Treatment of Breast Cancer Stages I-III (2024)

The stage of your breast cancer is an important factor in making decisions about your treatment.

Most women with breast cancer in stages I, II, or III are treated with surgery, often followed by radiation therapy. Many women also get some kind of systemic drug therapy (medicine that travels to almost all areas of the body). In general, the more the breast cancer has spread, the more treatment you will likely need.But your treatment options are affected by your personal preferences and other information about your breast cancer, such as:

  • If the cancer cells have hormone receptors. That is, if the cancer is estrogen receptor (ER)-positive or progesterone receptor (PR)-positive.
  • If the cancer cells have large amounts of the HER2 protein (that is, if the cancer is HER2-positive)
  • How fast the cancer is growing (measured by grade or Ki-67)
  • Your overall health
  • If you have gone through menopause or not

Talk with your doctor about how these factors can affect your treatment options.

What type of drug treatment(s) might I get?

Most women with breast cancer in stages I, II,or III will get some kind of systemic therapy as part of their treatment. This might include:

  • Chemotherapy
  • Hormone therapy (tamoxifen, an aromatase inhibitor, or one followed by the other)
  • Targeted drugs, such as trastuzumab (Herceptin), pertuzumab (Perjeta), or abemaciclib (Verzenio)
  • Immunotherapy
  • Some combination of these

The types of drugs that might work best depend on the tumor’s hormone receptor status, HER2 status, and other factors.

Treating stage I breast cancer

These breast cancers are still fairly small and either have not spread to the lymph nodes or have spread to only a tiny area in the sentinel lymph node (the first lymph node to which cancer is likely to spread).

Local therapy (surgery and radiation therapy)

Surgery is the main treatment for stage I breast cancer. These cancers can be treated with either breast-conserving surgery (BCS; sometimes called lumpectomy or partial mastectomy) or mastectomy. The nearby lymph nodes will also need to be checked, either with a sentinel lymph node biopsy (SLNB) or an axillary lymph node dissection (ALND).

Some women can havebreast reconstruction at the same time as the surgery to remove the cancer. But if you will need radiation therapy after surgery, it is better to wait to get reconstruction until after the radiation is complete.

If BCS is done, radiation therapy is usually given after surgery to lower the chance of the cancer coming back in the breast and to also help people live longer.

In a separate group, women who are at least 65 years old may consider BCS without radiation therapy if ALL of the following are true:

  • The tumor was 3 cm (a little more than 1 inch) or less across and it has been removed completely.
  • None of the lymph nodes removed contained cancer.
  • The cancer is ER-positive or PR-positive, and hormone therapy will be given.

Radiation therapy given to women with these characteristics still lowers the chance of the cancer coming back, but it has not been shown to help them live longer.

If you had a mastectomy, you are less likely to need radiation therapy, but it mightbe given depending on the details of your specific cancer. You should discussif you need radiation treatment with your doctor. You might be sent to a doctorwho specializes in radiation (a radiationoncologist)for evaluation.

Systemic therapy (chemo and other drugs)

If a woman hasa hormone receptor-positive (ER-positive or PR-positive) breast cancer, most doctors will recommend hormone therapy (tamoxifen or an aromatase inhibitor, or one followed by the other) as an adjuvant (after surgery) treatment, no matter how small the tumor is. Women with tumors larger than 0.5 cm (about ¼ inch) across may be more likely to benefit from it. Hormone therapy is typically given for at least 5 years.

If the tumor is larger than 0.5 cm (about 1/4 inch) across, chemo after surgery (adjuvant chemotherapy) is sometimes recommended. A woman's age when she is diagnosedmay help in deciding if chemo should be offered or not. Some doctors may suggest chemo for smaller tumors as well, especially if they have any unfavorable features (a cancer that is growing fast; hormone receptor-negative, HER2-positive; or having a high score on a gene panel such as Oncotype DX).

After surgery, some women with HER2-positive cancers will be treated with trastuzumab (with or without pertuzumab) for up to 1 year.

Many women with HER2-positive cancers will be treated with neoadjuvant (before surgery) chemo and trastuzumab (with or without pertuzumab) followed by surgery and more trastuzumab (with or without pertuzumab) for up to 1 year. If after neoadjuvant therapy, residual cancer is found during surgery, trastuzumab may be changed to a different drug, called ado-trastuzumab emtansine, which is given every 3 weeks for 14 doses.

For women with a BRCA mutation and hormone-positive, HER2-negative breast cancer who received neoadjuvant chemotherapy but still have residual cancer at the time of surgery, the targeted drug olaparib might be given after surgery. It is usually given for one year. When given this way, it can help some women live longer.

Treating stage II breast cancer

Stage II breast cancers are larger than stage I cancers and/or have spread to a few nearby lymph nodes.

Local therapy (surgery and radiation therapy)

Stage II cancers are treated with either breast-conserving surgery (BCS; sometimes called lumpectomy or partial mastectomy) or mastectomy. The nearby lymph nodes will also be checked, either with a sentinel lymph node biopsy (SLNB) or an axillary lymph node dissection (ALND).

Women who have BCS are treated with radiation therapy after surgery.Women who have a mastectomy are typically treated with radiation if the cancer is found in the lymph nodes. Some patients who have a SLNB that shows cancer in a few lymph nodes might not have the rest of their lymph nodes removed to check for more cancer. In these patients, radiation may be discussed as a treatment option after mastectomy.

If you were initially diagnosed with stage II breast cancerand were given a systemic treatment such as chemotherapy or hormone therapy before surgery, radiation therapy might be recommended if cancer is found in the lymph nodes during mastectomy. A radiation oncologist may talk with you to see ifradiation would be helpful.

If chemotherapy is also needed after surgery, the radiation will be delayed until the chemo is done.

In some women, breast reconstruction can be done during the surgery to remove the cancer. But if you will need radiation after surgery, it is better to wait to get reconstruction until after the radiation is complete.

Systemic therapy (chemo and other drugs)

Systemic therapy (drugs that travel to almost every part of the body)is recommended for some women with stage II breast cancer. Some systemic therapies are given before surgery (neoadjuvant therapy), and others are given after surgery (adjuvant therapy). For some women, systemic therapy will be started before surgery and then continued after surgery. Neoadjuvant treatments are a good option for women with large tumors, because they can shrink the tumor before surgery, possibly enough to make BCS an option.

Neoadjuvant treatment is also a preferable option for women with triple-negative breast cancer (TNBC) or HER2-positive breast cancer because the treatment given after surgery is often chosen depending on how much cancer is still in the breast and/or lymph nodes at the time of surgery. Some women with early-stage cancer who get neoadjuvant treatment might live longer if the cancer completely goes away with that treatment.

To help decide which women with stage II hormone receptor-positive, HER2-negative breast cancer will benefit from chemotherapy, a gene panel test such as Oncotype DXmay be done on the tumor sample.

The drugs used will depend on the woman’s menopause status, as well as tumor test results. Treatment might include:

  • Chemotherapy: Chemo can be given before and/or after surgery.
  • HER2 targeted drugs: Some women with HER2-positive cancers will be treated with adjuvant (after surgery) chemotherapy with trastuzumab with or without pertuzumab for up to 1 year. Many women with HER2-positive cancers will be treated first with trastuzumab (with or without pertuzumab) followed by surgery and then more trastuzumab (with or without pertuzumab) for up to a year.If after neoadjuvant therapy, residual cancer is found at the time of surgery, the targeted drug, ado-trastuzumab emtansine, may be used instead of trastuzumab. It is given every 3 weeks for 14 doses. For women with hormone receptor-positive cancer found in the lymph nodes after completing1 year of trastuzumab, the doctor might also recommend additional treatment with an oral targeted drug called neratinib for 1 year.
  • Hormone therapy: If the cancer is hormone receptor-positive, hormone therapy (tamoxifen, an aromatase inhibitor (AI), or one followed by the other) is typically used. It can be started before surgery, but because it continues for at least 5 years, it needs to be given after surgery as well.
  • Targeted drug therapy: For women with early-stage breast cancer that is hormone receptor-positive, HER2-negative, has cancer in the lymph nodes, and has a high chance of coming back, the targeted drug abemaciclib can be given after surgery along with tamoxifen or an AI. It is a pill typically given for 2 years twice a day. For women who have a BRCA mutation with a hormone receptor-positive, HER2-negative tumor who still have cancer in the tissue removed at surgery after neoadjuvant chemo, the targeted drug olaparib might be given for one year to help lower the chance of the cancer recurring. When given this way, it can help some women live longer.
  • Immunotherapy: Women with TNBC might get the immunotherapy drug, pembrolizumab, before surgery and then again after surgery. See Treatment of Triple-negative Breast Cancer for more details.

Treating stage III breast cancer

In stage III breast cancer, the tumor is large (more than 5 cm or about 2 inches across) or growing into nearby tissues (the skin over the breast or the muscle underneath), or the cancer has spread to many nearby lymph nodes.

If you have inflammatory breast cancer: Stage III cancers also include some inflammatory breast cancers that have not spread beyond nearby lymph nodes. These cancers are treated slightly different from other stage III breast cancers. You can find more details in Treatment ofInflammatory Breast Cancer.

There are two main approaches to treating stage III breast cancer:

Starting with neoadjuvant therapy

Most often, these cancers are treated with neoadjuvant (before surgery) chemotherapy. For HER2-positive tumors, the targeted drug trastuzumab is given as well, often along with pertuzumab (Perjeta). This may shrink the tumor enough for a woman to have breast-conserving surgery (BCS). If the tumor doesn’t shrink enough, a mastectomy is done. Nearby lymph nodes will also need to be checked. A sentinel lymph node biopsy (SLNB) is often not an option for stage III cancers, so an axillary lymph node dissection (ALND) is usually done.

Often, radiation therapy is needed after surgery. If breast reconstruction is planned, it is usually delayed until after radiation therapy is done. For some, additional chemo is given after surgery as well.

After surgery, some women with HER2-positive cancers will be treated with trastuzumab (with or without pertuzumab) for up to a year. Many women with HER2-positive cancers will be treated first with trastuzumab (with or without pertuzumab) followed by surgery and then more trastuzumab (with or without pertuzumab) for up to a year. If after neoadjuvant therapy, any residual cancer is found at the time of surgery, ado-trastuzumab emtansine may be used instead oftrastuzumab. It is given every 3 weeks for 14 doses. For women with hormone receptor-positive cancer that is in the lymph nodes, who have completed a year of trastuzumab, the doctor might also recommend additional treatment with an oral targeted drug called neratinib for a year.

Women with hormone receptor-positive (ER-positive or PR-positive) breast cancers will also get adjuvant hormone therapy which can typically be taken at the same time as trastuzumab.

For women with hormone receptor-positive, HER2-negative breast cancer that is in the lymph nodes, and has a high chance of coming back, abemaciclib can be given after surgery along with tamoxifen or an AI. It is a pill typically given twice a day for 2 years.

For women who have a BRCA mutation and hormone receptor-positive, HER2-negative breast cancer and still have cancer in the tissue removed at surgery after neoadjuvant chemo, the targeted drug olaparib might be given for one year to help lower the chance of the cancer recurring. When given this way, it can help some women live longer.

Neoadjuvant treatment is a preferable option for women with stage III TNBC or HER2-positive breast cancer because the treatment given after surgery is chosen depending on how much cancer is still in the breast and/or lymph nodes at the time of surgery. Some women with stage III cancer who get neoadjuvant treatment might live longer if the cancer goes away completely with that treatment.

Women with TNBC might get the immunotherapy drug, pembrolizumab, before surgery and then again after surgery. See Treatment of Triple-negative Breast Cancer for more details.

Starting with surgery

Surgery first is an option for some women with stage III cancers. Because these tumors are fairly large and/or have grown into nearby tissues, this usually means getting a mastectomy. For women with fairly large breasts, BCS may be an option if the cancer hasn’t grown into nearby tissues. SLNB may be an option for some patients, but most will need an ALND. Surgery is usually followed by adjuvant chemotherapy, and/or hormone therapy, and/or targeted drug therapy, and/or HER2-positive treatment (trastuzumab, pertuzumab, or neratinib) depending on the traits of the cancer cells. Radiation is recommended after surgery.

Treatment of Breast Cancer Stages I-III (2024)

FAQs

Treatment of Breast Cancer Stages I-III? ›

Most women with breast cancer in stages I, II, or III are treated with surgery, often followed by radiation therapy. Many women also get some kind of systemic drug therapy (medicine that travels to almost all areas of the body). In general, the more the breast cancer has spread, the more treatment you will likely need.

How is Stage 1 Grade 3 breast cancer treated? ›

Treatment for stages I to III breast cancer usually includes surgery and radiation therapy, often with chemo or other drug therapies either before (neoadjuvant) or after (adjuvant) surgery.

What is the treatment for Stage 1 triple negative breast cancer? ›

Stages 1-3 triple-negative breast cancer: If the tumor is small, breast-conserving surgery (lumpectomy) may be recommended. If there is lymph node involvement, a mastectomy and lymph node removal may be performed. If the tumor is large or if the cancer has spread to the lymph nodes, radiation may follow surgery.

How is Stage 3 HER2-positive breast cancer treated? ›

Trastuzumab (Herceptin) is added to chemotherapy for HER2-positive breast cancer. It is continued for 1 year after chemotherapy is finished. Pertuzumab (Perjeta) may be used alone or in combination with chemotherapy and trastuzumab before surgery for stage 3 HER2-positive breast cancer.

How long is chemo for HER2-positive? ›

Neoadjuvant therapy is typically administered for between 12 and 20 weeks, depending on the chosen regimen, and followed by surgery. When given as adjuvant chemotherapy following surgery, trastuzumab is given concurrently with chemotherapy, then continued for a total duration of 12 months.

What is the survival rate for Stage 1 Grade 3 breast cancer? ›

The 5-year relative survival rate is 99%. Regional breast cancer has spread to nearby tissue or lymph nodes. This includes stage IB (pronounced “stage 1-B”), some IIA (“stage 2-A”), some IIB (“stage 2-B”), and all stage III (“stage 3”). The 5-year relative survival rate is 86%.

Is Stage 1 Grade 3 breast cancer bad? ›

A low grade number (grade 1) usually means the cancer is slower-growing and less likely to spread. A high grade number (grade 3) means a faster-growing cancer that's more likely to spread.

Can you live 20 years after triple-negative breast cancer? ›

It is not impossible to live for 20 years after triple-negative breast cancer. Given how aggressive this cancer can be, survival rates are lower in the first years after diagnosis. After 20 years, the survival rate may be around 83.7% .

How bad is chemo for triple-negative breast cancer? ›

“Triple-negative breast cancer is often very sensitive to chemotherapy, which, despite the side effects, is an effective treatment that can save lives. Because this is an aggressive cancer, treatment is aggressive also.

What not to eat with triple-negative breast cancer? ›

The ACS advises people to limit or avoid the following foods and beverages: red and processed meats. sugar-sweetened drinks. highly processed foods.

How beatable is stage 3 breast cancer? ›

The current 5-year survival rates for stage 3 breast cancer are 86% for females and 83% for males. However, many factors can influence a person's life expectancy after a breast cancer diagnosis. A doctor can provide more detailed, personalized information.

How do you deal with Stage 3 breast cancer? ›

You might have drug treatments such as chemotherapy with or without a targeted cancer drug as a first treatment. This is followed by surgery and then radiotherapy or more drug treatments. Or you might have surgery as a first treatment followed by radiotherapy, chemotherapy or other drug treatments.

What is the gold standard treatment for HER2 breast cancer? ›

Trastuzumab is given intravenously (with an IV) weekly or every 3 weeks. As an adjuvant therapy, one year of treatment of treatment is typical. Multiple studies show that trastuzumab can dramatically improve survival. In fact, trastuzumab-based treatments for HER2+ breast cancer are considered the gold standard.

Does HER2+ always come back? ›

While HER2 positive breast cancer recurrence affects some patients, recent advancements in targeted therapies and long-term treatment approaches have made relapse less likely than ever before. The majority of patients with HER2 positive cancer do not experience recurrence.

Does HER2+ always require chemo? ›

What types of breast cancer should be treated with chemotherapy? Almost all women with HER2-positive cancers still need some amount of chemotherapy. And women with triple-negative tumors still need a relatively intensive course of chemotherapy, Dr. Lustberg says.

How often does HER2-positive metastasize? ›

Human epidermal growth factor receptor 2 (HER2) overexpression occurs in 15% to 20% of patients with early-stage breast cancers (EBCs). Without HER2-targeted therapy, 30% to 50% of patients relapse within 10 years, many developing incurable metastatic disease.

Does grade 3 breast cancer always need chemo? ›

Most women with breast cancer in stages I, II, or III will get some kind of systemic therapy as part of their treatment. This might include: Chemotherapy. Hormone therapy (tamoxifen, an aromatase inhibitor, or one followed by the other)

Can you beat grade 3 breast cancer? ›

Doctors consider stage 3 breast cancer a locally advanced but curable cancer. Your treatment options and outlook will depend on a variety of factors.

Can you recover from grade 3 breast cancer? ›

Stage 3. More than 70 out of 100 women (more than 70%) will survive their cancer for 5 years or more after diagnosis.

How do you treat grade 3 cancer? ›

Generally, treatment begins with chemotherapy and/or radiation. The patient may have chemotherapy and radiation at the same time, or may have them one after another. Surgery may follow this treatment if the care team thinks the remaining cancer may be successfully removed.

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