Treatment

Your treatment options will depend on several factors, including the extent of the disease, its hormone receptor status, the type of treatment you received for your first breast cancer and your overall health. Your doctor also considers your goals and your preferences for treatment.

Treating a local recurrence

Treatment for a local recurrence typically starts with an operation and may include radiation if you haven't had it before. Chemotherapy and hormone therapy also may be recommended.

• Surgery. For recurrent breast cancer that's confined to the breast, treatment usually involves removing any remaining breast tissue.

  If your first cancer was treated with a lumpectomy, your doctor may recommend a mastectomy to remove all of your breast tissue — lobules, ducts, fatty tissue, skin and nipple.

  If your first breast cancer was treated with a mastectomy and the cancer comes back in the chest wall, you may have surgery to remove the new cancer along with a margin of normal tissue.

  A local recurrence may be accompanied by hidden cancer in nearby lymph nodes. For this reason, the surgeon may remove some or all of the nearby lymph nodes if they weren't removed during your initial treatment.

• Radiation therapy. Radiation therapy uses high-energy beams, such as X-rays or protons, to kill cancer cells. If you didn't have radiation therapy for your first breast cancer, your doctor may recommend it now. But if you had radiation after a lumpectomy, radiation to treat the recurrence isn't usually recommended because of the risk of side effects.
• Chemotherapy. Chemotherapy uses drugs to kill cancer cells. Your doctor may recommend chemotherapy after surgery to reduce your risk of another cancer recurrence.
• Hormone therapy. Medications that block the growth-promoting effects of the hormones estrogen and progesterone may be recommended if your cancer is hormone receptor positive.
• Targeted therapy. If testing shows your cancer cells produce excess HER2 protein, medications that target that protein will likely be recommended.

Treating a regional recurrence

Treatments for a regional breast cancer recurrence include:

• Surgery. If it's possible, surgery to remove the cancer is the recommended treatment for a regional recurrence. Your surgeon may also remove the lymph nodes under your arm if they're still present.
• Radiation therapy. Sometimes radiation therapy may be used after surgery. If surgery isn't possible, radiation therapy may be used as the main treatment for a regional breast cancer recurrence.
• Drug treatments. Chemotherapy, targeted therapy or hormone therapy also may be recommended as the main treatment or may follow surgery or radiation.

Treating a metastatic recurrence

Many treatments exist for metastatic breast cancer. Your options will depend on where your cancer has spread. If one treatment doesn't work or stops working, you may be able to try other treatments.

In general, the goal of treatment for metastatic breast cancer isn't to cure the disease. Treatment may allow you to live longer and can help relieve symptoms the cancer is causing. Your doctor works to achieve a balance between controlling your symptoms while minimizing toxic effects from treatment. The aim is to help you live as well as possible for as long as possible.

Treatments may include:

• Hormone therapy. If your cancer is hormone receptor positive, you may benefit from hormone therapy. In general, hormone therapy has fewer side effects than chemotherapy, so in many cases it's the first treatment used for metastatic breast cancer.
• Chemotherapy. Your doctor may recommend chemotherapy if your cancer is hormone receptor negative or if hormone therapy is no longer working.
• Targeted therapy. If your cancer cells have certain characteristics that make them vulnerable to targeted therapy, your doctor may recommend these medications.

• Immunotherapy. Immunotherapy uses your immune system to fight cancer. Your body's disease-fighting immune system may not attack your cancer because the cancer cells produce proteins that help them hide from the immune system cells. Immunotherapy works by interfering with that process.

  Immunotherapy might be an option if you have triple-negative breast cancer, which means that the cancer cells don't have receptors for estrogen, progesterone or HER2. For triple-negative breast cancer, immunotherapy is combined with chemotherapy to treat advanced cancer that's spread to other parts of the body.

• Bone-building drugs. If cancer has spread to your bones, your doctor may recommend a bone-building drug to reduce your risk of broken bones or reduce bone pain you may experience.
• Other treatments. Radiation therapy and surgery may be used in certain situations to control signs and symptoms of advanced breast cancer.