Breast Cancer

Understanding treatment for breast cancer and how it is delivered

Last modified: March 15, 2022

What are the treatment options for breast cancer? Treatment options

The treatment options for breast cancer include surgery, chemotherapy, radiation therapy, hormone therapy and targeted therapies. The type of treatment you receive will depend on several different considerations, such as the type of breast cancer you have, its stage, your overall health and your treatment preferences.

Types of breast cancer treatmentTypes of treatment

Surgery for breast cancerSurgery

Surgery is commonly performed for people with breast cancer to remove cancerous tissue, identify whether the cancer has spread to the lymph nodes and, if possible, reconstruct the breast. Most people with breast cancer will receive surgery at some point during their treatment.

There are two types of surgery: breast conservation, also known as lumpectomy, where the cancer is removed with a rim of normal tissue; or mastectomy where the entire breast is removed.

After breast conservation surgery, a course of radiation therapy is usually recommended.

Cancer cells can travel from the breast in channels called lymphatic vessels and collect in nearby lymph nodes. To find out if the breast cancer has spread to lymph nodes in your underarm, one or more of these lymph nodes will be removed and looked at under the microscope. The most common form of lymph node surgery is called a sentinel node biopsy.

The sentinel lymph nodes are the first lymph nodes(s) that breast tissue, in the area of the tumour, drain into. This procedure requires injection of a special form of dye into the breast just prior to the surgery. A nuclear scan, called lymphoscintiography, and/or blue dye helps the surgeon locate the sentinel lymph nodes at the time of surgery.

If a sentinel lymph node biopsy is not appropriate or possible in your case, the surgeon will usually perform armpit surgery. This is when the surgeon removes most of the lymph nodes from the armpit, also called the axilla. Every person has a different number of axillary lymph nodes. An axillary dissection may also be recommended if cancer cells are found in your sentinel lymph nodes. This can occur as part of your breast cancer surgery or as a separate operation.


A lumpectomy, also known as breast-conserving surgery or partial mastectomy, is a procedure which focuses on removing the least amount of healthy tissue as possible when excising the breast cancer tumour/s. Lumpectomy may help in maintaining the appearance of your breast. Most women will be recommended radiation therapy after a lumpectomy.


Mastectomy refers to the surgical removal of the entire breast to prevent or treat breast cancer. There are many different types of mastectomies performed today including:

Total mastectomy

Removal of the entire breast including the nipple, areola and skin.

Skin-sparing mastectomy

Removal of the breast tissue, nipple and areola but not the skin. This offers an improved appearance but may not be suitable for certain cancers.

Nipple-sparing mastectomy

Removal of the breast tissue but not the skin or nipple. This may be an option for small, early tumours that do not affect the nipple or skin.

Bilateral mastectomy

Removal of both breasts. This is often a preventive surgery for women at high risk of breast cancer.

Chemotherapy for breast cancerChemotherapy

Chemotherapy uses different medicines to kill and slow the growth of breast cancer cells. These drugs may be delivered at any stage of your breast cancer treatment, from shrinking large tumours before surgery to destroying potential remaining cancer cells after surgery. Chemotherapy plays an important part in reducing the risk of your breast cancer returning in both the breasts and the rest of the body.

Learn more about chemotherapy and how it is delivered.

Chemotherapy for breast cancer takes place over several sessions, given once every one to three weeks depending on the type of treatment regimen used. This is known as a cycle. Your care team will walk you through how many cycles you may need for your treatment.

Radiation therapy for breast cancer Radiation therapy

Radiation therapy treatment is usually used for breast cancer patients who have had breast-conserving surgery (lumpectomy), and sometimes after a mastectomy. If you are scheduled to receive chemotherapy after your surgery, radiation therapy will typically be delivered following chemotherapy.

Although traditionally radiation therapy has been delivered over a period of five to six weeks, with recent advances in radiation therapy technology many patients can now receive their treatment across three to four weeks or even shorter in certain cases.

Radiation therapy can impact the comfort, feel and appearance of breast reconstructions. Your oncologist will speak with you about the timing of your treatments and may encourage you to delay breast reconstruction surgery until after you complete active treatment.

Types of radiation therapy commonly used for people with breast cancer include:

If you have had a lumpectomy, sometimes an extra dose of radiation is given to the region where your tumour has been removed. This can be done using an integrated ‘boost’ as part of a VMAT or IMRT plan or following treatment to the whole breast.

Reducing the risk of damage to your heart

Deep Inspiration Breath Hold (DIBH) is a technique for breast cancer patients that reduces the potential impact of radiation on the heart.

The process involves holding your breath for short bursts during treatment which allows the heart to move backwards into the chest and away from the breast while it is exposed to radiation.

Hormone therapy for breast cancerHormone therapy

Some types of breast cancers feed on your body’s natural hormones for growth. Hormone therapy can be used to stop hormone-sensitive cancers from growing or returning. Hormone therapy is commonly delivered as a tablet or injection, with surgery being used in some cases to remove the ovaries, which are the part of the body that produces most of these hormones.

For many women, hormonal therapy is used in combination with chemotherapy or surgery and may be delivered over five to ten years.

Targeted therapies for breast cancerTargeted therapies

Targeted therapies use specialised medicines to destroy specific proteins in breast cancer cells. These medicines are particularly effective for HER2-positive breast cancers, where the cancer cells have a higher-than-average amount of HER2 (a growth-promoting protein on the outside of breast cells).

Bone therapies

Bone therapy drugs are used to treat advanced breast cancer when the cancer has spread (metastasised) to the bones. They are used to help protect and strengthen your bones, and to reduce the risk of the cancer continuing to spread to the bones.

Immunotherapy for breast cancerImmunotherapy

Immunotherapy trains your body’s own immune system to recognise and fight breast cancer cells.

There are other medicines in immunotherapy currently being tested through clinical trials in Malaysia to assess their safety and effectiveness in treating breast cancer.

Treatment by stage of breast cancerTreatment by stage

When you are diagnosed with breast cancer, your oncologist will develop your treatment plan as part of a multidisciplinary team based on the stage of your cancer.

Common treatment options for each stage of breast cancer include:

  • Early breast cancer (Stage I and II)

    In Stage I and II breast cancer, the cancer is confined to the breast and may or may not have spread to nearby lymph nodes. Surgery to the breast and axilla is typically the first treatment option for early-stage breast cancer. Following breast conservation surgery, most patients will receive radiation therapy to the breast afterwards to reduce the risk of their cancer returning.

    In some cases, further treatments may be recommended including chemotherapy, radiation therapy to the lymph node areas, targeted therapy (such as Herceptin) and hormone therapy (for hormone-positive patients).

  • Locally advanced breast cancer (Stage III)

    In Stage III breast cancer, the breast cancer is either large, has spread to multiple lymph nodes or has spread to the surrounding tissues such as the skin and muscle. Locally advanced breast cancer requires a combination of treatments, which usually begins with surgery and chemotherapy. The chemotherapy may be given prior to surgery to help shrink the cancer. After surgery it is likely that you will receive radiation therapy to the breast and lymph node areas.

    Hormone therapy will be included as part of your treatment if you have hormone receptor positive breast cancer, alongside targeted therapies if you have HER2 positive breast cancer.

  • Metastatic or advanced breast cancer (Stage IV)

    In Stage IV breast cancer, the cancer has spread outside the breast and nearby lymph node regions to other parts of the body. Treatments commonly used are hormone therapy (if hormone receptor positive), targeted therapy (if HER2 positive) and chemotherapy. Hormone therapies may include fulvestrant and CDK4/6 inhibitors. Radiation therapy may also be used for metastatic breast cancer to help reduce symptoms caused by breast tumours (such as pain).


For a full list of references, click here.
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