HR+/HER2- breast cancer makes up about 70% of all cases. In the early stages, including stages II and III, your doctor may offer you several treatment options or a combination of treatments. It’s good to educate yourself about some of the choices you may have.
Surgery
Surgery is almost always part of the treatment plan for early breast cancer. It may be the first step, or it may happen after you’ve had a round of chemotherapy. Either way, surgery is critical to remove the tumor from your breast so that the cancer can’t continue to grow and eventually spread.
Stage II breast cancer. If your cancer is stage II, you’ll likely have two surgery options:
- Lumpectomy. Also called breast-conserving surgery, this procedure removes the tumor and leaves the rest of the breast. It’s a short surgery that usually takes less than an hour. Though most of your breast will be left intact, you’ll still lose some of it. So it will take reconstructive surgery to make it match the other breast again. You may have your breast rebuilt at the same time as the lumpectomy or later. You could be back to your usual activities in a week.
- Mastectomy. This surgery removes the entire breast in which the cancer was found. It can take a few hours, depending on whether you have breast reconstruction at the same time. You may go home that day. Recovery is a bit longer than it is for a lumpectomy – about 3 to 6 weeks until you’re back to your routine.
During your surgery, the surgeon will also remove nearby lymph nodes to see whether the cancer has spread to them. Depending on the size of the tumor, the feel of the lymph nodes, and other factors, the surgeon will take one of two approaches to lymph node removal:
- Sentinel node dissection. This less involved procedure takes out just the few lymph nodes closest to the affected breast to see if the cancer has spread there.
- Axillary node dissection. This procedure takes all the lymph nodes from the underarm, which is also called the axilla.
Which surgery you choose and the results of your lymph node biopsy will determine what else, if anything, is needed to treat your cancer.
If you go for breast-conserving surgery, you’ll likely have a few rounds of radiation to your remaining natural breast tissue after the surgery. This kills any stray cancer cells left behind.
If you have a mastectomy, you’ll only need radiation after surgery if cancer is found in your nearby lymph nodes. Otherwise, you may not need it.
Stage III breast cancer. If your cancer is stage III, surgery might be the first step in your treatment, but it’s more likely that you’ll have chemotherapy before surgery. This helps shrink the tumor, and kill any other stray cancer cells, as much as possible first before surgery. That way, the surgery might not have to be as involved.
In some cases, people with stage III breast cancer can get breast-conserving surgery. For example, if your breasts are fairly large, it would leave behind enough tissue to conserve your natural breast after the tumor is removed. But stage III tumors are large, too, so, more often, the recommendation is a mastectomy.
Radiation
Radiation is often suggested after breast cancer surgery. It gets at any remaining cancer cells in the area that surgery didn’t remove. If that’s part of your treatment plan, you may get:
- External radiation. For this treatment – the most common radiation used for breast cancer – a machine aims radioactive beams at the areas most likely to have lingering cancer cells.
- Internal radiation, also called brachytherapy. A doctor implants a device in the area that needs radiation. A radiation source will be placed inside the device for each round of radiation therapy.
Exactly when after surgery you have radiation therapy depends on the other parts of your treatment plan. For example, if you’re also having chemotherapy after surgery, you’ll get radiation after that.
Systemic Therapy for Stage II and III Breast Cancers
Surgery and radiation directly target the breast. Medications – like chemotherapy, targeted drugs, and immunotherapy – affect your whole body. That’s why they are called “systemic” treatments.
Neoadjuvant or adjuvant chemotherapy. Some people with stage II HR+/HER2- breast cancer benefit from chemotherapy before or after surgery. When you get it before surgery, it’s called “neoadjuvant” therapy. If it’s after surgery, you’ll hear it called simply “adjuvant” therapy. Your doctor might order a test to look at the genetic makeup of your tumor to find out whether chemo would be a good choice for you.
Most people with stage III breast cancer will get chemotherapy before surgery.
Hormone therapy. HR+ cancers feed on the female hormones estrogen or progesterone. Hormone therapy for breast cancer can stop your body from producing those hormones or interfere with the effects that those hormones have on cancer cells. Doctors often suggest hormone therapy, such as tamoxifen, an aromatase inhibitor, or one followed by the other, for people with both stage II and III HR+ cancers. You might start it before surgery, but regardless, you’ll usually continue it for at least 5 years.
Targeted therapy. These kinds of drugs are used to treat many kinds of cancer. They shut down or disable the specific proteins that help your cancer cells grow. Different cancers are helped along by different types of proteins. A variety of drugs are available to target many of those proteins.
If your early-stage HR+/HER2- cancer has reached your lymph nodes and has a high risk of coming back, your treatment plan might include a targeted drug.
If you have HR+/HER2- breast cancer at stage II or III, a risk-raising BRCA gene mutation, and some remaining cancer cells after surgery and chemotherapy, you might be prescribed a targeted drug called olaparib. You’ll take it for one year to lower the risk that the cancer comes back someday.
You won’t necessarily have all of these options available to you. Your doctor’s suggestions will be based on a number of things specific to your unique case. But now you know some of the terms you might hear in your discussion with your doctor and the reasons for their recommendations.
Show Sources
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SOURCES:
American Cancer Society: “Treatment of Breast Cancer Stages I-III,” “Targeted drug therapy for breast cancer.”
MD Anderson: “Lumpectomy: 7 Things to Know.”
Mayo Clinic: “Mastectomy,” “Radiation therapy for breast cancer.”
Memorial Sloan Kettering Cancer Center: “Mastectomy,” “Lumpectomy.”
Breastcancer.org: “Sentinel lymph node dissection.”
Canadian Cancer Society: “Axillary lymph node dissection (ALND).”
National Cancer Institute: “Hormone therapy for breast cancer.”
