Treatments for invasive ductal carcinoma (IDC) include surgery, chemotherapy, radiation therapy, hormonal therapy, and targeted therapy. You and your doctor will decide what treatment or combination of treatments is right for you depending on the characteristics of the cancer and your personal preferences.
Surgery is used to treat IDC not only to remove the breast tumor itself, but also to confirm whether or not cancer is in the lymph nodes.
Surgery is considered a local treatment because it treats just the tumor and surrounding area.
You will work with your doctor to determine what type of surgery is right for you based on the stage and grade of the cancer and other factors specific to your situation.
In most cases, surgery is the first treatment for IDC. However, if the tumor is large or the cancer has spread to many lymph nodes or other parts of the body, treatments such as chemotherapy or hormonal therapy may be given first to shrink the cancer. Possible surgical procedures used to treat IDC include:
- Lumpectomy: Surgery that removes only the tumor (the “lump”) and some of the normal tissue that surrounds it. Sometimes, axillary (underarm) lymph nodes are removed for examination. Learn more about lumpectomy.
- Mastectomy: Surgery that removes some or all of the breast tissue. There are several types of mastectomy that remove different amounts of tissue.
- Partial or segmental mastectomy (sometimes also called quadrantectomy): Surgery that removes the portion, or segment, of the breast that contains the tumor. In some cases, up to one-quarter of the breast needs to be removed. Depending on your situation, your doctor may want to also remove some lymph nodes.
- Total or simple mastectomy: Surgery that removes the breast tissue only, without removal of the lymph nodes or any muscle tissue beneath the breast.
- Modified radical mastectomy: Surgery that removes the breast, the lining of the chest wall muscle, and some of the lymph nodes under the arm.
- Radical mastectomy: Surgery that removes the breast, all of the muscle under the breast, and the lymph nodes under the arm. However, radical mastectomy is not often done today because the more limited forms of this surgery generally are just as effective.
Learn more about mastectomy.
As you plan for surgery, your surgeon may also talk with you about removing one or several of your lymph nodes to find out if cancer cells have traveled there. If they have, there is a greater chance that the cancer could have traveled to other parts of the body. The lymph nodes are part of the body’s “filtration system,” removing bacteria and other foreign substances from the body. Breast cancer cells can make their way to the lymph nodes under the arm, which offer them a pathway to other parts of the body. Knowing whether or not the lymph nodes have any breast cancer cells in them is important in selecting the best treatment.
There are two types of lymph node surgery:
- Sentinel lymph node dissection: In this procedure, your surgeon looks for the very first lymph node — the “sentinel node” — that filters fluid draining away from the area of the breast that contains the cancer. If cancer cells are breaking away from the tumor and traveling away from your breast through the lymph system, the sentinel lymph node is more likely than other lymph nodes to contain cancer. The surgeon uses a special radioactive substance or dye to identify that first node and the couple of nodes where it drains. These nodes are then removed and sent for examination by a pathologist. If the lymph nodes are cancer-free, no further surgery is necessary. If cancer is found, then more lymph nodes in the armpit need to be removed, either now or at a later date.
Sentinel lymph node dissection can be difficult for surgeons to perform, so it’s important to have it done by a surgical team experienced in this technique. It may be right for you if your surgeon has reason to believe that none or just a few of your lymph nodes are likely to be affected.
- Axillary lymph node dissection: The surgeon removes a group of lymph nodes from under the arm to examine them for any signs of cancer. After surgery, he or she will tell you whether any lymph nodes had cancer cells in them and if so, how extensive the cancer was in each node.
Lymphedema, or swelling caused by backup of lymph fluid in the arm, is a possible side effect of lymph node dissection. Axillary lymph node dissection carries a greater risk of lymphedema than sentinel lymph node dissection.
Learn more about lymph node surgery.
Chemotherapy uses medicine to weaken and destroy cancer cells in the body, including any cells left at the original cancer site and any cells that may have spread to another part of the body. These medicines travel through the bloodstream to all parts of the body, so it is sometimes called a systemic treatment. As chemotherapy damages the cancer cells, it also can damage some of the body’s healthy cells, which is why you may experience side effects.
Chemotherapy medicines are often given by IV infusion, which means the medicine is delivered directly into your bloodstream through an IV or a port. Other chemotherapy medicines are taken by mouth in the form of a pill. Two or more chemotherapy medicines are often given in combination.
If the IDC is larger than 1 centimeter in diameter and/or has spread to the lymph nodes, chemotherapy is usually recommended or, at the very least, seriously considered. When chemotherapy is given after surgery, it is called “adjuvant therapy.” In cases where the tumor is large, or breast cancer cells have traveled to many lymph nodes or other parts of the body, chemotherapy may be given before surgery to shrink the cancer. This approach is called “neoadjuvant therapy.” In either case, chemotherapy will be given in cycles, usually with a day (or days) of treatment followed by a period of “off” days. The exact schedule can vary depending on the medication or medications used. An entire course of chemotherapy usually takes about 3 to 6 months.
Some examples of the many chemotherapy medicines that may be used to treat IDC are:
- Adriamycin (chemical name: doxorubicin)
- Ellence (chemical name: epirubicin)
- Cytoxan (chemical name: cyclophosphamide)
- Taxotere (chemical name: docetaxel)
- Taxol (chemical name: paclitaxel)
- Xeloda (chemical name: capecitabine)
- Ixempra (chemical name: ixabepilone)
- fluorouracil (also called 5-fluorouracil or 5-FU)
You and your doctor will work together to determine which chemotherapy treatments are best for your situation. This can depend on the features of the cancer and any other health conditions you may have. For example, if you have a history of heart disease or heart-related risk factors, you and your doctor will want to avoid medications that can affect the heart.
Learn more about chemotherapy.
Tests to determine the need for chemotherapy
If the cancer is early-stage and has certain characteristics, you may be eligible for a genomic test, which looks at specific genes in the cancer to predict how likely the cancer is to recur (come back). If a cancer is not very likely to come back, you might not need chemotherapy. If the cancer is more likely to come back, you and your doctor might decide that chemotherapy is right for you. Oncotype DX, MammaPrint, and the Prosigna Breast Cancer Prognostic Gene Signature Assay are some examples of genomic tests. Learn more about breast cancer tests.
Radiation therapy directs high-energy rays at the breast, chest area, under the arm, and/or the collarbone area to destroy any cancer cells that may be left behind after surgery. This treatment also reduces the risk of recurrence (the cancer coming back).
Radiation therapy is most often recommended after surgeries that conserve healthy breast tissue, such as lumpectomy and partial mastectomy. Radiation therapy may be recommended after mastectomy as well, especially if the tumor was large (over 5 centimeters) and/or the lymph nodes were involved.
Like surgery, radiation is considered a local treatment because it treats just the tumor and surrounding area.
There are different ways of giving radiation therapy, including:
- External beam radiation: This method uses a machine called a linear accelerator to deliver the radiation therapy. The treatments are directed to the entire breast after lumpectomy, to the area of skin and muscle where mastectomy was done, and possibly to any areas where lymph nodes were involved. Treatment is given daily for about 5 to 7 weeks.
- Internal partial-breast irradiation: Also called brachytherapy, this is a form of treatment in which radioactive materials such as seeds or pellets are temporarily placed in or near where the tumor was removed.
- External partial-breast irradiation: This is a method of external beam radiation that zeroes in on the area around where the cancer was. This area is at highest risk of recurrence. Partial-breast radiation takes only 5 to 10 days for treatment, vs. 5 to 7 weeks for whole breast radiation.
Researchers are studying partial-breast radiation for use after lumpectomy to see how the benefits compare to the current standard of radiation to the whole breast. Because this technique is still under investigation, it is not yet widely available.
You and your doctor can work together to determine what form of radiation therapy is best for you.
Learn more about radiation therapy.
If the cancer tested positive for hormone receptors, your doctor likely will recommend some form of hormonal therapy. Hormonal therapy, also called anti-estrogen therapy or endocrine therapy, works by lowering the amount of estrogen in the body or blocking the estrogen from signaling breast cancer cells to grow. Because hormonal therapy affects your whole body, it’s sometimes called a systemic treatment.
In some cases of advanced-stage IDC, hormonal therapy can be given before surgery to help shrink the cancer (called neoadjuvant treatment). Still, it's more common for hormonal therapy to start after other treatments, such as chemotherapy or radiation therapy, unless these treatments aren’t needed.
Hormone receptors are special proteins found on the surface of certain cells throughout the body, including breast cells. These receptor proteins are the “eyes” and “ears” of the cells, receiving messages from the hormones in the bloodstream and then telling the cells what to do. In other words, the receptors act like an on-off switch for a particular activity in the cell. If the right substance comes along that fits into the receptor — like a key fitting into a lock — the switch is turned on and a particular activity in the cell begins.
When breast cells have hormone receptors, estrogen and/or progesterone can attach to those receptors and tell the cell to grow and divide. Many breast cancer cells have high numbers of receptors for estrogen, progesterone, or both. This means that when these hormones are present, the cells receive a strong message to keep on growing and dividing — and this creates more cancer. If you take the hormone away or block it, the cancer cells don't receive the instructions to grow and divide and are less likely to survive.
You and your doctor will work together to decide which form of hormonal therapy is best in your situation. Two types of hormonal therapy are most frequently used:
- Selective estrogen-receptor response modulators (SERMs): The best-known SERM is tamoxifen. Tamoxifen acts like estrogen and attaches to the receptors on the breast cancer cells, taking the place of real estrogen. As a result, the cells don’t receive the signal to grow. Tamoxifen can be used to treat both pre- and postmenopausal women. Other examples of SERMs are Evista (chemical name: raloxifene) and Fareston (chemical name: toremifene).
- Aromatase inhibitors: The aromatase inhibitors are:
- Arimidex (chemical name: anastrozole)
- Aromasin (chemical name: exemestane)
- Femara (chemical name: letrozole)
Other types of hormonal therapy include:
- Estrogen-receptor downregulators (ERDs): ERDs destroy the estrogen receptors in cells, which prevents the estrogen from getting its message through. Faslodex (chemical name: fulvestrant) is an ERD used to treat postmenopausal women diagnosed with advanced-stage or metastatic breast cancer.
- Ovarian shutdown or removal: The ovaries are the main source of estrogen in women before menopause. Shutting the ovaries down temporarily (for a set period of time), or even permanently, can reduce the amount of estrogen in the body. Ovarian shutdown methods include:
- Medicines such as Zoladex (chemical name: goserelin) and Lupron (chemical name: leuprolide), given by injection once a month for several months to stop the ovaries from producing estrogen.
- Surgery to remove the ovaries, called oophorectomy.
Learn more about hormonal therapy.
Targeted therapies are medicines that target specific characteristics of cancer cells, such as a protein that allows the cancer cells to grow in a fast or abnormal way. Targeted therapies affect the whole body, so they are considered systemic treatments.
There are many targeted therapy medicines that fall into different drug classes depending on the characteristic they target. Examples of targeted therapy drug classes include HER2 inhibitors, PARP inhibitors, CDK4/6 inhibitors, and PI3K inhibitors. Whether certain targeted therapies are used also may depend on your treatment history and other characteristics of the cancer.
Targeted therapies that can be used to treat early-stage IDC, depending on the characteristics of the cancer and your individual situation, include:
- Herceptin (chemical name: trastuzumab)
- Kadcyla (chemical name: T-DM1 or ado-trastuzumab emtansine)
- Nerlynx (chemical name: neratinib)
- Perjeta (chemical name: pertuzumab)
Targeted therapies that can be used to treat advanced-stage or metastatic IDC, depending on the characteristics of the cancer and your individual situation, include:
- Afinitor (chemical name: everolimus)
- Enhertu (chemical name: fam-trastuzumab-deruxtecan-nxki)
- Herceptin (chemical name: trastuzumab)
- Ibrance (chemical name: palbociclib)
- Kadcyla (chemical name: T-DM1 or ado-trastuzumab emtansine)
- Kisqali (chemical name: ribociclib)
- Lynparza (chemical name: olaparib)
- Perjeta (chemical name: pertuzumab)
- Piqray (chemical name: alpelisib)
- Talzenna (chemical name: talazoparib)
- Tykerb (chemical name: lapatinib)
- Verzenio (chemical name: abemaciclib)
Learn more about targeted therapies.
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