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What are the most common treatments for breast cancer?

After the diagnosis of the disease, the physician will discuss with the multidisciplinary team and the patient the treatment options, which will depend on the type and stage of the tumor, location, prognostic profile, oncogenetic assessment and general health status of the patient.

The main types of cancer treatments are:

Surgery. Cancer surgery is the oldest type of cancer therapy. It is the main treatment used for many types of cancer, and can be curative when the disease is diagnosed at an early stage. Surgery can also be performed for diagnostic purposes, such as surgical biopsy, relief of symptoms such as pain, and in some cases, removal of metastases.

  Chemotherapy. Chemotherapy treatment uses anticancer drugs to destroy tumor cells. As it is a systemic treatment, it affects not only cancer cells, but also healthy cells in the body. In general, chemotherapy is administered intravenously, although some chemotherapy drugs can be administered orally and usually a multidrug regimen. Chemotherapy, according to its objective, can be curative (when used with the objective of obtaining complete control of the tumor), adjuvant (when performed after surgery, with the objective of eliminating the remaining cancer cells, reducing the incidence of recurrence and metastases at a distance), neoadjuvant (when performed to reduce the size of the tumor, so that surgical treatment can be more successful) and palliative (without curative purpose, it is used to improve the quality of patient survival).

  Radiotherapy. It is the use of ionizing radiation to destroy or inhibit the growth of abnormal cells that form a tumor. There are several types of radiation, but the most used are electromagnetic (X-rays or gamma rays) and electrons (available in high-energy linear accelerators). Although normal cells can also be damaged by radiation therapy, they can usually repair themselves, which cancer cells cannot. Radiotherapy is always carefully planned in order to preserve healthy tissue as much as possible. However, there will always be healthy tissue that will be affected by the treatment, causing possible side effects. There are several types of radiotherapy and each one of them has a specific indication depending on the type of tumor and disease stage: external radiotherapy, 3D conformational radiotherapy, intensity modulated radiotherapy (IMRT), stereotaxic radiosurgery (Gamma Knife) and brachytherapy. Radiotherapy can be used as the main treatment for cancer, as adjuvant treatment (after surgical treatment), as neoadjuvant treatment (before surgical treatment), as palliative treatment, to relieve disease symptoms such as pain or bleeding, and for the treatment of metastases.

  Hormone Therapy. It is a therapeutic modality that aims to prevent the action of hormones in sensitive cells. Some tumor cells have specific receptors for hormones, such as estrogen, progesterone and androgen, and in some cancers, such as breast and prostate, these hormones are responsible for the growth and proliferation of malignant cells. Therefore, hormone therapy is a form of systemic treatment that reduces the level of hormones or blocks the action of these hormones in tumor cells, with the aim of treating malignant tumors dependent on hormonal stimulation. Hormone therapy can be used alone or in combination with other therapeutic forms.

  Target Therapy. It is a type of systemic treatment that uses molecularly targeted drugs that specifically, or at least preferentially, attack certain elements found on the surface or inside of cancer cells. Each type of targeted therapy works in a different way, but they all alter how a cancer cell grows, divides, repairs itself, or how it interacts with other cells. Molecular target drugs can be used alone or in combination with other therapeutic forms.,

  Immunotherapy. It is a biological treatment whose objective is to enhance the immune system, using antibodies produced by the patient or in the laboratory. The immune system is responsible for fighting infections as well as other diseases. Acting to block certain factors, immunotherapy causes an increase in the immune response, stimulating the action of the body's defense cells, making these cells recognize the tumor as an aggressor agent.

How to define the best treatment?

Currently there are international algorithms or guidelines, constantly being updated, that guide every step. The National Comprehensive Cancer Network  (NCCN) is a network of centers of excellence and makes all therapeutic recommendations available on the internet ( ). This is the gold standard of treatment and is based entirely on scientific evidence.

The initial therapeutic decision depends on the presentation of the disease. We can classify it as early, locally advanced and metastatic breast cancer.

In general, patients with early-stage breast cancer (up to 2 cm) undergo primary surgery (conservative surgery or mastectomy with reconstruction) and axillary sentinel lymph node, with or without radiotherapy (RT).

After local treatment, adjuvant systemic therapy is indicated based on primary tumor characteristics such as tumor size, grade, number of involved lymph nodes, estrogen (ER) and progesterone (PR) receptor status, and HER2 expression. However, some patients with early-stage breast cancer (particularly those with HER2 positive or triple negative disease) may be treated with neoadjuvant therapy first, followed by surgery.

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Americas Medical City

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