Treatment of Stage 2 Breast Cancer

Stage 2 breast cancer is a more advanced stage of cancer as compared to stage 1 breast cancer, but it is still considered an early-stage cancer with a relatively good prognosis. Anatomically, stage 2 breast cancer has two subcategories.

Stage 2A Breast Cancer

• The tumor is larger than 3/4 of an inch (2 cm) but not larger than 2 inches (5 cm), and it has not spread to nearby lymph nodes.
• Or, the tumor is smaller than 2 cm but has spread to one to three nearby lymph nodes under the arm (axillary lymph nodes).
• Or, no tumor is identified, but cancer is found in lymph nodes.

Stage 2B Breast Cancer

• The tumor is larger than 3/4 of an inch (2 cm) but not larger than 2 inches (5 cm) and has spread to one to three nearby lymph nodes under the arm.
• Or, the tumor is larger than 2 inches (5 cm) but has not spread to nearby lymph nodes.

It is important to note that many medical institutions, especially in the United States, now use an updated staging system which includes other factors to determine a patient’s treatment and outcome. This is known as prognostic staging. Prognostic staging takes into account the tumor grading, estrogen receptor (ER) status, progesterone receptor (PR) status, ‘human epidermal growth factor 2’ (HER2) status and sometimes multigene prognostic tests, in addition to the cancer’s anatomical characteristics. In this current staging system, the stage of cancer is determined from a combination of all of these factors. While it is a more accurate classification, it is also much more complex. Therefore, it is best to consult with your doctor on your specific cancer classification and what it means for you.

Stage 2 breast cancer treatment is typically more extensive than stage 1, but it still offers a good chance of successful treatment and long-term survival. As with stage 1 breast cancer, both local and systemic therapies may be used to treat stage 2 breast cancer.

Local therapy refers to treatments that target the cancerous tumor and the surrounding area without affecting the entire body. It is often used to remove or destroy the cancer cells in a specific area while preserving as much healthy tissue as possible. The types of local therapy used for stage 2 breast cancer include surgery and radiation therapy.

Surgery

There are two main surgical options:

• Lumpectomy (Breast-conserving surgery)

In this procedure, the surgeon removes the tumor and a small margin of healthy tissue around it. This allows the patient to keep most of their breast. After a lumpectomy, radiation therapy is often recommended to reduce the risk of cancer recurrence in the breast.

• Mastectomy

When patients undergo a mastectomy, the entire breast is removed. Some patients may choose this option for various reasons, including a strong family history of breast cancer, or personal preference. In some cases, a nipple-sparing mastectomy or skin-sparing mastectomy may be possible to preserve breast appearance.

If cancer is found in the lymph nodes, radiation therapy will often be given.

It may be possible for some women to undergo breast reconstruction at the same time as the surgery to remove the cancer. However, if radiation therapy is recommended after the surgery, it may be recommended to delay completion of the breast reconstruction until after recovering from radiation therapy. It is important to follow the advice and guidance of your doctors, who will recommend the most appropriate treatment plan for you.

Radiation Therapy

Radiation therapy is a cancer treatment method that uses high doses of radiation to kill cancer cells and shrink tumors. If a lumpectomy is performed, radiation therapy is often recommended to target any remaining cancer cells in the breast. This helps to reduce the risk of local recurrence. Patients who undergo a mastectomy may also receive radiation therapy, particularly if cancer cells involve the lymph nodes. If post-operative (adjuvant) chemotherapy is recommended, then radiation therapy may be delayed until after the completion of chemotherapy.

Systemic therapy is a type of cancer treatment designed to target cancer cells throughout the entire body. Unlike local therapies, which focus on treating the breast tumor and surrounding breast tissue or lymph nodes, systemic therapies are delivered through the bloodstream and can reach cancer cells in various parts of the body. In stage 2 breast cancer, systemic therapies may be given prior to surgery (neoadjuvant treatment) to shrink tumors to reduce the extent of surgery or assess the tumor’s response to treatment, or they may be used as an adjuvant treatment to kill remaining cancer cells and reduce the recurrence risk. The types of systemic therapy used for stage 2 breast cancer include:

• Hormone Therapy

If the breast cancer is hormone receptor-positive (estrogen or progesterone receptor-positive), hormone therapy (such as tamoxifen or an aromatase inhibitor) may be recommended to block the effects of hormones on cancer cells.

• Chemotherapy

Chemotherapy can be given in the neoadjuvant or an adjuvant setting. People with triple-negative or HER2-positive breast cancer often benefit from neoadjuvant chemotherapy as their first treatment for breast cancer. This begins to treat the cancer medically and some tumors may completely disappear in the breast or the lymph nodes at the completion of therapy. Additional treatments may be considered post-surgery depending on the tumor’s response to neoadjuvant therapy.

For patients with hormone receptor-positive or HER2 negative breast cancer, tumor genomic tests such as Oncotype DX or MammaPrint may help to determine if you would benefit from chemotherapy. With the help of these assays, your treatment plan can be tailored to be more effective and help increase your chances of a successful outcome.

Learn more: Breast Cancer Hormone Receptor Status: What You Need to Know

• Targeted Therapy

In cases where the cancer overexpresses HER2/neu protein (HER2-positive), targeted therapies like Herceptin (trastuzumab) may be considered in combination with chemotherapy.

• Immunotherapy

Immunotherapy in combination with chemotherapy might also be a possible treatment for some women with triple-negative breast cancer.

The specific treatment plan is developed in consultation with a multidisciplinary team of healthcare professionals, including surgeons, medical oncologists, radiation oncologists, and other specialists. The goal of treatment is to effectively treat the cancer while minimizing side effects and preserving quality of life with a goal of cure.

It's essential for individuals with stage 2 breast cancer to have a detailed discussion with their healthcare team to understand the recommended treatment plan, potential side effects, and long-term follow-up care. Regular follow-up appointments and ongoing monitoring are crucial to detect recurrences or new developments.