
There are two main types of targeted therapy:
- Monoclonal antibodies: These drugs block a specific target on the outside of cancer cells.
- Small-molecule drugs: These can inhibit the process that allows cancer cells to multiply and spread.
Your oncologist may recommend specific tests to help determine the most effective targeted therapy. These tests can identify the presence of factors, including genes and proteins in the tumor. Based on the results, one of the following types of targeted therapy may be included in your breast cancer treatment plan:
- Targeted therapy for HER-2 positive breast cancer: Drugs such as trastuzumab, pertuzumab, ado-trastuzumab, lapatinib, fam-trastuzumab deruxtecan, margetuximab, and neratinib target breast cancers that test positive for the human epidermal growth factor receptor 2 (HER2) protein. These medications may be prescribed alongside chemotherapy, radiation, or other treatments.
- Targeted therapy for hormone receptor-positive breast cancer: Medications like everolimus, bevacizumab, palbociclib, ribociclib, or abemaciclib are often used in combination with hormone therapy for breast cancers that test positive for hormone receptors.
- Targeted therapy for breast cancer caused by genetic mutations: Olaparib is a type of drug known as a PARP inhibitor that targets hereditary breast cancer syndromes linked to inherited changes in the BRCA1 and BRCA2 genes.
- Targeted therapy for triple-negative breast cancer: Sacituzumab govitecan-hziy is a common targeted therapy drug used for triple-negative breast cancer. This medicine targets Trop-2, a protein that helps breast cancer cells to grow and spread.
Immunotherapy for Breast Cancer
Immunotherapy for breast cancer uses specific medications to enhance the immune system's ability to recognize and destroy cancer cells more effectively.
Breast cancer cells can often disguise themselves as healthy cells, making it hard for the immune system to recognize and attack them. Immunotherapy helps the immune system identify these unhealthy cells by targeting checkpoint proteins on the cancer cells.
Currently, the approved immunotherapy drugs for breast cancer are known as PD-1 inhibitors. These medications specifically target the PD-1 protein found on immune system T cells, which normally stops them from attacking other cells in the body. These medicines are mainly used for patients with advanced triple-negative breast cancer when the genetic makeup of their tumor includes the PD-L1 protein.
Pembrolizumab is the most common immunotherapy used for breast cancer. This drug targets PD-1 and is given as an intravenous (IV) infusion, usually every 3 or 6 weeks.
Breast Cancer Clinical Research Trials Available in Central New York
Breast cancer research continues to explore potential new combinations of therapies. HOA has been actively participating in these studies and currently offers clinical trials for breast cancer patients. If you meet the study's eligibility criteria, your oncologist will discuss possible clinical trial participation with you.
Learn more about clinical trials available at Hematology-Oncology Associates of CNY.
Supportive Care for Breast Cancer Patients
In addition to cancer treatments, HOA provides supportive care focused on relieving cancer symptoms and side effects, while enhancing the patient's quality of life. This supportive care may include emotional counseling, pain management, nutritional assistance, and guidance on addressing practical challenges related to the disease and its treatment.
If you need help managing life with cancer, please reach out to a member of your breast cancer care team.
Find a Breast Cancer Specialist in the Syracuse Area
At Hematology-Oncology Associates of CNY, we are dedicated to delivering expert, patient-centered breast cancer care. Through a multidisciplinary approach, we can ensure each patient receives a personalized treatment plan based on the latest advancements in breast cancer care. With a committed team, comprehensive diagnostic imaging, state-of-the-art treatment options, access to clinical research trials, an in-house pharmacy and laboratory, and a post-treatment survivorship program, HOA provides exceptional breast cancer care in Central New York.
Our cancer centers offer care for patients in Central New York, in the Syracuse area, including Camillus and all of Onondaga County; Auburn and the rest of Cayuga County; Madison County, including Oneida; Jefferson County, including Watertown; Oswego County, including Fulton and Oswego, Cortland County, and Herkimer County.
Source: American Cancer Society, National Cancer Institute.
