Breast Cancer Treatment Options by Stage

When making treatment decisions, the breast cancer’s stage is an important factor that you and your doctor will consider. Each stage of breast cancer has common treatment options, but they’re not set in stone. Your treatment plan and your treatment timeline may be different, depending on your specific situation.

Surgery — either mastectomy or lumpectomy — to remove the cancer is commonly the first treatment for stage 0 breast cancer. People who have mastectomy usually don’t have radiation after surgery, but in rare cases they might. People who opt for lumpectomy sometimes have radiation to the breast area after surgery.

Because most stage 0 breast cancers are hormone receptor-positive, hormonal therapy is also recommended after lumpectomy. Hormonal therapy reduces the risk that the cancer will come back, also called recurrence. Hormonal therapy usually isn’t necessary if you've had a mastectomy.

Surgery to remove the cancer is often the first treatment for stage IA and IB breast cancer.

During surgery, your doctor also will remove some lymph nodes to see if there is cancer in them. There are two types of lymph node surgery: sentinel lymph node dissection and axillary lymph node dissection. The type of lymph node surgery you have depends on the size and other characteristics of the cancer.

After mastectomy, some people may receive radiation to the breast area. After lumpectomy, most people receive radiation to the breast area.

If the cancer is hormone receptor-positive, your doctor will recommend hormonal therapy after surgery to reduce the risk of recurrence. If hormone receptor-positive cancer is in the lymph nodes, your doctor may recommend a medicine called a CDK4/6 inhibitor in addition to hormonal therapy.

Depending on the features of the cancer, chemotherapy also may be recommended after surgery for some people. Chemotherapy also reduces the risk of recurrence.

Targeted therapy medicines may be recommended for cancers that have certain characteristics, for example, cancers that are HER2-positive or cancers diagnosed in people with a BRCA mutation. These medicines may be given before surgery, after surgery, or both.

If the breast cancer is triple-negative, immunotherapy will likely be recommended before and after surgery.

Surgery to remove the cancer may be the first treatment for stage IIA and IIB breast cancer.

During surgery, your doctor also will remove some lymph nodes to see if there is cancer in them. There are two types of lymph node surgery: sentinel lymph node dissection and axillary lymph node dissection. The type of lymph node surgery you have depends on the size and other characteristics of the cancer.

After mastectomy, some people may receive radiation to the breast area. After lumpectomy, nearly everyone receives radiation to the breast area. In certain cases, your doctor may recommend radiation to the lymph nodes.

Chemotherapy is commonly recommended for people with stage IIA and stage IIB breast cancer. It may be given before surgery, after surgery, or both before and after. Chemotherapy given before surgery aims to shrink the cancer so surgery can be less extensive. Chemotherapy after surgery reduces the risk of recurrence.

If the breast cancer is triple-negative, immunotherapy will likely be recommended before and after surgery.

If the cancer is hormone receptor-positive, your doctor will recommend hormonal therapy after surgery to reduce the risk of recurrence. If hormone receptor-positive cancer is in the lymph nodes, your doctor may recommend a CDK4/6 inhibitor in addition to hormonal therapy.

Targeted therapy may be recommended for cancers that have certain characteristics, for example, cancers that are HER2-positive or cancers diagnosed in people with a BRCA mutation. These medicines may be given before surgery, after surgery, or both.

There are a number of treatment paths for stage III breast cancer. The order of your treatment depends on the features of the cancer and your personal preferences.

In some cases, mastectomy followed by radiation will be the first treatment.

In many cases, chemotherapy to shrink the cancer and treat any cancer in the lymph nodes will be the first treatment. After chemotherapy is completed, you have either mastectomy or lumpectomy, with either sentinel lymph node dissection or axillary lymph node dissection. After breast cancer surgery, you’re doctor will likely recommend radiation to the breast area. Some people may also receive radiation to certain lymph nodes.

Even if you received chemotherapy before surgery, you may receive it again after surgery to reduce the risk of recurrence.

If the breast cancer is triple-negative, immunotherapy, along with chemotherapy, will likely be recommended before and after surgery.

If the cancer is hormone receptor-positive, your doctor will recommend hormonal therapy after surgery to reduce the risk of recurrence. If hormone receptor-positive cancer is in the lymph nodes, your doctor may recommend a CDK4/6 inhibitor in addition to hormonal therapy.

Targeted therapy medicines may be recommended for cancers that have certain characteristics, for example, cancers that are HER2-positive or cancers diagnosed in people with a BRCA mutation. These medicines may be given before surgery, after surgery, or both.

Inflammatory breast cancer is considered at least stage IIIB and has a slightly different treatment path. Surgery usually isn’t the first treatment because inflammatory breast cancer involves the breast skin and may not even develop a lump. So the first treatment is usually chemotherapy along with targeted therapy, if the cancer is HER2-positive, or chemotherapy with immunotherapy if the cancer is triple-negative.

After the cancer responds to these treatments, mastectomy and axillary lymph node dissection are usually done.

After surgery, you receive radiation to the breast area and lymph nodes.

After radiation, you may receive another course of chemotherapy, along with targeted therapy or immunotherapy, depending on the features of the cancer.

If the inflammatory breast cancer is hormone receptor-positive, hormonal therapy will be recommended.

Treatment recommendations and the order in which you received treatment for stage IV or metastatic breast cancer are influenced by any previous treatments you’ve received. Treatment also depends on where in the body the cancer has spread to and if the cancer is causing pain.

Chemotherapy is almost always recommended for stage IV breast cancer, usually in combination with targeted therapy, based on the features of the cancer.

There are a number of targeted therapy medicines used to treat stage IV breast cancers with mutations in specific genes, such as PIK3CA, AKT1, or PTEN. Other targeted therapy medicines — the CDK4/6 inhibitors, for example — are often used to treat people with metastatic hormone receptor-positive HER2-negative breast cancer.

If the cancer is hormone receptor-positive, hormonal therapy will be recommended.

Immunotherapy may be recommended if the cancer is triple-negative or has a biomarker called microsatellite instability-high (MSI-H), is mismatch repair deficient (dMMR), or has a high level of mutations in its DNA.

Your doctor may recommend surgery to ease specific symptoms or to remove spots of cancer from other organs, such as the liver.

If you have small, isolated spots of metastatic breast cancer, your doctor may recommend a type of procedure called cryoablation (or cryotherapy) to remove them. Your doctor also may recommend these areas be treated with concentrated radiation therapy.

Radiation therapy for stage IV breast cancer is commonly used to ease specific symptoms, such as bone pain or pain from a pinched nerve. Radiation also may be used to lower the fracture risk for a bone that’s been weakened by cancer. It also may be used to reduce internal bleeding or bleeding from the skin caused by the cancer tumor.

If the breast cancer has spread to the brain, whole brain or stereotactic radiation may be recommended.

Learn more about treatments for metastatic breast cancer.