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Breast cancer

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Treatment of stage II breast cancer

The following are treatment options for stage II breast cancer. The types of treatments given are based on the unique needs of the woman with cancer.

Invasive ductal and invasive lobular carcinomas are treated the same way. Stage IIA and stage IIB breast cancers are also treated the same way.

Surgery

Surgery is the primary treatment for stage II breast cancer. The types of surgery are:

  • breast-conserving surgery (BCS)
    • In some situations, chemotherapy may be given before surgery (neoadjuvant therapy) to shrink a large breast tumour so that breast-conserving surgery can be done.
  • modified radical mastectomy
  • axillary lymph node dissection
  • sentinel lymph node biopsy

The risk for breast cancer recurrence will influence the type of adjuvant therapy offered after surgery for stage II breast cancer. These treatments may be used alone or in combination to reduce the chance of breast cancer recurrence and improve survival. Adjuvant therapy is often started 4–12 weeks after breast cancer surgery.

Radiation therapy

External beam radiation therapy is almost always offered after BCS for stage II breast cancer.

Radiation therapy may also be offered after a mastectomy if:

  • The tumour is larger than 5 cm in diameter.
  • The cancer has invaded the skin or muscles of the chest wall.
  •  Cancer was found in 4 or more lymph nodes.
  • There were cancer cells in the tissues close to where the breast was removed.

Chemotherapy

Chemotherapy may be offered to women with stage II breast cancer who:

  • are premenopausal
  • are post-menopausal
    • Chemotherapy is given for hormone receptor–negative breast cancer.
    • Chemotherapy is given before hormonal therapy for hormone receptor–positive breast cancers.
  • have hormone receptor–positive tumours but do not wish to have hormone therapy

Chemotherapy for breast cancer is not usually given as a single drug. Drugs are more commonly used in combination with one another because this has been shown to be more effective.

The most common chemotherapy combinations used to treat stage II breast cancer are:

  • AC
    • doxorubicin (Adriamycin) and cyclophosphamide (Cytoxan, Procytox)
  • AC – Taxol
    • doxorubicin and cyclophosphamide, followed by paclitaxel (Taxol)
  • AC – Taxol (dose dense)
    • doxorubicin and cyclophosphamide, followed by paclitaxel, with less time between treatments (dose dense)
      • This combination is usually given with filgrastim (Neupogen) or pegfilgrastim (Neulasta).
  • TC
    • docetaxel (Taxotere) and cyclophosphamide
  • TAC (or DAC)
    • docetaxel, doxorubicin and cyclophosphamide
  • FAC (or CAF)
    • cyclophosphamide (by mouth), doxorubicin and 5-fluorouracil (Adrucil, 5-FU)
  • CEF
    • cyclophosphamide (by mouth), epirubicin (Pharmorubicin) and 5-fluorouracil
  • FEC
    • cyclophosphamide (into a vein – intravenous), epirubicin and 5-fluorouracil
  • FEC – T
    • cyclophosphamide, epirubicin and 5-fluorouracil, followed by docetaxel
  • CMF – IV
    • cyclophosphamide (intravenous), methotrexate and 5-fluorouracil
  • CMF – PO
    • cyclophosphamide (by mouth), methotrexate and 5-fluorouracil
  • Taxol – FAC
    • paclitaxel, followed by cyclophosphamide, doxorubicin and 5-fluorouracil

For more detailed information on specific drugs, go to sources of drug information.

Hormonal therapy

Hormonal therapy may be offered to women who have stage II breast cancer that is hormone receptor–positive (ER+, PR+ or both).

The types of hormonal therapy offered for stage II breast cancer are:

  • anti-estrogens
    • tamoxifen (Nolvadex, Tamofen) – the most common anti-estrogen
      • Tamoxifen is used to treat both premenopausal and post-menopausal women.
      • Post-menopausal women may be switched to an aromatase inhibitor after a period of time on tamoxifen.
  • aromatase inhibitors – used only in post-menopausal women
    • letrozole (Femara)
    • anastrozole (Arimidex)
    • exemestane (Aromasin)
  • ovarian ablation – may be offered to premenopausal women who do not wish to take other types of hormonal therapy

Biological therapy

Women with HER2-positive stage II breast cancer may also be offered treatment with trastuzumab (Herceptin). It may be given with the chemotherapy, or immediately after completing chemotherapy.

Clinical trials

Women with breast cancer may be offered the opportunity to participate in clinical trials. For more information, go to clinical trials.

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