Invasive Ductal Carcinoma Treatment

Invasive ductal carcinoma, also known as IDC, is a form of invasive breast cancer that happens when cancerous cells begin to grow outside the milk ducts of your breast into the surrounding fatty tissue.

There are a number of effective treatment options for IDC.

The type of treatment you receive for IDC will depend on the size of your cancer; other biological features, such as hormone receptor status; and whether or not it has spread to lymph nodes or other organs. Many women will also sometimes opt for a combination of therapies.

Surgery

There are several types of surgical procedures for IDC, including:

• Lumpectomy or Partial Mastectomy Surgeons remove only the tumor and some of the tissue surrounding it. Underarm lymph nodes, known as axillary nodes, may also be taken out.
• Total or Simple Mastectomy The entire breast that contains the tumor is removed. Some lymph nodes may also be taken out, but the muscle beneath the breast is left alone.
• Modified Radical Mastectomy Surgeons remove the breast, the lining of the chest wall muscle, and (with exceptions in a few very well-defined cases) underarm lymph nodes, typically one to three nodes in what’s called a sentinel lymph node biopsy, or a full axillary lymph node dissection, in which all of the axillary lymph nodes are removed. This is necessary to determine staging and prognosis. For invasive cancer, lymph node removal is usually not up for discussion.

The type of surgery your doctor recommends will depend on where the cancer is located, the size of the tumor, and how much of the breast is affected by the cancer.

Radiation

Radiation therapy delivers either high-energy X-rays called photons or high energy particle beams to shrink tumors and kill cancer cells.

This treatment is usually given after a lumpectomy to decrease the chance of having cancer cells regrow in the breast, also known as a local recurrence. Women over age 65 may not always need radiation after a lumpectomy because they tend to have less aggressive disease than younger women.

The decision to recommend radiation therapy after a mastectomy depends on a number of factors, including the biology of the breast cancer type, the size of the tumor (usually if the tumor is larger than 5 centimeters), lymph node status, involvement of the pectoralis muscle, and whether the cancer has spread to the skin.

There are different ways of delivering radiation after breast surgery, including:

• External Whole Breast Radiation With or Without Lymph Node Treatment This type of radiation uses an external machine called an accelerator to deliver treatment. Historically, radiation therapy for breast cancer has been given daily for five to seven weeks. But an accelerated radiation schedule has been developed that involves fewer treatments at higher doses, so that the same total dose of radiation is administered within three to four weeks.

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   A radiation oncologist can explain the different options and take the patient's choices into consideration. The decision often also depends on the treatment preference of the radiation therapy center.
• External Partial-Breast Irradiation This technique involves delivering external beam radiation to the area of the breast tissue that’s at the highest risk of recurrence. Treatment usually lasts one to three weeks.

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   There are quality, randomized clinical trials that show, in certain patients, partial breast irradiation is equivalent to full breast radiation in terms of outcomes.
• Brachytherapy With this treatment, radioactive materials like pellets or seeds are temporarily placed in or around the area where the tumor was located. The seeds emit radiation. This approach can be used in certain women after a lumpectomy.

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The most important thing people should know is that doctors are evolving their use of radiation therapy to more closely match the biology of breast cancer a patient has, taking into consideration the type of cancer, whether it is receptor positive or negative, and also the patient's age, says Michele Halyard, MD, a radiation oncologist at Mayo Clinic in Phoenix, Arizona, and co-founder of Coalition of Blacks Against Cancer. "Also, we have increasing data that patients may be treated with higher doses per day with overall less number of treatments with equivalent outcomes in appropriately selected patients,” she says.

Hormone Therapy

• Aromatase inhibitors, which stop the body from making estrogen. Aromatase inhibitors used to treat breast cancer are anastrozole (Arimidex), exemestane (Aromasin), and Femara (letrozole).
• Selective estrogen receptor modulators (SERMs), which block estrogen from binding to the receptors. SERMs include tamoxifen (Nolvadex), raloxifene (Evista), and toremifene (Fareston).
• Selective estrogen receptor downregulators (SERDs), which also stop the hormone from attaching to the receptors. SERDs include fulvestrant (Faslodex) and elacestrant (Orserdu).

Side effects can be difficult for some people; they can include joint and bone pain, menopausal symptoms like hot flashes and vaginal dryness, fatigue, mood swings, and nausea.

Chemotherapy

• AC-T: doxorubicin (Adriamycin) and cyclophosphamide (Cytoxan), followed by paclitaxel (Taxol)
• AC-TH: doxorubicin and cyclophosphamide, followed by paclitaxel and trastuzumab (Herceptin)
• CMF: cyclophosphamide, methotrexate, and fluorouracil
• TC: docetaxel (Taxotere) and cyclophosphamide

Targeted Treatment

Targeted treatments home in on specific cancer cell traits to stop the cells from growing rapidly.

Generally, targeted approaches are less likely to kill healthy cells in your body compared with chemo and are often easier to tolerate. Still, a number of side effects are possible, depending on the drug you’re using.

Immunotherapy

While no complementary treatments have been proved to cure IDC, many can help you cope with stress, anxiety, and treatment side effects.

• Exercise
• Yoga or tai chi
• Meditation
• Massage
• Acupuncture
• Hypnosis
• Music therapy
• Aromatherapy

Women with IDC may choose to enroll in a clinical trial to receive a new treatment that’s not yet available to the general public.

Additionally, clinical trials help scientists determine if up-and-coming therapies are safe and effective.

Talk to your doctor about the benefits and risks of participating in a research study. You can also search for clinical trials near you at ClinicalTrials.gov.

Deciding on a treatment for IDC isn’t always easy. You and your doctor will work together to make the best choice possible.

Often, your physician will suggest a treatment based on:

• The size of your cancer
• How much your cancer has spread
• What type of tumor you have
• Your family history
• Whether you have a gene mutation that increases your risk for breast cancer

You may have many concerns about your condition and the suggested treatments. Writing them down is a good idea.

Finding a doctor you’re comfortable with is important. Don’t hesitate to schedule an appointment with another physician if you feel like your practitioner isn’t meeting your needs.

Finally, remember that although your provider may make recommendations, treatment decisions are ultimately yours.

Invasive ductal carcinoma, a form of breast cancer that happens when cancerous cells begin to grow outside the breast’s milk ducts, is the most common form of breast cancer. Treatment depends on the size of the cancer, hormone receptor status, and whether the cancer has spread. Surgery, radiation, hormone therapy, chemotherapy, targeted therapy, or immunotherapy are all different options, which may be combined. Complementary approaches can help you manage the stress of this diagnosis and the side effects from medications. There are many different, effective treatments and your doctor will work with you to find the ones that are best for you.