Options by Stage and Grade

Stage 0 (Tis)

Treatment of ductal carcinoma in situ (DCIS) may include the following:

• Breast-conserving surgery and radiation therapy
• Breast-conserving surgery without radiation therapy (only for small, low grade DCIS)
• Mastectomy with sentinel lymph node biopsy

Stage I, Stage II, Stage IIIA, and Operable Stage IIIC Breast Cancer

Surgical treatment of stage I, stage II, stage IIIA, and operable stage IIIC breast cancer may include the following:

• Breast-conserving surgery with sentinel lymph node biopsy +/- axillary clearance, followed by radiation therapy
• Mastectomy with or without breast reconstruction surgery with sentinel lymph node biopsy +/- axillary clearance
• Neoadjuvant therapy (to shrink the tumor before surgery) followed by either breast-conservative surgery or mastectomy with sentinel lymph node biopsy +/- axillary clearance

Plus adjuvant therapy (treatment given after surgery to lower the risk that cancer will come back) may include the following:

• Radiation therapy to the lymph nodes and/or to the chest wall if after mastectomy
• Hormone therapy alone
• Chemotherapy with or without hormone therapy
• Target therapy with trastuzumab combined with chemotherapy
• A clinical trial of new targeted therapies

Stage IIIB and inoperable stage IIIC breast cancer

Treatment of stage IIIB and inoperable stage IIIC breast cancer may include the following:

• Chemotherapy
• Neoadjuvant chemotherapy followed by surgery (breast-conserving surgery or total mastectomy), with lymph node dissection followed by radiation therapy. Additional therapy (chemotherapy, hormone therapy, or both) may be given after surgery
• Clinical trials testing new anticancer drugs, new drug combinations, and new ways of giving treatment

Stage IV and metastatic breast cancer

Treatment of stage IV or metastatic breast cancer may include the following:

• Hormone therapy and/or chemotherapy with or without trastuzumab
• Target therapy with trastuzumab combined with chemotherapy
• Radiation therapy and/or surgery for relief of pain and other symptoms
• Bisphosphonate drugs to reduce bone disease and pain when cancer has spread to the bone
• Clinical trials testing new chemotherapy and/or hormone therapy
• Clinical trials of new combinations of treatments, including targeted therapy, hormone therapy, and chemotherapy