Stage II

Overview

Patients diagnosed with stage II breast cancer have a primary cancer that either involves axillary lymph nodes and is less than five centimeters (two inches) in size, or is greater than two centimeters (3/4 inch) in size and does not involve any axillary lymph nodes. Stage II breast cancers are curable with current multi-modality treatment consisting of surgery, chemotherapy, radiation therapy and hormonal therapy.

Effective treatment of stage II breast cancer requires both local and systemic therapy. Local therapy consists of surgery and/or radiation and is directed at destroying any cancer cells in or near the breast. Systemic therapy is directed at destroying cancer cells throughout the body, and may include chemotherapy, targeted therapy, or hormonal therapy . Systemic therapy is often administered as adjuvant therapy , which means treatment after surgery.

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The following is a general overview of treatment for stage II breast cancer. Multi-modality treatment, which utilizes two or more treatment techniques, is increasingly recognized as an important approach for improving a patient’s chance of cure or prolonging survival. In some cases, participation in a clinical trial utilizing new, innovative therapies may provide the most promising treatment. Circumstances unique to each patient’s situation may influence how these general treatment principles are applied. The potential benefits of multi-modality care, participation in a clinical trial, or standard treatment must be carefully balanced with the potential risks. The information on this website is intended to help educate patients about their treatment options and to facilitate a mutual or shared decision-making process with their cancer physician.

Local Therapy: Surgery and Radiation

Surgery and radiation are considered local therapies because they can treat the cancer in the breast and prevent cancer recurrence in the affected breast and surrounding area, but cannot treat cancer that has already spread to other locations in the body.

Surgery: Surgery for stage II breast cancers may consist of mastectomy or lumpectomy. A mastectomy involves removal of the entire breast, whereas a lumpectomy involves removal of the cancer and a portion of surrounding tissue. Because a lumpectomy alone is associated with a higher rate of cancer recurrence than mastectomy, patients who elect to have a lumpectomy are also treated with radiation therapy. This combination of lumpectomy and radiation therapy is called breast-conserving therapy. Clinical studies have shown that breast conserving therapy is associated with a lower risk of local cancer recurrence compared to lumpectomy alone. [1], [2]

Mastectomy and breast-conserving therapy are the current standard of care for the local treatment of stage II breast cancers and both are considered acceptable options. Furthermore, breast conserving therapy and mastectomy have been shown to produce identical long-term survival. [3]

Surgery for early stage breast cancer may also involve the evaluation of axillary (underarm) lymph nodes in order to determine whether cancer has spread outside the breast and establish the stage of the cancer. This is important to determine whether additional treatments beyond local therapies, such as chemotherapy, are required. For over 30 years, the standard of practice for breast cancer staging has included the removal of approximately 10-25 axillary lymph nodes to help determine whether the cancer has spread. This procedure, called an axillary lymph node dissection, can be associated with chronic side effects, including pain, limited shoulder motion, numbness, and swelling.

A new approach for evaluating whether cancer has spread to the lymph nodes is a sentinel lymph node biopsy. The advantage to this procedure is that it involves the removal of a single lymph node, called the sentinel node, which is the first lymph node to collect excess fluid surrounding the cancer. Prior to surgery, blue dye is injected near the cancer. The dye drains from the area containing the cancer into the nearby lymph nodes, through the sentinel node. The node containing the dye is removed during surgery and evaluated under a microscope to determine whether cancer has spread. Sentinel lymph node biopsy is becoming the standard approach for determining whether cancer has spread to the axillary lymph nodes. [4]

Researcher now indicates that sentinel node biopsy appears to be just as effective in determining cancer spread to axillary lymph nodes as an axillary lymph node dissection and results in fewer side effects in patients with early stage breast cancer. [5]

For more detailed information, go to Surgery for Breast Cancer.

Systemic Therapy: Chemotherapy, Targeted Therapy, and Hormonal Therapy
Hormonal Therapy
Strategies to Improve Treatment

askthedoc2

Ask the Doctor: How can I Ensure I am Getting the Care I need to Avoid Recurrence?

Ask the Doctor: Understanding the Role of Radiation in Early Stage Breast Cancer

References
[1] Fisher B, Anderson S, Bryant J, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. New England Journal of Medicine. 2002;347:1233-1241.

[2]Lichter AS , Lippman ME, Jr Danforth DN, et al. Mastectomy versus breast-conserving therapy in the treatment of stage I and II carcinoma of the breast: a randomized trial at the National Cancer Institute. Journal of Clinical Oncology, Classic Papers and Current Comments. 1996;1:2-10.

[3] Veronesi U, Cascinelli N, Mariani L, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. The New England Journal of Medicine. 2002;347;1227-1232.

[4] Edge SB, Niland JC, Bookman MA, et al. Emergence of sentinel node biopsy in breast cancer as standard-of care in academic comprehensive cancer centers. Journal of the National Cancer Institute. 2003;95:1514-1521.

[5] Veronesi U, Paganelli G, Viale G, et al. A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer. The New England Journal of Medicine 2003;349:546-553.