Standard Regimens for Breast Cancer Treatment

If You Have … The Usual Treatment Is …
Stage 0
Lobular carcinoma in situ (LCIS) Observation OR in special circumstances
with certain risk factors, bilateral
mastectomy
Stage 0
Ductal carcinoma in situ (DCIS)
a. DCIS in 2 or more quadrants a. total mastectomy (without lymph
node dissection)
b. DCIS in 1 quadrant and negative b. total mastectomy (without lymph
margins node dissection) OR lumpectomy with
radiation
c. DCIS in 1 quadrant with small, c. lumpectomy with radiation OR
low-grade cancer and negative lumpectomy without radiation OR
margins total mastectomy (without lymph node
dissection)
Stages I and II
Invasive breast cancer Lumpectomy and removal of underarm
lymph nodes and radiation therapy OR
modified radical mastectomy
Additional treatment dictated
by tumor size and nodal status,
as follows:
a. Node negative and …
a-1. tumor smaller than .05 cm a-1. no adjuvant therapy
a-2. cell type is tubular, colloid, a-2. no adjuvant therapy
or medullary and smaller than 1 cm
a-3. cell type is tubular, colloid, a-3. consider adjuvant therapy
or medullary and larger than
1 cm but smaller than 3 cm
a-4. cell type is tubular, colloid, a-4. adjuvant therapy recommended
or medullary and 3 cm or larger
a-5. cell type is invasive ductal a-5. no adjuvant therapy
or invasive lobular and tumor is
less than 1 cm with no unfavorable
features
a-6. cell type is invasive ductal a-6. consider adjuvant chemotherapy or
or invasive lobular and tumor is hormonal therapy
less than 1 cm but with unfavorable
features
continues
Stages I and II
a-7. cell type is invasive ductal a-7. adjuvant chemotherapy
or invasive lobular and tumor recommended
larger than 1 cm that is hormone
receptor-negative
a-8. cell type is invasive ductal a-8. Tamoxifen, with or without
or invasive lobular and tumor chemotherapy for tumors up to 3 cm
larger than 1 cm that is hormone and chemotherapy and Tamoxifen
receptor-positive for tumors over 3 cm
b. Node positive and …
b-1. hormone receptor-negative b-1. adjuvant chemotherapy
recommended
b-2. hormone receptor-positive b-2. adjuvant chemotherapy and
Tamoxifen
Stage IIIA
Invasive breast cancer, if operable Modified radical mastectomy followed
by chemotherapy and radiation
(if hormone receptor-negative) OR
chemotherapy, followed by modified
radical mastectomy followed by
additional chemotherapy, radiation,
and (if hormone receptor-positive or
uncertain) Tamoxifen, OR chemo-
therapy, followed by lumpectomy,
underarm lymph node removal, and
followed by additional chemotherapy
and (if hormone receptor-positive or
uncertain) Tamoxifen
Stage IIIB
Invasive breast cancer, inoperable Neoadjuvant chemotherapy, with or
without Tamoxifen; if tumor shrinks
enough to be operable, treatment
follows treatments for Stage IIIA;
otherwise, individualized therapy with
no standard treatment
Stage IV
Invasive breast cancer, if tumor is …
a. hormone receptor-positive and/or a. hormonal therapy followed in some
distant spread affects only bone or cases by chemotherapy
soft tissue
Stage IV
b. hormone receptor-negative and/or b. chemotherapy and/or other
distant spread affects internal chemotherapy protocol
organs