Breast cancer

Treatment

Today, women facing breast cancer have more treatment options than they did even a few years ago.

At Seattle Cancer Care Alliance (SCCA) our breast cancer experts understand that every woman’s cancer is different, as are her genetics, lifestyle, and personal preferences. We work together as a team to design an individualized treatment plan specifically for you—using the most advanced therapies—and to surround you with the support you need.

A diagnosis of cancer can feel overwhelming. We have an experienced, compassionate team ready to help. 

Treatment plan A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A treatment plan may also include information about how much the treatment is likely to cost and about regular follow-up care after treatment ends.

Breast cancer expertise at SCCA

Breast cancer survival rates

Data collected from cancer centers across the country show that people who begin their breast cancer treatment at SCCA have higher survival rates on average than those who started treatment at other centers.

Everything you need is here

Our surgeons, radiation oncologists and medical oncologists are UW Medicine doctors who specialize exclusively in breast cancer and have extensive experience with every type, grade and stage of the disease. We have the most advanced diagnostic, treatment, recovery and support programs.

Grade In cancer, a grade is a description of a tumor based on how abnormal the cancer cells and tissue look under a microscope and how quickly the cancer cells are likely to grow and spread. In cancer, a grade is a description of a tumor based on how abnormal the cancer cells and tissue look under a microscope and how quickly the cancer cells are likely to grow and spread. Low-grade cancer cells look more like normal cells and tend to grow and spread more slowly than high-grade cancer cells. Grading systems are different for each type of cancer. They are used to help plan treatment and determine prognosis. Also called histologic grade and tumor grade. Radiation oncologist A physician who has special training in using radiation to treat cancer. Stage The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer and whether the cancer has spread from the original site to other parts of the body.
Breast cancer treatment tailored to you

To formulate your personal treatment plan, your team members meet in the same room to share their expertise. Based on your unique needs, we combine and carefully coordinate treatments — surgery, radiation therapy, chemotherapy, hormonal therapies and targeted biological therapies — to achieve the best results for you, including if you have metastatic breast cancer. 

Chemotherapy Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. It may be given alone or with other treatments. Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy may be given by mouth, injection, infusion or on the skin, depending on the type and stage of the cancer being treated. It may be given alone or with other treatments, such as surgery, radiation therapy or biologic therapy. Metastatic A metastatic cancer is a cancer that has spread to other areas of the body by way of the lymph system or bloodstream. Radiation therapy The use of high-energy radiation from X-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. The use of high-energy radiation from x-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Treatment plan A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A treatment plan may also include information about how much the treatment is likely to cost and about regular follow-up care after treatment ends.
Innovative breast cancer therapies

SCCA patients have access to advanced therapies being explored in clinical studies for breast cancer conducted here and at our founding organizations Fred Hutchinson Cancer Research Center and UW Medicine.

Clinical trial A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis or treatment of a disease.
Team-based approach

Your personal team includes more than your breast cancer doctors. For medical and emotional support, we connect you with a range of experts — like nutritionists, physical therapists, social workers, chaplains and palliative care specialists who care for you alongside your oncology team.

Ongoing care and support

Nearly all breast cancer survivors can look forward to a long life after their treatment is complete. You’ll receive follow-up care to monitor your healing, watch for signs of possible recurrence and enhance your well-being through our Women’s Wellness Clinic.

Recurrence Cancer that has come back, usually after a period during which it could not be detected. It may come back to the same place as the original (primary) tumor or someplace else. Also called recurrent cancer. Sign In medicine, a sign is something found during a physical exam or from a laboratory test that shows that a person may have a condition or disease. In medicine, a sign is something found during a physical exam or from a laboratory test that shows that a person may have a condition or disease. Some examples of signs are fever, swelling, skin rash, high blood pressure and high blood glucose.

Treatment types

Surgery

Nearly all women with breast cancer have surgery as part of their cancer treatment.

Surgery for SCCA patients is performed by UW Medicine breast surgeons who are fellowship-trained in breast surgery/surgical oncology. They perform breast surgeries exclusively, and they partner with UW Medicine breast reconstructive surgeons for patients who want reconstruction.

Your first step toward surgery is to meet with your breast surgeon, who will carefully review your imaging and biopsy results, evaluate your health needs, ask about your personal preferences and explain your options, the type of surgery we recommend for you and what to expect.

  • If you have ductal carcinoma in situ (DCIS), you may be able to have a lumpectomy, depending on the size of the cancer and whether the surgeon can get cancer-free margins (called negative margins). The margins are important in ensuring that no cancer is left behind. Some women with a large area of DCIS need a mastectomy. 
  • If you have invasive breast cancer, you may be able to have a lumpectomy, or you may need a mastectomy. The decision depends in part on the size of the tumor compared to the size of your breast and whether the cancer is in more than one segment of your breast.

Lumpectomy

The goal of a lumpectomy is to remove your tumor completely while leaving as much of your healthy breast tissue as possible — an approach called breast-conserving surgery.

Some women who need a lump removed have surgery called donut mastopexy to remove their tumor with negative margins while preserving the shape and appearance of their breast. 

If your cancer doesn’t form a lump that surgeons can feel, they need guidance to locate and remove exactly the right tissue.

At SCCA, we offer SAVI SCOUT Surgical Guidance System.

  • Up to 30 days before your surgery, a breast radiologist uses ultrasound or other imaging to locate your tumor and insert a tiny infrared chip into it through a needle.
  • During your surgery, your surgeon scans your breast with a small wand that emits a radar signal. The signal bounces back from the chip so your surgeon can precisely locate the tissue you need removed.

If SAVI SCOUT is not the best option for you, your surgeon may pinpoint your cancer using wire localization.

  • On the morning of your surgery, a breast radiologist uses mammography or ultrasound to locate your cancer and insert a thin guide wire into your breast to mark the cancer.
  • During your surgery, your surgeon uses the guide wire to tell which tissue to remove.

 

Mastectomy

If a lumpectomy is not an option for you or if you would rather have all breast tissue removed to reduce your risk of cancer recurring in your breast, you may have a mastectomy. You might need a mastectomy if:

  • You have certain types of breast cancer, such as inflammatory breast cancer.
  • Your cancer has advanced and is quite large when it’s diagnosed.
  • Your cancer is in more than one-quarter of your breast.

There are several choices for how the surgery can be done. Your surgeon will talk with you about which option they recommend for you and why.

  • Total mastectomy — If you don’t want reconstruction at the time of your mastectomy, or if you can’t have reconstruction at the same time for health reasons, your surgeon removes all your breast tissue, your nipple and the first lymph nodes where your cancer might have spread. These nodes are checked for cancer during your surgery. If cancer is present, the surgeon removes more lymph nodes from under your arm.
  • Skin-sparing mastectomy — If your cancer does not involve your skin and you want immediate breast reconstruction, your cancer surgeon makes an incision around your nipple and areola (the darker colored skin around your nipple), removes the nipple and areola, and removes your breast tissue through this small opening. Your reconstructive surgeon uses the same opening to insert tissue from your abdomen (DIEP flap) or a temporary expander (replaced later with an implant). 
  • Nipple-sparing mastectomy — This surgery requires a small incision under the fold of your breast or on the outer side of your breast, leaving the nipple and areola intact. It is an option if you are having a preventive, or prophylactic, mastectomy because you have genetic mutations that put you at high risk for breast cancer or you have a strong family history of breast cancer. It is also an option for many women with small, early-stage cancers that don’t involve the nipple or areola.

Sentinel lymph node biopsy

Your surgeon may remove some lymph nodes under your arm on the same side as your cancer to see if cancer has spread there. 

The fewer lymph nodes you have removed, the lower your risk of side effects, such as lymphedema (swelling) in your arm or nerve injury. This is why SCCA performs sentinel lymph node biopsy whenever possible.

Your surgeon locates and removes only the first lymph nodes where your breast cancer might spread (the sentinel, or gatekeeper, nodes).

  • If the nodes are cancer-free, you do not need any more removed.
  • If the nodes contain cancer, you may need more removed (called axillary lymph node dissection).

Our experienced team of surgeons is led by David R. Byrd, MD, who pioneered sentinel node biopsy in the Pacific Northwest.

Preventing and treating lymphedema

Lymphedema is not common, but it is a possible complication. So after any lymph node surgery, we refer our patients to physical therapists (PTs) with expertise in preventing, detecting and managing lymphedema.

We have several resources for lymphedema treatment, including PTs who provide complete decongestive therapy and specialized reconstructive surgeons who offer advanced surgical treatments, such as lymph vessel reconnection surgery and lymph-node transfer.

Biopsy The removal of a sample of tissue or fluid that is examined to see whether cancer is present. This may be done with a large needle or through surgical removal of tissue or fluids. Imaging In medicine, a process that makes pictures of areas inside the body. Imaging uses methods such as X-rays (high-energy radiation), ultrasound (high-energy sound waves) and radio waves. Lymphedema A condition in which extra lymph fluid builds up in tissues and causes swelling. It may occur in an arm or leg if lymph vessels are blocked, damaged or removed by surgery. Mammography The use of film or a computer to create a picture of the breast. Radiologist A physician who has special training in creating and interpreting pictures of areas inside the body. The pictures are made with X-rays, sound waves or other types of energy. Sentinel lymph node biopsy The removal and examination of the sentinel node(s), the first lymph nodes to which cancer cells are likely to spread from a primary tumor. The removal and examination of the sentinel node(s), the first lymph nodes to which cancer cells are likely to spread from a primary tumor. To identify the sentinel lymph nodes, the surgeon injects a radioactive substance, blue dye or both near the tumor. Next, the surgeon uses a probe to find the sentinel lymph nodes containing the radioactive substance or looks for the lymph nodes stained with dye. Then the sentinel nodes are removed to check for the presence of cancer cells. Side effects A problem that occurs when treatment affects healthy tissues or organs. Some side effects of cancer treatment are nausea, vomiting, fatigue, pain, decreased blood cell counts, hair loss and mouth sores. Ultrasound A procedure that uses high-energy sound waves to look at tissues and organs inside the body. The sound waves make echoes that form pictures of the tissues and organs on a computer screen. A procedure that uses high-energy sound waves to look at tissues and organs inside the body. The sound waves make echoes that form pictures of the tissues and organs on a computer screen (sonogram). Ultrasound may be used to help diagnose diseases, such as cancer. It may also be used during pregnancy to check the fetus (unborn baby) and during medical procedures, such as biopsies. Also called ultrasonography.
Surgery

Nearly all women with breast cancer have surgery as part of their cancer treatment.

Radiation therapy

Radiation therapy clears cancer cells that may be left behind in your breast, your chest wall, or the lymph nodes in your armpit, chest or neck after surgery.

The radiation oncologists on your SCCA team specialize in breast cancer treatment and have extensive experience with every type, grade and stage of the disease. We use state-of-the art equipment and technology to design and deliver treatment that gives you the best possible outcome.

  • If you have a lumpectomy, having radiation therapy after surgery may mean you can keep more of your breast tissue while also significantly lowering the chance of cancer recurring in your breast.
  • If you have a mastectomy, you may not need radiation therapy because all your breast tissue on the side of your cancer was removed. However, some women may be at higher risk for recurrence, so your team may recommend radiation therapy to reduce your risk.

External-beam radiation therapy

Most women with breast cancer receive external-beam radiation therapy to their whole breast. In this form of therapy, a machine generates radiation beams and aims them at your breast, where cancer cells might remain.

  • You will likely have radiation therapy every day, Monday through Friday, for three to six weeks. Each treatment takes only a few minutes.
  • Your radiation oncology team carefully designs and carries out a plan to precisely target the tissue that needs treatment while limiting the effects of radiation to the rest of your body.
  • During each treatment, we use an advanced multicamera system to track your body position to within less than a millimeter and make sure you are lined up the right way for the radiation beam.

Proton therapy

Proton therapy is an advanced therapy and an important alternative to conventional radiation for many types of cancer (and some noncancerous tumors).
 
Breast cancer is frequently located close to critical structures. The advantage of using protons to treat this cancer is that doctors can target high doses of radiation at the cancer with the goal of minimizing radiation to healthy tissues. This may reduce side effects. SCCA Proton Therapy Center is the only facility in a seven-state region to offer this treatment.

Accelerated partial breast irradiation

This is a safe option for some women with early-stage breast cancer who are having a lumpectomy. 

  • Only part of the breast receives radiation, using a device placed inside the breast. 
  • Maximum radiation reaches the tissue at high risk for cancer with less radiation to surrounding healthy tissues. 
  • Treatment is given twice a day for five days.
  • SCCA participated in a national study comparing this approach with standard external-beam radiation therapy.

Tattooless radiation oncology

Patients must no longer get tattoos to identify the precise location for treatment. With tattooless radiation oncology, we are able to scan your breast and record the position of your cancer, so on later visits, the scan is projected onto you for guiding the radiation towards its exact location.

  • You’ll be scanned on your first appointment.
  • All of the remaining appointments will project the scan onto you, so thetherapists can duplicate the exact position for your radiation.
  • Tattoos are no longer used for locating the tissues receiving radiation.
Grade In cancer, a grade is a description of a tumor based on how abnormal the cancer cells and tissue look under a microscope and how quickly the cancer cells are likely to grow and spread. In cancer, a grade is a description of a tumor based on how abnormal the cancer cells and tissue look under a microscope and how quickly the cancer cells are likely to grow and spread. Low-grade cancer cells look more like normal cells and tend to grow and spread more slowly than high-grade cancer cells. Grading systems are different for each type of cancer. They are used to help plan treatment and determine prognosis. Also called histologic grade and tumor grade. Radiation oncologist A physician who has special training in using radiation to treat cancer. Radiation therapy The use of high-energy radiation from X-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. The use of high-energy radiation from x-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Recurrence Cancer that has come back, usually after a period during which it could not be detected. It may come back to the same place as the original (primary) tumor or someplace else. Also called recurrent cancer. Side effects A problem that occurs when treatment affects healthy tissues or organs. Some side effects of cancer treatment are nausea, vomiting, fatigue, pain, decreased blood cell counts, hair loss and mouth sores. Stage The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer and whether the cancer has spread from the original site to other parts of the body.
Radiation therapy

Radiation therapy clears cancer cells that may be left behind in your breast, your chest wall, or the lymph nodes in your armpit, chest or neck after surgery.

Proton therapy

According to the American Cancer Society, every year more than 200,000 women are diagnosed with breast cancer. For decades, conventional breast radiotherapy (X-rays or photons) has helped save the lives of many women. Despite its great success, conventional breast radiotherapy can expose the heart, lungs, and other organs to radiation. The result can be an increased risk of side effects such as coronary artery disease, lung scarring, and secondary malignancies.

Until recently, patients and the medical community accepted these side effects as a given in order to appropriately treat the cancer. But now there is proton therapy, an advanced radiation treatment that targets the cancer and dramatically reduces excess radiation to healthy tissues and organs.

Radiation therapy The use of high-energy radiation from X-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. The use of high-energy radiation from x-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Side effects A problem that occurs when treatment affects healthy tissues or organs. Some side effects of cancer treatment are nausea, vomiting, fatigue, pain, decreased blood cell counts, hair loss and mouth sores.
Advantages of Proton Therapy in Locally Advanced Stage III Breast Cancer

Advantages of proton therapy in locally advanced stage III breast cancer

Proton therapy (right, above) has unique attributes that reduce radiation exposure to normal, healthy organs. This is especially important in left-sided breast cancer, as the cancer is close to critical organs such as the heart and the lungs. As the data above shows, patients with left-sided breast cancer are more likely than patients with right-sided breast cancer to develop cardiovascular diseases after receiving radiation treatment.

Our radiation oncologists will evaluate each case, but generally, protons are useful in treating:

  • Node-positive breast cancer
    • Triple-negative breast cancer
    • Lobular carcinoma
  • Early stage breast cancer
  • Locally advanced breast cancer (stage II and III)
  • Recurrent breast cancer
  • Select patients who have received previous radiation

SCCA Proton Therapy Center offers a breast cancer clinical trial to qualifying patients

The Patient-Centered Outcomes Research Institute (PCORI) allocated $11.8M towards a study that will provide patients and physicians the long-awaited answers to many critical questions relating to breast cancer control and survival. This is the first clinical trial designed to compare the effectiveness of proton beam therapy versus conventional photon radiation therapy in treating certain breast cancers and minimizing radiation exposure to surrounding healthy tissue. 

Clinical trial A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis or treatment of a disease. Radiation oncologist A physician who has special training in using radiation to treat cancer. Radiation therapy The use of high-energy radiation from X-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. The use of high-energy radiation from x-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Stage The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer and whether the cancer has spread from the original site to other parts of the body.
Proton therapy

Proton therapy is an advanced radiation treatment that targets the cancer and dramatically reduces excess radiation to healthy tissues and organs.

Chemotherapy

Your SCCA medical oncologist specializes in breast cancer and has deep knowledge about the latest, most effective drug treatments for your type and stage of cancer, including chemotherapy, hormonal therapies and targeted therapies.

Chemotherapy after surgery

For breast cancer, most chemotherapy drugs are given in cycles by infusion into a vein. Some are taken by mouth in pill form. The standard approach is to have chemotherapy after surgery.

  • If you have early-stage breast cancer (it is not outside your breast and nearby lymph nodes), you’ll typically have four to six cycles of chemo with the goals of eliminating your cancer and keeping it from coming back. Chemo may reduce your risk of a recurrence by 30 to 50 percent.
  • If you have metastatic breast cancer (it has spread beyond your breast  and nearby tissues), you’ll typically have ongoing chemo to give you the longest, healthiest possible life. If your chemo stops working or side effects are too troubling, the next step is to consider switching to a different drug that might be effective.

Chemotherapy before surgery

Your SCCA team may recommend chemotherapy to shrink your tumor before surgery if:

  • Your tumor is too large to remove with surgery alone and still get a result that’s cosmetically acceptable to you.
  • You have inflammatory breast cancer or another form of breast cancer that is aggressive or locally advanced (near your breast but involving other tissue, such as your skin or many lymph nodes).
  • Shrinking the tumor might mean you can have a lumpectomy instead of a mastectomy. 

Another reason for chemotherapy before surgery is to see how sensitive your cancer is to the medicine, which may help your team design your individualized treatment plan

Chemotherapy Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. It may be given alone or with other treatments. Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy may be given by mouth, injection, infusion or on the skin, depending on the type and stage of the cancer being treated. It may be given alone or with other treatments, such as surgery, radiation therapy or biologic therapy. Infusion An injection of medications or fluids into a vein over a period of time. Medical oncologist A physician who has special training in diagnosing and treating cancer in adults using chemotherapy, hormonal therapy, biological therapy and targeted therapy. A physician who has special training in diagnosing and treating cancer in adults using chemotherapy, hormonal therapy, biological therapy and targeted therapy. A medical oncologist is often the main health care provider for someone who has cancer. A medical oncologist also gives supportive care and may coordinate treatment given by other specialists. Metastatic A metastatic cancer is a cancer that has spread to other areas of the body by way of the lymph system or bloodstream. Recurrence Cancer that has come back, usually after a period during which it could not be detected. It may come back to the same place as the original (primary) tumor or someplace else. Also called recurrent cancer. Side effects A problem that occurs when treatment affects healthy tissues or organs. Some side effects of cancer treatment are nausea, vomiting, fatigue, pain, decreased blood cell counts, hair loss and mouth sores. Stage The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer and whether the cancer has spread from the original site to other parts of the body. Targeted therapy A type of treatment that uses drugs or other substances to identify and attack specific types of cancer cells while causing less harm to normal cells. A type of treatment that uses drugs or other substances to identify and attack specific types of cancer cells while causing less harm to normal cells. Some targeted therapies block the action of certain enzymes, proteins or other molecules involved in the growth and spread of cancer cells. Other types of targeted therapies help the immune system kill cancer cells, or they deliver toxic substances directly to cancer cells and kill them. Targeted therapy may have fewer side effects than other types of cancer treatment. Most targeted therapies are either small molecule drugs or monoclonal antibodies. Treatment plan A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A detailed plan with information about a patient’s disease, the goal of treatment, the treatment options for the disease and the possible side effects and expected length of treatment. A treatment plan may also include information about how much the treatment is likely to cost and about regular follow-up care after treatment ends.
Chemotherapy

Your SCCA medical oncologist specializes in breast cancer and has deep knowledge about the latest, most effective drug treatments for your type and stage of cancer, including chemotherapy, hormonal therapies and targeted therapies.

Hormonal therapies

Most women with breast cancer have hormone-receptor positive (HR+) disease. This means your cancer cells have receptors where hormones, like estrogen and progesterone, can attach. These hormones help the cancer cells multiply quickly.

Hormonal therapy, also called endocrine therapy, may prevent HR+ breast cancer or keep it from coming back by reducing or blocking the production or effects of hormones.

  • If you have early-stage breast cancer, hormonal therapies may reduce the risk that the same cancer will come back or a new breast cancer will develop. 
  • If you have a metastatic recurrence (breast cancer returns in distant parts of your body), hormonal therapies may extend your life. They can be effective against tumors for a long time.

Estrogen-receptor blockers

These medicines bind to estrogen receptors on cells in the breast tissue. This keeps estrogen from attaching there, and it shuts down the cancer cells’ ability to grow and divide. Options include:

  • Selective estrogen-receptor modulators (SERMs), such as tamoxifen (Nolvadex), toremifene (Fareston) and raloxifene (Evista)
  • Selective estrogen-receptor downregulators (SERDs), such as fulvestrant (Faslodex), which binds to estrogen receptors and also decreases the number and the shape of receptors, making it harder for cancer to thrive

Aromatase inhibitors

Aromatase inhibitors, which decrease the amount of estrogen circulating in your body, are used in women who’ve gone through menopause. They include anastrozole (Arimidex), letrozole (Femara) and exemestane (Aromasin).

Ovarian suppression

If you are premenopausal, your doctors might recommend medicine that stops your ovaries from making estrogen, such as leuprolide (Lupron) or goserelin (Zoladex). 

Hormone therapy Hormones can cause some cancers to grow. To slow or stop growth, synthetic hormones or other drugs can be used to block the body’s natural hormones, or surgery is used to remove a hormone-producing gland. Treatment that adds, blocks or removes hormones. For certain conditions (such as diabetes or menopause), hormones are given to adjust low hormone levels. Hormones can also cause certain cancers (such as prostate and breast cancer) to grow. To slow or stop the growth of cancer, synthetic hormones or other drugs can be used to block the body’s natural hormones, or surgery is used to remove the gland that makes a certain hormone. Also called endocrine therapy, hormonal therapy and hormone treatment. Hormone therapy Hormones can cause some cancers to grow. To slow or stop growth, synthetic hormones or other drugs can be used to block the body’s natural hormones, or surgery is used to remove a hormone-producing gland. Treatment that adds, blocks or removes hormones. For certain conditions (such as diabetes or menopause), hormones are given to adjust low hormone levels. Hormones can also cause certain cancers (such as prostate and breast cancer) to grow. To slow or stop the growth of cancer, synthetic hormones or other drugs can be used to block the body’s natural hormones, or surgery is used to remove the gland that makes a certain hormone. Also called endocrine therapy, hormonal therapy and hormone treatment. Metastatic A metastatic cancer is a cancer that has spread to other areas of the body by way of the lymph system or bloodstream.
Hormonal therapies

Most women with breast cancer have hormone-receptor positive (HR+) disease. This means your cancer cells have receptors where hormones, like estrogen and progesterone, can attach. These hormones help the cancer cells multiply quickly.

Targeted biological therapies

Targeted therapies block the growth or spread of cancer cells through a specific pathway or receptor — rather than generally attacking all fast-growing cells the way conventional chemotherapy drugs do.

Target biological therapies use substances, like antibodies, that come from living organisms, or versions of these substances made in a laboratory.

HER2-targeted therapies

Several targeted drugs are approved to treat breast cancer that is HER2 positive (the cancer cells make too much of a protein called HER2/neu). You might receive one of these alone or along with chemotherapy or another targeted therapy:

  • Trastuzumab (Herceptin)
  • Lapatinib (Tykerb)
  • Pertuzumab (Perjeta)
  • Ado-trastuzumab emtansine (Kadcyla)

mTOR inhibitors

Everolimus (Afinitor) targets a protein that can mutate in cancer cells, allowing them to grow out of control. The drug blocks, or inhibits, this mutated protein, known as mTOR (mammalian target of rapamycin, or mechanistic target of rapamycin).

Your doctor may recommend everolimus along with the hormonal therapy exemestane if you are past menopause and have advanced cancer that is HER2 negative and HR+.

Cell-cycle inhibitors

These drugs help stop the growth and spread of tumors by blocking one or more proteins involved in the life cycle of cancer cells. 

For advanced breast cancer or metastatic disease that is HR+, your doctor may recommend palbociclib (Ibrance) or ribociclib (Kisqali). They may be used in combination with hormonal therapies.

PARP inhibitors

These drugs help kill cancer cells by making DNA repair harder for them. Cells that can’t repair their DNA are more susceptible to other cancer treatments, like chemotherapy and radiation therapy

Several PARP inhibitors are approved to treat ovarian cancer, especially in women with inherited mutations in the BRCA1 and BRCA2 genes. Studies show these drugs are also effective against breast cancer in women with BRCA1 and 2 mutations. PARP inhibitors are being studied in other women with breast cancer too.

Antibody A protein made by immune system cells and released into the blood. Antibodies defend the body against foreign substances, such as bacteria. Chemotherapy Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. It may be given alone or with other treatments. Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy may be given by mouth, injection, infusion or on the skin, depending on the type and stage of the cancer being treated. It may be given alone or with other treatments, such as surgery, radiation therapy or biologic therapy. Gene The functional and physical unit of heredity passed from parent to offspring. Genes are pieces of DNA, and most genes contain the information for making a specific protein. Hormone therapy Hormones can cause some cancers to grow. To slow or stop growth, synthetic hormones or other drugs can be used to block the body’s natural hormones, or surgery is used to remove a hormone-producing gland. Treatment that adds, blocks or removes hormones. For certain conditions (such as diabetes or menopause), hormones are given to adjust low hormone levels. Hormones can also cause certain cancers (such as prostate and breast cancer) to grow. To slow or stop the growth of cancer, synthetic hormones or other drugs can be used to block the body’s natural hormones, or surgery is used to remove the gland that makes a certain hormone. Also called endocrine therapy, hormonal therapy and hormone treatment. Metastatic A metastatic cancer is a cancer that has spread to other areas of the body by way of the lymph system or bloodstream. Radiation therapy The use of high-energy radiation from X-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. The use of high-energy radiation from x-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Targeted therapy A type of treatment that uses drugs or other substances to identify and attack specific types of cancer cells while causing less harm to normal cells. A type of treatment that uses drugs or other substances to identify and attack specific types of cancer cells while causing less harm to normal cells. Some targeted therapies block the action of certain enzymes, proteins or other molecules involved in the growth and spread of cancer cells. Other types of targeted therapies help the immune system kill cancer cells, or they deliver toxic substances directly to cancer cells and kill them. Targeted therapy may have fewer side effects than other types of cancer treatment. Most targeted therapies are either small molecule drugs or monoclonal antibodies. Targeted therapy A type of treatment that uses drugs or other substances to identify and attack specific types of cancer cells while causing less harm to normal cells. A type of treatment that uses drugs or other substances to identify and attack specific types of cancer cells while causing less harm to normal cells. Some targeted therapies block the action of certain enzymes, proteins or other molecules involved in the growth and spread of cancer cells. Other types of targeted therapies help the immune system kill cancer cells, or they deliver toxic substances directly to cancer cells and kill them. Targeted therapy may have fewer side effects than other types of cancer treatment. Most targeted therapies are either small molecule drugs or monoclonal antibodies.
Targeted biological therapies

Targeted therapies block the growth or spread of cancer cells through a specific pathway or receptor — rather than generally attacking all fast-growing cells the way conventional chemotherapy drugs do.

Advanced breast cancer

Treating metastatic breast cancer

Metastatic breast cancer can be highly treatable. Recent data show women with metastatic breast cancer are living longer with better quality of life than ever before.

Our goal at Seattle Cancer Care Alliance (SCCA) is to provide the best and longest life possible to every woman who comes to us for care. New treatments available at SCCA may put your cancer in remission and give you a good quality of life for years — even decades. 

At SCCA, you have many options for treatment, including therapies available only through clinical studies designed specifically for women with advanced breast cancer.
Many women who started treatment elsewhere come to SCCA if their disease recurs or spreads, because of our doctors’ expertise and our focus on research into improving outcomes for women with metastatic disease. 
Your team is here to help you and your family cope with the emotional aspects of your health and treatment. We offer resources such as support groups as well as social workers and chaplains specially trained to meet your needs.

Clinical trial A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis or treatment of a disease. Metastatic A metastatic cancer is a cancer that has spread to other areas of the body by way of the lymph system or bloodstream. Remission A decrease in, or disappearance of, signs and symptoms of cancer. A decrease in, or disappearance of, signs and symptoms of cancer. In partial remission, some (but not all) signs and symptoms of cancer have disappeared. In complete remission, all signs and symptoms of cancer have disappeared, although cancer still may be in the body.

ASSIST program 

At SCCA, we recognize that patients with metastatic breast cancer have unique perspectives, care expectations and treatment goals. To help meet those needs, we created the Advanced Stage Support Information Symptoms Trials (ASSIST) program. The goal of ASSIST is to connect you with specialized supportive care from the start, in complete coordination with your clinical treatment. 

Before your first appointment

  • Our nursing team will contact you to discuss which supportive services you might benefit from. This speeds up the process of connecting you with supportive services such as nutrition, physical therapy and others once you arrive. If you’re feeling overwhelmed or need help understanding SCCA’s general process before you get here, they may connect you with a social worker or patient navigator. View more information on SCCA’s Supportive Care Services.
  • Our clinical trials team will review your medical history and see if you are eligible for any of the clinical trials we’re offering. If you are, your provider will review options with you at your appointment.

If you are interested in scheduling an appointment or learning more about the ASSIST program, contact our team at (206) 606-6487 . 

Clinical trial A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis or treatment of a disease. Metastatic A metastatic cancer is a cancer that has spread to other areas of the body by way of the lymph system or bloodstream. Patient navigator A person who helps guide a patient through the health care system. This includes help going through the screening, diagnosis, treatment and follow-up of a medical condition, such as cancer. A person who helps guide a patient through the health care system. This includes help going through the screening, diagnosis, treatment and follow-up of a medical condition, such as cancer. A patient navigator helps patients communicate with their health care providers so they get the information they need to make decisions about their care. Patient navigators may help patients set up appointments for physician visits and medical tests and get financial, legal and social support. They may also work with insurance companies, employers, case managers, lawyers and others who may have an effect on a patient’s health care needs. Also called a patient advocate. Stage The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer and whether the cancer has spread from the original site to other parts of the body. Symptom A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. Some examples of symptoms are headache, fatigue, nausea and pain.

Frequently Asked Questions (FAQs)

What is metastatic breast cancer?

Breast cancer cells can travel through your lymph system or blood to reach other parts of your body, such as your liver, lungs, brain or bones and can form tumors there. This is metastatic breast cancer.

  • In some women, breast cancer has already metastasized, or spread, by the time she learns she has the disease. Doctors sometimes refer to this as de novo metastatic breast cancer.
  • In other women, cancer that was only in the breast comes back in other parts of her body after her initial treatment. This may be called metastatic breast cancer or distant recurrence.
De novo The first occurrence of cancer in the body. Lymph system The tissues and organs that produce, store and carry white blood cells that fight infections and other diseases. The tissues and organs that produce, store and carry white blood cells that fight infections and other diseases. This system includes the bone marrow, spleen, thymus, lymph nodes and lymphatic vessels (a network of thin tubes that carry lymph and white blood cells). Lymphatic vessels branch, like blood vessels, into all the tissues of the body. Metastatic A metastatic cancer is a cancer that has spread to other areas of the body by way of the lymph system or bloodstream. Recurrence Cancer that has come back, usually after a period during which it could not be detected. It may come back to the same place as the original (primary) tumor or someplace else. Also called recurrent cancer.
How is metastatic breast cancer treated?

Your treatment  will mostly be drug based — using chemotherapy, hormonal therapies and targeted therapies. These systemic treatments travel throughout your body and can fight cancer cells wherever they are.

There may be times when your SCCA team recommends surgery or radiation therapy, mainly to relieve symptoms, such as radiation therapy to relieve pain by shrinking bone tumors. 

Support and care to reduce symptoms and enhance quality of life (palliative care) are important for everyone with cancer, regardless of the stage of your disease, and are provided by SCCA experts alongside your cancer treatment. 

Chemotherapy Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. It may be given alone or with other treatments. Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy may be given by mouth, injection, infusion or on the skin, depending on the type and stage of the cancer being treated. It may be given alone or with other treatments, such as surgery, radiation therapy or biologic therapy. Radiation therapy The use of high-energy radiation from X-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. The use of high-energy radiation from x-rays, gamma rays, neutrons, protons and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy or brachytherapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Stage The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer and whether the cancer has spread from the original site to other parts of the body. Symptom A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. A physical or mental problem that a person experiences that may indicate a disease or condition. Symptoms cannot be seen and do not show up on medical tests. Some examples of symptoms are headache, fatigue, nausea and pain. Targeted therapy A type of treatment that uses drugs or other substances to identify and attack specific types of cancer cells while causing less harm to normal cells. A type of treatment that uses drugs or other substances to identify and attack specific types of cancer cells while causing less harm to normal cells. Some targeted therapies block the action of certain enzymes, proteins or other molecules involved in the growth and spread of cancer cells. Other types of targeted therapies help the immune system kill cancer cells, or they deliver toxic substances directly to cancer cells and kill them. Targeted therapy may have fewer side effects than other types of cancer treatment. Most targeted therapies are either small molecule drugs or monoclonal antibodies.
What clinical trials options are there?

Many women with advanced breast cancer, especially those with metastatic disease, receive treatment in clinical studies looking for tomorrow’s cures.

Taking part in a study can give you access to new interventions that are not available otherwise. If the new intervention proves to be better than standard care, you may be among the first to benefit from it. If standard treatments aren’t working for you, a clinical study may provide you another option.

  • Ask your doctor about taking part in clinical studies of promising treatments. 
  • Find breast cancer clinical trials that are accepting patients at SCCA.
  • Check for phase 1 trials, which test the newest potential therapies.

View Breast Cancer Clinical Trials

View Phase 1 Program Clinical Trials

Clinical trial A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis or treatment of a disease. Clinical trial A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis or treatment of a disease. Metastatic A metastatic cancer is a cancer that has spread to other areas of the body by way of the lymph system or bloodstream. Standard care A treatment or other intervention currently being used and considered to be of proven effectiveness based on past studies.